12564 (PLBG)Building
Address
I
53-968 Cortez
T441�p
P.O. BOX 1504
78-105 CALLE ESTADO
LA OUINTA, CALIFORNIA 92253
".. Coachella Valley Lana
Address 78-150 Calle Tampico #230
City Zip Tel.
La Quinta, CA 92253 564-1155
Contractor
Ed G. Wise
AW150 Calle Tampico #238 -
ity Zip Tel.
C11 Quint�a, CAI 92253 1 564-1.377
& Classif. 664 238
LDING: TYPE CONST
A.P. Number
No. 12564
OCC: GRP.
Legal Description
Project Description Sewer Connect
Lic. # 2851 I Sq. Ft.
Size
CityI Zip I State
Lic. #
ICE S D?CONTRACTOR'S DECLARATION
I hereby affil t I am ensed�under provisions of Chapter 9 (cc
7000) of Divi / f the usiness and P rgYa Ions Code, and my IIc
effect.!).: �°r�
I hereby affirm.that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,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 file a signed statement that he is licensed pursuant to
Me provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section- 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than Ove 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, Buisnass and
Professions Code: The Contractor's License Law does not apply to an owner of 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
of proving that he did not build or improve for the purpose of sale.)
O -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 w4h a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 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 Company
Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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. d, 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
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued..(Sec. 3087, 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.
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, 21p
I
No.
Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
(Estimated Valuation $1,500.00
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
30.00
ZONE: BY:
Minimum Setback Distances: f
Front Setback from Center Line
Rear Setback from Rear Prop. Line
4ML-Mreel,gteJoack t4otn CejaLej Line
FINAL DATEE- AI "W"
Issued by: Date bb i
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. a $
UNITS
SLAB GRADE
2ND FL. SQ. FT. @
BONDING
Y
ARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT. ®
GAS (ROUGH)
DRAINAGE.PIPING
WALL SO. F7. ®
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
'WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 34c
HOUSE SEWER
LATHING
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 S AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWERUGH
WIRING
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION Z
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL 71
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From: C C= FSC_ /'� LC.��{ �/�► LG- 7_ •/ T !� I
Address: '753 0 CA L.45 {. I C O S'
Account No. Lot($) /O
Service Add
❑ Meter(s)
❑ Servlce(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ MeterSuroharge
❑ UP14flon Capacity. Charge 0/ �� S
ElWS.B.F.C.
❑ Temporary Construction Meter
❑ Turnon'Charge
❑ Uncollected Account- Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. -_Bond_
Asamt=
❑ Customer Deposit
❑ Other
re
PLO 46117
. . �� _
so 3 " zEt� ZI In - COAL?4 Z a:A. Code
Remarks:
❑Copy to:
Cash
Check
Money
Order
D
O
pC
TOTAL $
Water Service
A3B(111a8)
O
pC
TOTAL $
Water Service
A3B(111a8)
U
W
W
m
Z
0.1
U
LLI
m
to
Y
m
Q
W
m
-
COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH - 7 � _
SERVICES DIVISION 17
ENVIRONMENTAL HEALTH /I//
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 specifications required on the attached check list.
A non-refundable filing feeok�Pf Muired when the application is submitted. Check must be made payable to the County of Riverside.
�'�6
Building Department Application Log 4
Name{Owner, Agent. Contractor. Etc.)
Mailing Address
City
State
zip Code
Telephone
.Job Property Address A/Eml�74
Gt CeR-ow-
Legal. Description of Property (Lot. PAA
S7394,f- ed�OT%e2
.LA►4
io Big Ife. —Lew.,- /9
'Assessor's Parcel No
fWaier A ncN r Well
Use Per u/ vtp¢�,nmg Case
Lot Size
A7 d ,P�
:
t/
7 — �7� — 2
�l�.SYrrLIG"�'
SFD. MH Site Preparation Etc ���
r
SO )r/ vat
Signature of Applicant Date
'The above information must be ver/Ned from Building Appficetbn
STAFF USE — DO NOT WRITE BELOW THIS LINE
/IInniitial Date
'
"�^" '
Certification of Existing S.D. System required. ❑ Yes /I' r'
�,i,__,i�
WQCB Clearance required. ❑ Yes 2
il' it Ld
Sods feasibility report requited. ❑ Yes
Special feasibility boring report required. ❑ Yes
Detailed contour plot plans required. ❑ Yes
Staff Specialist approval required.. 10 Yes ONo Lot I spection Date
"Soils/boring rennrtby Project p Date
Soils Map Pag 4koil TypeOid Approved byZ:kAJ/1_ Date
Type of System:
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
/
❑ Existing LFJ^New ❑ Additional ❑ Replacement
3 1 Keq?C
Ali Gals.
Ile. ���j
(2) ach line sq. ft.
Sidewall allowance
Long.
Install Lines) Ft�Iines
L bed Sq.
(Sotto rich area)
h; rock/ Sq, Ft.
Finches
Ft. of bo
per running ft. C1;IQ%A
rock below
area
Leach lines/bed-special design for slope:
(3) Pit Diameter
No. Pits
Pit. BI
Seepage Pit total depth N6�'
Applicable
N/A Overburden factor
gK
Max. allowable depth t4�' .
�i �y
This application ia roved or the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
..
set forth in Section a ove. A building permit is necessary for the installation of the above -designed system_
(1) Septic tank and sewer lines must be 50' from any wells ' 0 1'-t.a;� 1` * _&aA 4
�
Leach lines must be 100' min. from any wells includinNexp nsiortarea
3) Seepage pits must be 150': min. from any wells including expansion area.(/ ^��
.411
Signature of Health 00aal
i
RECEIPT NO: Issued by I I -` Dat --// - PiP,
District: ❑ Riverside ❑ I�o ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept., GOLDENROD—Pending File
DOH.SAN-122 (Rev: 4188)
Jr
A F R 4 OF F ICE OF E. LEON SPAVGY
� f
�, AGRICULTURAL C.OMMISSIONL11 )AMES O'WALLACE
o I ? b AND ASSIPAM rIMMISSIOW1
WEIGHITS & MEASURES CLE�IEyS(8 EgVEIrISiE
. tit
4.9-613 Ilwy 86, 8uiite 0-12
'Coachells, CA 92236
MA r v. j6`11' 619-342-8291
DATE bcA I
��� CASE NO.
MVEL OPER' S WHE s !3 T fi R R
AuoREss i Z17 0 T..dNQ u I r z 2
• PALM SPIe I C -r 5 9 ZZ4..2, -
TELEPIIONEs (
Lor/. ,dxe /fG
Dear Developers 7-1-4-141-10 2-1
After reviewing your landscaping plans, all. plant material listed is not in
violation of quarantine laws governing the Coachella Valley. if substitutions
do occur and they differ frun plant material listed, this office must be notified
imnediately.
Thank you Lor protecting mid preserving the Coachella Valley's pest -free environment.
Alticultural Cannissioner's Office
ccs Indio and Riverside Office
r ..