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05169 (SFD)Building Address Address city Contractor 4 P.O. BOX 1504 78-105 CALLE ESTADO 51-925 Velasco LA QUINTA, CALIFORNIA 92253 Tel. 4 Tel: State Lic. City & Classif. 317390 Lic. # Arch., Engr., Designer Address _FTel city Zip State I I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under Provisions of Chapter 9 (commencing with Section 7 rl .Mal Division 3 of the Busines� aj d I?rofessions Code, and my license is in full force and SIGNATURE DATE OW`kER­BJUILD11ER DECLARATION I hereby affiryn that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,13usiness and Professions Code: Any city or County which requires a Peru* to construct, affer. improve, demolish, of repair any structure, prior to its issuance also requires Me appfficant for such permit to We a signed statement that he is licensed pursuant to the provisions of the Conitractor's License Law, Chapter 9 (commencing with Section 7000) of MvIsion 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exempgon. Any violation of Section 7031.5 by 'any applicant for a permit sidjects theapplicanthia crvilperially ofmit more than rive hundreddallars ($500). 0 1, 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: Ithe Contractors License Law does not apply to an owner of property who budds or anproves thereon and who does such work himself or through his own employees, provided fiNd such orprovements are not intended or offered for sale. If, however , the building of improvement is sold widdin one year of completion, the owner -builder will have the burden Of Proving that he did not build or #Wrove for the purpose of sale.) 0 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 pippetty who builds or improves thereon, and who contracts for such projects with a contractorfs) 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 N Company - 11 Copy is filed with the city. 0 Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE (This section need not be completed ff the pernti is for one hundred dollars ($100) valuation or less-) I certify that in the performance of thp work for which this permit is issued, I shall not employ any L.s of Calir .,Zon in any manner so as to become subject to the Workers' Compensation Date_ovmer NOTICE TO APPL#CANT: ff. after making this Certificate of Exemption you should become sLdrect to Me Workers' Compensation provisions of the Labor Code, you must forthwith comply sib'? 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, 309 7, Civil Code.) Lenders Nam Lender's Add This is ia building permit when properly filled out, signed and validated, and is subject to expiration I work thereunder is suspended for 180 days. - I cer tity 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 Add City, State, Zip No. 05169 BUILDING: TYPE C.ONST.-OCC,. GRP.- A.P. Number Legal Description Project Description 1=0 POD Sq. Ft. 1,500 No. No. Dw. Size Stories Units New 0 Add 0 Alter 0 Repair 0 -Demolition 0 Estimated Valuation 4104 e%'70 PERMIT AMOUNT Minimum Setback Plan Chk. Dep. A2 SID W) Front Setback from Center Lin Plan Chk. Bal. All _7A Const. IRA .!]n Side Setback from Property Line Mech. -4 6 () q, Electrical 76 -4 ft Plumbing i n s tie S.M.I. Grading Driveway Enc. 2A - 010 Infrastructure TOTAL 1V t.0 REMARKS J14 ft,�J �f 4,4*�!-&?_ �#A Rh 44 1 ZONE: BY: Minimum Setback Distances: Front Setback from Center Lin Rear Setbac k from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: j1 2 / 2 9 / 8 a Da e Permit e Validated by - Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. @ $ UNITS LA13 GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. @ GAS(ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SQ. FT. @ �IKT E M P. PO L I GROUT DRAINAGE PIPING CAR P. SO. FT. @ FINAL INSP. WALL SO. FT. @ WATER SYSTEM DRINKING FOUNTAIN. GRADING cu.yd. s -plus -x$-=$ LUMBER GR. URINAL SO. FT. @ FRAMING FINAL INSP. ESTIMATED CONSTRUCTION VALUATION $ �VIR 0 0 F I N G WATER PIPING NOTE: Not to be used as property tax valuation REMARKS, FLOOR DRAIN MECHANICAL FEES WATERSOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER SPARK ARRESTOR GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY 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 PATH TUB INSPECTOR'S SIGNATURES11NITIALS SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11/4 c SEWAGE DISPOSAL SO.FT.GAR @ V4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.FEE CONST. FEE ELECT.FEE SMIFEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK2;.2 