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04794 (SFD)'t 0 104 P.O. BOX 1504 Building -78-105 CALLE ESTADO ,7 Address 5a -920 valasito LA.QUINTA, CALIFORNIA 92253 Owner Joe.'stemmr BUILDING: TYPE CONST. - OCC. GRP. -Mailing Address 79-940 Horseshoe 773-326-010 A.P. Number. . City Zip Tel. ..., La, Quinta922 3 ,342-!317Q Legal Description, � r Contractor r~S. F. D.Project Description C7Lit3 er%suilde3t: . Address y City Zip Tel. State Lic. City & Classif. Lic. # Sq. Ft. _ : No. No. Dw. , Size JL200 Stories Units Arch., Engr.; Designer New ❑ Add O Alter O Repair ❑ Demolition ❑ . Address Tel. City -^ Zip State, Lic. # w LICENSED CONTRACTOR'S DECLARATION ,, n -K orovi.i-._ ._ I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3ofthe B`6sines�s%%an��dP+ro_�fessions Code, and my license is in full force and r effect. �k_rlZ,6- ��':K_�.. !.�•�e3. ..�..,.,,,.,..ti'• •a. X IGNATURE,r' DATE �• OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following $64,,,830 reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also r - requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT - AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan'Chk. Dep. $250.60 subjects the applicant to a civil penalty of not more than five hundred dollars ($500).- O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 9 36a84, 6•w do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and378.00 •Professions Code: The Contractor's License Law does not apply to an owner or property who Const. = - builds or improves thereon and who does such work himself or through his own employees. Mech. iijt•r - 'Provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden Electrical va 1•s., 9i -s -y;•'~ of proving that he did not build or improve for the purpose of sale.) .- O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing in:i -y • ' struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law n - does,not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. -i , '� •; such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - Grading ❑ 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date Owner Infrastructure r • WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Secff3800, Labor Code.) Policy No. Company 'P* �, r.0 t 24 ❑ Copy is filed with the city. O Certified°copy is hereby furnished. . TOTALv'�I$i'i REMARKS . 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 thg work for which this permit is issued, I shall not ,( M1 r' E tLrri� •"s,L,v d.5 ,. 46 13 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. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION. LENDING AGENCY Side Street Setback from'Center Line I 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.) , Side Setback from Property Line Lender's Name •r eL_ender's Address j 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. - FINAL DATE - ^• NSPEQ Og 7 D' 1>*' r 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. 1 Issued by: Validated by: Date Permit .. Signature of applicant Date ,Mailing Address Validation: GOLDENROD - ASSESSOR'S OFFICE; HARD COPY - FILE. City, State, Zip -- ipWHITE WH . ITE= FINANCE,'PINK -APPLICANT, GREEN'.' BUILDING, :. 'f i CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT (p $ UNITS COLL. AREA SLAB GRADE ROUGH PLUMB YARD SPKLR SYSTEM 2ND FL SO FT. 4 STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR SO FT. Qr ROCK STORAGE FOUND. REINF. POWER OUTLET ROOF DRAINS GAR SO. FT. re OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. SO FT. 6 1 GROUT WATER HEATER DRINKING FOUNTAIN WALL SO. FT. Q BOND BEAM WATER SYSTEM URINAL SO. FT. to _$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION b FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTONDISH) APPLIANCE DRYER VENTILATION , GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRYTRAY AIR HANDLING UNIT CFM FIREPLACE KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC 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 a I V. c SEWAGE DISPOSAL SO.FT.GAR @ V c HOUSE SEWER 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 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.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. b _plus_x$ _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. WOOFING — REMARKS: VENTILATION , FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR - GAR. FIREWALL LATHING MESH WSULATIONISOUND 2 FINISH GRADING FINAL INSPECTION CERT: OCC. FENCE FINAL INSPECTOR'S SIGNATURE311NITIALS , GARDEN WALL FINAL RECEIPT NO.la [j Issued By - Date DISTRICT: ❑ Riverside, Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑. Blythe DOH SAN 122 (Rev:5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records ' - J COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH L7a Assessors Parcel ENVIRONMENTAL'HEALTH SERVICES O 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 checklist. 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. Q VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'* Z z O Agent, Contractor, Contact Person Phone Address & Phone H W Owner hone Mailing Add A G nr r� State c ) A Zip Job Property Address Legal Description Prop. (PM, Tract, Lot)ru'77la -�, Lot Size Wi geoc`y/We11" Use of Permit P/P, CU etc. 6 t fiti Other / 00 � A& C 1.4� wel g MH Signature of Applicant Date CATEGORY: REV CODE FEE^-� C]'" SUBSURFACE DISPOSAL 1238 .00H - CATEGORY: REV CODE FEE ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 m ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) Z LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 Q a. 1 st d Parcels (Each) 1238 $45.00 (Less than 1 year) I�- b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 W ❑ Rereview (2nd review same parcel) 7344 $16.00 EVALUATION (Attach DOH SAN 53) CIO ❑ 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. 7347 $86.00 INITIAL DATE p � / �d Holding Tank Agreements Completed ❑ Yes Certification of Existing S.D. System Required ❑ Yes rNy/ WQCB Clearance Form required. (Attach ❑ Yes 01 No DOW SAN 007, Santa Ana Region Only) / Soils Percolation Report Required. ❑ Yes Q/ ' Special Feasibility Boring Report Required. ❑ Yes El NN Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes �'/�o'� Other ❑ Yes Staff Specialist Lot Inspection Required ❑ Yes a No „C Lot Inspection -date Soils boring report by /r'Project # Date % (� Soils Page ` / t / �' �� /r T p, Map Soli Type Approved by Date u U No. of Systems Type of Syatem(s) No. Dwelling tints % (1) Septic Tank Soil Rafe Grease/Sand Z Q � ❑ Holding Tank ❑ Existing v�lew ❑ Replacement Bedrooms, Fixture• n fr vu (! Greasee intcpp U v � ( leach Line Sq. Ft Sidewall allowance Install Urals) R long tt wide with Laach Bed sq: ft Bollo,trench area R rock/ sq. R per running ft min. inc�hes`rbdc.bebw drainlines or of m f ❑SNA Leabhlines/bed special design for -slope:— (3) Pit Diameter _ No. Pits P8 Below Seepage Pit T Depth Ot Applicable N/A , Overburden factor i --ft 6"6 Inlet (BI) 113 q r I-, , Max. A 0 le Depth No. 2 Systt REMARKS:` )'_b<i_.--I' P1, % f k � R.t s! Q . / v J • j This application is PPO /UE EDIfor the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompariied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the Zbove-designed system. No construction is permitted in the required reserved 100% expansion area. ZL'J' Septic tank and sewer lines must be 50' minimum from any wells 741 (2), Leach lines must be 100' minimum from any wells, including expansion area d Seepage pits must be%450' minimum from any wells, including expansion area , - _1i ��� r (y} /) *i.'6 ter« / •uC2ar/ }41 '11 5 t , Signature Health Official �" of Date E < RECEIPT NO.la [j Issued By - Date DISTRICT: ❑ Riverside, Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑. Blythe DOH SAN 122 (Rev:5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records ' - J