04406 (SFD)w
Building
53-945 Cortez
Coachella Valley Lang Co.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA,92253
Address 247 Z. ah; tz Way 02
City Zip Tel.
Palm apri»Qs 1 92263 1 322-4020
ress
State Lic. City
& Classif. 387934 Lic. #691
Arcn., tngr.,
Designer
Address Tel.
City IZip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that) am licensed under provlslOns of Chapter 9'(commencing with Section
7ff c of Division 3 oVthe Business and Profession, Code, and,my Ilcense3e in full I rce.and
M
��� f
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buslness and Professions Code: Any city or county which requires a
permit to construct, after, improve, demoash, or repair any structure, prior to Its Issuance also
requires the applicant for such permit to No 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 thersimm, and the beak
for the alleged ezemptidn. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the appfkant.ro a civil penalty of not more than, five 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 sate. (Sec. 7044, Buisness 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 budding
or Improvement Is sold within one year of completion, the owner -budder wig have the burden
of proving Mat he did not buildor improve for the purpose or sa(e.)
11'1, as owner of the property, am, exclusively contracting with licensed contractors to coo-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does notappiy to an owner of property who bulfds-or Improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the ContrectWs'Llcense Law.)
❑ I am exempt under Sec. B. 3 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. (SVc a00, Labor Code:)
Policy No: Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTIONFROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the pem* 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. pparson in any manner so as to become subject to the Workers' Compensation
Laws of Califomia.
Date Owner
NOTICE TO APPLICANT: ,9, after maklny this Certificate of Exemption you should became
subject to the Nbrksrs' Compensation provisions of the Labor Code, you must forthwith
comply with such. provisions or thls permit shat/ be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby. 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,fllled out, signed and validated, and is subjectd0
expiration If work "thereunder is suspended for 180 days.
I certify that) 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;
mentloned property for Inspection purposes.
Signature of applicant Date
Melling Address
City, State, ZIp
ILDING: TYPE CONST. OCC. GRP.
1. Number 774-141-000
Legal Description
Project Description « �' • •
Ft. .1416 No.
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
428 eq. ft. garage
1701 61 ftod
:�anca
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
2 � 00
Plan Chk. Bal.7
.r 3 s 7
Const:*
•
Mech.
3 1 o '
Electrical
0 1 I
Plumbing
U5 n u
S.M.I.
5, 35
Grading
ZU.00
Driveway Enc.
0 n U 0
Infrastructure
a b •
IVIAL I tiymIaiv<v....,r
REMARKS
}
ZONE: BY:
Mlnimum: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 I/ E �`t
Issued by: Date -Permit
/r+
£� Permit
Validated by:
Validation:
WHITE - FINANCE, PINK -APPLICANT, GREEN = BUILDING, GOIAENO90 =-A38E5,SOR'S OFFICE,'HARD COPY - FILE , _
CONSTRUCTION ESTIMATL
NO., ELECTRICAL FEES
NO. PLUMBING FEES—
EESIST.OL
IST OLSO FT p =
UNITS
ROUGH PLUMB BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL SO F.T. Q
�y%�
S WER OR SEPTICROUGH WIRING
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR SO FT M
GAS (ROUGH) METER LOOP
HEATING (FINAL)
GAR S0_ FT. M
POWER OUTLET
ROOF DRAINS
60
DRAINAGE PIPING
CARP FT 6
WATER HEATER SERVICE:
WALL SO. FT. 41
DRINKING FOUNTAIN
50. FT. M
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION ><
LUMBER GR.
WATER PIPING
NOTE: Not to be used as Property tax valuation
FINAL INSP,
FLOOR DRAIN
MECHANICAL FEES
L9 �� T(j �Jl�'+'Y� l /
/
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHERIAUTOMDISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
SO.,FT.•@ c
WATER. HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a I Vi c
SEWAGE DISPOSAL
SO.FT.GAR C JAc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE L.CK.FEE
CONST. FEE ELECT. FEE
i SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
iETBACK Q + I '?—?-TWXFROUND
PLUMBI UNDERGROUND
A.C. UNIT
COLL. AREA
CG<AB GRADE
ROUGH PLUMB BONDING
HEATING (ROUGH)
STORAGE TANK.