L/ GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA LA13 GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. GAS(ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) �IKT E M P. PO L GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu.yd. s -plus -x$-=$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. �VIR 0 0 F I N G 0/c 70 A-1 /2 & -7 0 7 REMARKS, VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL ro Z 0 U.J (1) M Z 0 i5 U.1 17) A Z C t LL Cr Ws Z U. Cr eon COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH -.Assessbm Parcel N!).. ENVIRONMENTAL HEALTH SERVICES PERMIT APPLICATION FOR A SUB SURFACE'SEWAGE DISPOSAL SYSTEM Applibant: Submifthis form with four copies of a scaled plot plan (1 -20 scale) drawn.to County specUlations.as indicat.ed'o'n tKe'afta6hed chfi�k,list. A non-refundable filing fee (see below) is required when the application is submitted. -'Check must be.;made payible't6 the County of Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval. VEkiFy ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'* Agent Contractor, Contact Person P�o2n Address & Phone 1 Ow. r 4"-x.,ce bv1_1r) Phone 24/r- _1A 36 Mailing Address &L 0A) city State Zip Job Property Address.40 Legal Description Prop. (PM, Tract Lot) 9 - 19, tajk5 C) Lot Sze - Water Agency/Well Use of Permft P/P, CU, etc.. Other )e NO r 61� 12 Dwelling, MH Site Prep, etc. __4%) (Z Signature d/Applicant Date CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE ,15', SUBSURFACE DISPOSAL 1238 E5�0_0 0 SITE EVALUATION UPON REQUEST 7349 $42.00 [3 MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION 0 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 0 PRELIMINARY ELECTIVE 7352 $45.00 • Rereview (2nd review same parcel) 7344 $16.00 EVALUATION (Aftach DOH SAN 53) 0 Site Evaluation in Conjunction with 0 HOLDING TANK '1351 445.00 Critical Area 7346 $86.00 11 ALTERNATIVE/EXPERIMENrAL 7345 $13iOO • Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. .7347 $86.00 I Tit DATE Holding Tank Agreements Completed 0 Yes No 14 Certification of Existing S.D. System Required 13 Yes I I No WQCB Clearance required. (Attach Form 0 Yes 13 No DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. 0 Yes I I No Special Feasibility Boring Report Required. 0 Yes No Detailed Contour Plot Plans Required (1 to 5 fL interval) 0 Yes No Other 0 Yes No Staff Specialist Lot Inspection Required 0 Yes No . Lot Inspection Date f-, Soils boring report by' Project Date Soils Map Page Soil Type Approved by Date No. of Systems Type of System(s) No. Dwelling Units (1) Septic Tank Soil Rate. . q Holding Tank 0 Existing I-d"'New 0 Replacement Bedrooms, Fixture Units 71A Vt-c')( �d I / . . G intop YIAQ� Gal Gal (2) Leach Line Sq. Ft Bottom trench a Sidewall allowance Install Line(s) wide %�fth Leach Bed s(V7ft. ft. rock/ It min. Inches rock drainlines or of bottom area per running It. 0 NA Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Ph Below Seepage Pit Total Depth Other: Applicable �e Inlet (BI) N/A _7��a�fburdk wz, 0 5 6 2q' Max. Allowable Depth No. 2 System REMARKS: A �O'� )A This application is ArP-P-ROAD/DENIED for the category checked in SECTION B above, regarding the design of a subsurfacedisposal system as indicated on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the IVesigned system. No construction is permitted in the required reserved 100% expansion area. Septic tank and sewer lines must be 50' minimum from any wells (2) Leach lines must be 100' minimum from any wells, including expansion area ts must I . t, 1,�w , :;Geepage pi any wells cluding expansion area f ` C3 I Signature of Health Official_,�� Date RECEIPT NO. I ssued By Date I C, DISTRICT: 0 Riverside, 0�lndio 0 Hemet 0 Pems 0 Rancho Calif. 0 Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD'- Plans/Records Ail r-ctsirm-al P oi na OF E LEON SPAUbY C0% A6aiCUL'I URAL MNIIN -IISSIONER )AMES 0 WALLACE 0 AND ASS:S;A*.f CININIMIONER v UL CLE MENT BE-N.,VENISTE - - WEIGHT.S MEA . �URIS SLALER . 49-613:11wy 86, Suite 11-12 -4 q yg, CA 92236. 619--�342-8291 DATE iCASE NO. DEVELOPER.S M4E*. ADDRESSt '2 '2. 0 TELEPI [ONE: Or 3 Yr -1/ .36 v Dear DeVeloper. After reviewing your landscaping plans, all, plant waterial l.isted is.not i ri alley. lf*s bstituti ns violation'Of "quarantine laws governijig the Coactiella Vc u 1 0 do occur and they differ frun p�wit material listed-, this' office nust be notified' imnediately. 'Tha . nk you for protecting and.preserving the Coachella Valleyls pest -free environvent.