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05545 (SFD)-7-5�5 T4ty� 4 C 14 / LL. 6 Li P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 54"9~5 XINAI LA QUINTA, CALIFORNIA 92253 Owner Tucker—.Sattley Address 41-625 Eclectic GI City Zip Tel. Palm Descrt 92260 619/340-1361 Contractor 68Y>Qe City (Zip State Lic. I City & Classif. 248823 Lic. # 056 Arch., Engr., Designer Address I Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division -3 of the Business and Professions.l:Code, and my license is in full force and effect. � SIGNATURE - - 7 DATE I — OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractofs License Law for the following 'reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also -.requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's license Law, Chapter 9 (commencing with Section 7000) of t Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation or Section 7031.5 by any applicant for a permit "subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner or property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden or proving that he did not build or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 0 1 am exempt under Sec B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company �s•' ` ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out; signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant —Date— Mailing ateMailing Address City, State, Zip No. 05545 BUILDING: TYPE CONST. A.P. Number Legal Description Project Description. OCC: GRP. 774-211-013 Lot 1 $i0 Sq. Ft. 1"0 Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $89,913.00 PERMIT AMOUNT Plan Chk. Dep. 250.00 Plan Chk. Bal. 225,86 Const. 554.00 Mech. 53.50 Electrical 108.00 Plumbing 157054 S.M.I. 5.67 Grading 20.00 Driveway Enc. 20.00 Infrastructure t,730.88 TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center, Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR 3/22139 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE (- ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SQ. FT. g HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SQ, FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) DRAINAGE PIPING CAR P. I SO. FT. ® GAS (FINAL) &MP. POLE t WALL SQ. FT. DRINKING FOUNTAIN SQ FT a WATER HEATER URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES GRADING cu. yd. plus x$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED �` ``' `�� ac LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER MESH GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK L — \ GROUND PLUMBIN UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE (- ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) &MP. POLE t GROUT WATER HEATER SERVICE FINAL INSP. (BOND BEAM 7-1 WATER SYSTEM $ GRADING cu. yd. plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING �` ``' `�� ac REMARKS:- EMARKS:VENTILATION VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL CLATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESJINITIALS GARDEN WALL FINAL 1 Desert Sands Unified School District CERTIFICATION OF PAYMENT OF SCHOOL FACILITY FEES MUTICE: THIS DOCUMENT CANNOT 0CfUPQ�CATD,T:io� Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 DATE: 404 -44 This is to certify that ,,/ s f�'"_tq- developer of -i L which is located at 0MIA within this District, has paid school faci ty fees imposed pursuant to the authority g erat by overnment C de Se tion 30AV 8 i the am unt of cov ring a total of square feet of ( ) r sidential or ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction. CL* 11, -/3 for DESERT S NDS UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 \ Of f ICE OF E. LEON SPAUGY i�CO�I�t15i10.