FORMS
�y%�
S WER OR SEPTICROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPAQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE:
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
S DIuS xt
=t'
LUMBER GR.
FINAL INSP.
FRAMING _.
FINAL INSP,
�OOFING _
L9 �� T(j �Jl�'+'Y� l /
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
GAR. FIREWALL
LATHING
MESH
&ISULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S 810NATURESIINITUilS
GARDEN WALL FINAL
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COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH.
ENVIRONMENTAL HEALTH SERVICES DIVISION
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 fee of S40 is required when. the application is submitted. Check must be made payable to the County of Riverside.
Building Department Application Log #
Name (Owner. Agent. Contractor.. Etc.)
Mailing Addresses ,' 9
ZI// �-rAA4Qyf it i �► 4yr
,5�I'/ X� G a' S rA
/ {/V
City State
f'44M SPP1v4s
Zip Code
Telephone.
7.
'Job Property Address 'City or community -
,.'t�gafiSesCript;o'ri' oi'Property�'(CtSt'.'PM:"TRj _ - �'a..
53 40 ",,.J7 n
Assessor's. ParcelNo
-
water Agency, or well
a (J Gti A MA41
�`
Use.of Permit Planrnng-6ese,#-
Lot Size
y
SFD. MH Site Preparation Etc.
Signature of Applicant Date
*The above information must be verffW from Building Application
STAFF USE — DO NOT WRITE BELOW THIS UNE
Initial;, D to
Certification of Existing S.D. System required. ❑ Yes No
WOCB Clearance required. El Yes No
Soils feasibility report required. ❑ Yes 13 No.
Special feasibility boring report requited. ❑ 'Yes I No
Detailed contour plot plans required. ❑ Yes No
Staff Specialist approval required. ❑ Yes No Lot Inspection Date
Soils/boring report by "' ` Project # Date
Soils Map Page Soil Type Approved by Date
Type of,System:
No. of Bedrooms
(1) Septic Tank
Soil Rate (iequired
❑ Existing U New El Additional ❑ Replacement
, �0'1'wz . V' iax
t QUO Gals.
(2) Leach line sq. ft.
Sidewall allowanc i
Install Line(s) Ft. Long,
Leach be'd Sq.
(Bottom trench"area) '
tt. roc Sq. Ft.
Ft. wide with min. inches
Ft. of bottom
per running tt:. ❑ N/A
rock below drain lines
area
Leach lines/bed-special designfor slope:
(3) Pit Diameter
No. Pits
Pit BI
Seepage Pit total depth ( f
Applicable
❑ 5' EK -6'
t
y
Max; allowable depth
N/A Overburden factor
1
V t, 40 C' s
This application is—a ov /denied for the design of a.subsurface,disposal system as indicated on the accompanied plot plan using the requirements
set forth in Section 8 above. A building permit is necessary for the installation of the above -designed system.
\_414) Septic tank and sewer lines must be 50' from any wells
(2) Leach lines must be 100' min. from any wells including expansion area
(b) Seepa�e pi"At be 14 from anvwells including expansion area >
I y
Signature of Health Official Dale
RECEIPT NO. �� Issued by (\,\ t Date v & r �`
District: ❑ Riverside ® Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -'^SAN -122 (Rev. 4/88)
0
;3 e
4t OF R��t
r OF f ICE OF E. LEON SPAUGY
s AGRICULTURAL COMMISSIONER ����W�SWALL
? � t� JAMES 0 WALLACE
f) O AND ASSISIANI rhWMUSSIOW
WCIGI ITS �C N1E/�SUttCS CLE�1E�StAt gVEtvISTE
49-61.3 Ilwy 86, Suite 8-12
'Coachella, CA 92236
4Y? j $q 619-342-8291
DATE $" g` CASE W. 88 4.5 Of O T
DE+VEMPER' S H MEs '47Q .[> S ->�GLS T! Oj
ADDRESS s 2'Z E 720H CQGL / L WAV "-;Z)
`ALIh S/0,01i4)n s G?tq 9I z z Z - L
TELEPI UMs (/,/5F) j Z 2 -- / 0 Z- C-)
Dear Developers
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 p1mit material listed, this office must be notified
immediately..
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
venoot����
Agricultural Comnissio s Office
ecs Indio and Riverside Office