`.EA AGRICULTURAL COMMISSIONEIt 1AME5 O WALLACE o o AND i , ►�) "' WEIGHTS & MEASURES CLEMENT BUNVENISiE su�En t•'J� 49-613 Ilwy 86, Bulte 8-12 • �`.,� ,e•''I �I.4 'Coachella, CA 92236 r p 69 619=342-8291 DATE VV A,-� 15 I cASE w. a i i,QL 031 14 DEVEWPER'S N11MEt ADDRESS: J TELEP110Mt kb (t SARA , L: t Uti���� Dear Developer: After reviewing your landscapiuig plans, all plant material listed is not in violation of quarantine laws governbig the Coachella Valley. if substitutions do occur and they differ frun plaint n►aterial listed, this office must be notified immediately. Thmik you for protecting and preserving the Coachella Valley's pest -free environnEent. I r ultural C m►us` ' a sinner s Office cct Indio and Riverside Office A GREIIAL NOM jwwss alMnrfsm apaeeiad) 11 Lnsbr slut to d Veda and Wade graft Wproled r'awl a K d WAaa1r stem V" 21 Tam phem b be m 011 '3p LYr m phos n to be meow spmwt* an to J*4 an adt III d tuns. _41 Oa7 OoR t not mAnOuttle tr pno m or may brat*m7. `• ; UVPau. &Aral and a Nor v/sbn or Or3mupe d sane. . N 11b1b onor s m.ussa7 mYm = L / 72o - q Appoal ou lsof WC rTtr2 RW TCB r2 oc FMI-74 BOCA 75-24. ,_PITCH '. 25/12 h MIN HRG SPRN i4 " `a" I:hic`•� NO SPLICE '� 3X4 35'8 I+X7 34'6' 6T•LICE 5X 35'a 1SX41 35'6' STRRTING HEIGHT -2-8-0 4X5 28'8' Tealtssray� 5X4 30'0' 33'6' 5X6 3518' y min r bee SPLICE * k 0 5X4 27'8• + 5X5 28'0' cmT �R 6X4 30'0', 4tpyVA 6X6 35'8• 1144- uc�'6 . mr�r � front a a At all V 2000 708158413 CLARY CORPORATION 320 Wiest Clary Avenue San Gabriel. CA 91776 (818) 288-4180 -- I (8170) 038-4; 71 baatmm is to napOaa*y d ft aActbn aomeacbr. SOOT" N) ReramBaa um be liken b ton fr ft; am6 an d iu. P1AQ 1.1110111411 mat TO R m,a, = GPM aKMM ' pikk am. lkvdtq E Sb^p Wood Trussw (tam edtgon). n� fib tnm rmbmr vlft ft dmdpm. Imlay M OCFW. -Tal balsa is amoo 01a.T ram TIC tis Mase. 8) Pard scim (Wd") - Na to ober In corer 1/3 d Our. 15) RepMe mmernba tim" awe n used as eoeddlied in Naaar ram TIC rRYOfYIOM or rbm 0&-451 rabMIX 9) Splim in too ud Wim domd m b am amay 4X6 4X7 Omit Spmvcmcn tr Wand CwwUm m (last ommi). F W 22 MY THE 11113111IOWNI C rOK abaw one aWdW. 115) pmv Is b a" WeiSeS my. Ad*brr pu" tr Wrmsnp d 711100 11dmgOROm COM tiearr COVOMnON. 10) Rwoo mw UWW $tcpon d of d- - Cowessbmm dmam an (--'--� utter Omr.4 mamm taauar trusses is ft msprdwty of ft hbmir7lor. TOP talal9 BUST s LRTEMXLT tsslt2L WTH AnrfILT at 3=dime an amnr oma L emd 4mabml dorm n a can bot . ,. 17) Truss MsI m *"m b ft orma TR deso spem to 11 mO tr er771Nao FLYMM tsalenamomm L4') an cruor mmsoc 34'10' 10X neW date mrnmecled woad malas am b haed m fs ans oar uu a 28910 11) ® tdc" 2 r 4 Ooahmp Pm (by COmem). .. lmbmial toh—V ft maomnnw pratimss s fel bum b ft G=AMAAW OR r AM TO 29 MIX Iem¢rcm�. a Win r do1®Q{: 12) C=!a= mdWms mrommo uww braomq at bmw 35'8' ... III camOd mm yl tam TR. - .n araomQsn sa. Aur. an, era. .. - oown (try coo 1. ... • • .. 18) RM Ahs in d*mI wrfWl by WWI 3.• MA �L' t ' wee fro rrmoen d fie temss may m mIA. 2x 35'.? -1705 3X6 29.0• OVERFILL n� 29.6' H 3 0rs X5 33'0• 33'6• 2611, 4X6 4X7 34'0• 34'6' t2 HFIR 3X5 4X6S�fp35'8• tTxb Tb 35'8' ^.� 013I0111" nal am (--'--� utter Omr.4 mamm taauar 5X7 35'8• 30'9' 34'3' Z AWN% TC LL LONG PSF TC LUMBER 2X4 TOP 34'10' TC OL— PSF BC LUMBER 2X4 HOT O.C. MAX NO SPLICE PSF25% BC LL+ 32'9' 35'8' BC OL PSF TOTAL— PSF WEBS ZX3 83 SPF UCEPT RS NOTED y. INC FOR DURATION OF LOAD 35'8' 3X4 34 0' SS DFL 35'8' 35'8' NO SPLI 3X4 35'8 NO SPLICE X 35'8 ICE 3X5 35'8' SPLICE X4 34'0: r•: -. ; 4X4 ZB'8' FORCES RT MRX SPRN(L-R) TOP AOT KIM mm ' I X4 35'8• 5X5 35'8 5X7 35.8• -178 e -1370 1954 5X4 35'6' -3979 -4491 31119 4814 42 1119 -1374 -174875-3559 453 -1434 :84 74 i:N zst� - 292 �9 u NO SPLICE NO SPLICEI NO SPLICE 3X4 35'0' V26'fi :;4A 3X 340' SPLI 4X4 35'0'X4 26'6' SPLICE 5X5 30'0' 4 27'05X6 33'0' 5XS'5X7 35'8• 5%6 34'0• 5X7 35'8• NO SPL. E 2x 35'.? -1705 3X6 29.0• OVERFILL 3X5 29.6' H 5X3 35 e• 34'6' 4X6 4X7 1 33'0• 33'6• 2611, 4X6 4X7 34'0• 34'6' t2 HFIR 3X5 4X6S�fp35'8• 5X7 35'6• 32'0' 5X7 35'8• 30'9' 34'3' Z AWN% TC LL LONG PSF TC LUMBER 2X4 TOP 34'10' TC OL— PSF BC LUMBER 2X4 HOT O.C. MAX PSF25% BC LL+ 32'9' 35'8' BC OL PSF TOTAL— PSF WEBS ZX3 83 SPF UCEPT RS NOTED y. INC FOR DURATION OF LOAD NO SPL. E 2x 35'.? -1705 4X4 28 0' SPRNS TO 35'8' OVERFILL SX4 H 5X3 35 e• Pze f2 SPF 2611, 2 '0' X4LI a 6x6 35 8• t2 HFIR 28'4' 31'0' f1 SPF 28'11' 32'0' t1 HFIR 30'9' 34'3' 02 DFL 30'11' 34'10' SS SPF 31'2' 34'10' SS HFIR 32'9' 35'8' t1 DFL 33'9' 35'8' SS DFL 35'8' 35'8' oti "T WFIM DESCRIPTIONEN 32 --"SEEP, 5 /& PANEL ENNGGR OR: OWI f 4 (D-32 sAL LIBRFIRY M. EZZO _ 11 -2 - PROJECT: ENG. BY: DATE I • i r .. .. ice., .: _ -' -'? • i 4 -% 7-54 5 P.O. BOX 1504 APPLICATION ONLY Building�n% 78-105 CALLE ESTADO Address S AL /4A" -u r Z LA QUINTA, CALIFORNIA 92253 ... 7-11 Mailing rr Address C.., W �S ��l,Qt t j (G' t? - City Zip Tel. I LI 0 3 y 0 1 3 (► r Contractor _;;1`4 PUNI.I, Address � 1 Zip State Lic. City & Classif. $ 0 Lic. # �� 6 Arch., Engr., Designer 9 Address I Tel. I City IZip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed u!�� sions of apter 9 (commencing with Section 7000) of Division 3 of the Business aio and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby of rin that 1 am exempt from the Contractor's License Law for the following reason: (Sec. 031.S,Business and Professions Code: Any city or county which requires a permit to construct, after, Improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to fie a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a permit - subjects the applicant to a civil penally of Trot more than hva hundred dollars (5500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who drills or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or krprove for the purpose of sale.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) O 1 am exempt under Sec B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy NoCompany ❑ Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed N the pem* is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT., ff. after making this Certificate of Exemption you should become subject to, the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this perm shag be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is abuilding permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING DIVISION BUILDING: TYPE CONST. OCC. GRP. A.P. Number %7 Legal Description 1—o / • % Project Description , ZONE: BY: Minimum Setback Distances: - I' Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR , 1 Issued by: Date Permit Validated by: Validation: t Sq. Ft. / // Size ( (iJ 0 No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 1 4 Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. eg Plan Chk. Bal. Const. st 00 Mech. S Q Electrical / 'o'o Plumbing ( 771.9-0 S.M.I. 5 .6 Grading Zo. Driveway Enc. Infrastructure - f / 4; If TOTAL REMARKS 005182 1O 5555 03-16-89 13 x Q LHSHx IUIHL I zt. .Vu ZONE: BY: Minimum Setback Distances: - I' Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR , 1 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK YARD SPKLR SYSTEM 2ND FL SQ. FT. @ ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. MOBILEHOME SVC. METER LOOP BAR SINK POR. SQ. FT. ® REINF. STEEL GAS (FINAL) TEMP. POLE % POWER OUTLET GROUT ROOF DRAINS GAR. SQ. FT. @ FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus -x$-=$ DRAINAGE PIPING CAR P. SQ. FT. ® FINAL INSP. FRAMING "a 1 ROOFING DRINKING FOUNTAIN WALL SQ. FT. ® REMARKS: (6o (� s URINAL SQ. FT. FIRE ZONE ROOFING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation SPARK ARRESTOR FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINISH GRADING LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC CERT. OCC. WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO. FT. ®c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c 57iIr ! SEWAGE DISPOSAL SQ.FT.GAR ® 3/4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE L PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus -x$-=$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL -� � .�+:�'',,.� •�'*;1"'�r�`�"�'.�� ' 4 ' +` �:.+s��:.:��r�,�,�r,�,,•,'r.0 i14f w` �.; *x�i Vis'';.;;.,; i:' COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. ENVIRONMENTAL HEALTH SERVICES PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County speculations as indicated on the attached check IIsL A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval. VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOGS, Agent, Contractor, Contact rson ' Phone 31o I3W Address & Phone 41`11Ls^ £C,C ,4-{'rz C -T: J Phone Mailing Address City 4 QV *,t State Zip Job pe dress � `( d legal Description Prop. (PMI ) /� E07� Lot Size, ter et Use of Permit P/P, CU, etc. 'c'pw, Other d " ee1llo9, q�Jt . H Prep, etc. Date signatL6 of Appiiaarf CATEGORY: REV CODE FgE, CATEGORY: REV CODE FEE RFACE DISPOSAL 1238 © SUiFLE ❑ SRE EVALUATION UPON REQUEST 7349 $42.00 MU PARCELS WITHIN SAME (NO PLOT PLAN)❑' LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 a. 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year) b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 ❑ Rereview (2nd review same parcel) 7344 $16.00 EVALUATION (Attach DOH SAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $45.00 Critical Area 7346 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 3 7347 $86.00 A7/t Holding Tank Agreen►ents Completed ❑Yes 5,; � r Certification of Existing S.D. System Required ❑ Yes .0 Noo W0CB Clearance required. (Attach Form ❑ Yes l2eNo DOH SAN 007, Santa Ana Region Only) �Solis Peroolation Report Required. ❑ Yes Special �easlbility Boring Repot Required. ❑ Yes No Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes OUner ' ❑ Yes No' Staff Specialist Lot Inspection Required ❑ Yes 0-'o r, Lot Inspection Date � ye. Soils boring report by Prow Data p Soils Map Page r Soil Type Approved by Date 0 No. of Syatenre T4 of Systems) ❑ 1=ing Tank ❑ Existing No. Dwelling Units( Bedrooms, Fixtare (1) Septic Tank Soil Rate Gresse/Sand Intcp O Replacement ©0120ft- �(% t/� �/ Gal s. 2() Leach Line Sq. Ft 'Bottom Sidewall allowance Instal . --- Line(s) ft long a wide with Bed sq. ft "hof -bottom trench area R rocs/ aq. R per running ft NA min. ores rok k chbeladratnlirres or Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit TcoLnDepth Applicable � N/A Overburden factor <`J 1 Inlet (BI) / // i T Max. Allowable Depth V No. 2 System N111 REMARKS: � _ This application 'slAPPR� O NENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompanied p o Plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed system. No construction is permitted in the required reserved 100% expansion area. N ' Septic tank and sewer lines must be 50' minimum from any wells /Q &1�1 ,cid S^ yr wells, ( Leach lines must be 100' minimum from any including expan o a-- ' Seepage p 3 Sits must be 150' minimum from acludinny wells, inexpansio arLe y',,Gf Z Signature of Health Official GCiLtJ:Y... l n RECEIPT NO. Issued By Date DISTRICT: ❑ Riverside, ®0 Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe T'f DOH SAN 122 (Rev. 5/88) pDISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records I r .