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06787 (SFD)permit to construct, atter, improve, 'demolish, or repair any structure, prror to its issuance also requires the applicant for such permit to rile 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) of " Division 3 of the Business and Professions Code, or that. he is exempt thereliom, and the bas' the alleged exemption.. Any violation of Section 703 1. 5 by 'any applicant for a permit Plan Chk. Dep. ✓ J•'/rte P.O. BOX 1504 �r N u . 09787 Building 78-105 CALLE ESTADO Address 53-820-Veiasce _ .LAQUINTA,.CALIFORNIA 92253 as owner of 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 , Owner //�//1 Code: The Contractor's License Law does not apply to an owner of property who BUILDING: TYPE CONST. • OCC: GRP. ' Mailing ` o - " Address HIAlmy III. Suite 'C A.P. Number 774�i65-OSS 774-465-005 City Zip Tel. Electrical i2�.76 •"• �•s." '• _ of proving.that he did not build or improve for the purpose of sale.)., • "La Q"nta 92253 564-1205 '. Legal Description _ Plumbing • Contractor Project.Description '3� linin Coustructioa S.M.I. 6.79 ,•�1 such projects with a,contractor(s) licensed pursuant to the Contractor's License Law.) - Address - ❑ I am exempt under Sec. B. 8 P.C. for this reason Grading P.. ©. Box 2982 ' Driveway Enc. 20.00 • ` rCit P y ZI J Tel._ Infrastructure 2s138,28, •Palm Desert 92260 340-6899 State Lic. _. City Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) A Classif. 4soin Lic. # Sq. Ft.1756 Size No. Stories No. Dw. Units . Arch.,'Engr.; New ❑ Add ❑ Alter ❑ Repair.❑ .- Demolition ❑ Designer. Address.; ' Tel. REMARKS d1_Nr~4!x (This section need not be completed if the permit is for one hundred dollars (S100) valuation - LAP— +"'►> f! - ,A - 7 LYd it. d .s 3 •:. w• . ,•::. or less.) .. - City. zJ Zip State employ any person in any manner so as to become subject to the Workers' Compensation • - _ Lic. # Date_!_______ • Owner NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become ZONE: - BY: - - LICENSED CONTRACTOR'S DECLARATION ' Minimum Setback Distances: - I hereby affirm that I am licensed undecp ovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busi5erss4nd•Professions Code, and my. license'is.m force Ill and effect., ti' ;• s / } Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 1 hereby affirm that there is a construction lending agency for the performance of the SIGNATURE•. DATE 0WNER•BUILDER DECLARATION Estimated Valuation Side Setback from Property Line I hereby affirm that I am exempt from the Contractors License Law for the following $96,734 Lenders Address This is a building permit when properly filled out, signed and validated, and is subject to reason: (Sec. 7031.5,Bustness -and Professions Code: Any city or county which requires a INSPECTOR' expiration if work thereunder is suspended for 180 days. permit to construct, atter, improve, 'demolish, or repair any structure, prror to its issuance also requires the applicant for such permit to rile 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) of " Division 3 of the Business and Professions Code, or that. he is exempt thereliom, and the bas' the alleged exemption.. Any violation of Section 703 1. 5 by 'any applicant for a permit Plan Chk. Dep. 250.00 ? y subjects the applicant to a civil penalty of not more than five hundred dollars ($500). _ ❑ I, the Plan Chk. Bal. • a 280.53 as owner of 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 Const. 4 .f 626..®V 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,•] Mech.. ' 53.50 provided that'such improvements are not Intended or offered for sale. 1f, however, the building or improvement is sold within one year of completion, the owner-bm7der wig have the burden ' Electrical i2�.76 •"• �•s." '• _ of 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- Plumbing r• s dI t struct he 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 S.M.I. 6.79 ,•�1 such projects with a,contractor(s) licensed pursuant to the Contractor's License Law.) - ❑ I am exempt under Sec. B. 8 P.C. for this reason Grading 20.00 ' Driveway Enc. 20.00 • ` Date owner Infrastructure 2s138,28, WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, ora certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company ~ ❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.' TOTAL 0.673.36 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS d1_Nr~4!x (This section need not be completed if the permit is for one hundred dollars (S100) valuation LAP— +"'►> f! - ,A - 7 LYd it. d .s 3 •:. w• . ,•::. 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 ZONE: - BY: - - subject to the Workers' Compensation provisions of the Labor* Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. - ' Minimum Setback Distances: - Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lenders Name Lenders Address This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR' expiration if work thereunder is suspended for 180 days. 1 90 I certify that 1 have read this application and state that the above information is correct. -city Issued by: Date Permit 1 agree to comply with all 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. Validated by: Signature of applicant Date .; Mailing Address ' VdlldatlOn; City,. State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADE L� P v/ ROUGH PLUMB. BONDING YARD SPKLR SYSTEM �. 2ND FL. SQ. FT. FORMS SEWER O E ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® TEMP. POLE GROUT DRAINAGE PIPING CAR P. SQ. FT. ® FINAL INSP. WALL SO. FT. WATER SYSTEM DRINKING FOUNTAIN. GRADING cu_yd. $ plus x$ =$ URINAL SQ. FT. FINAL INSP. �� QP FRAMING �IrAv ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER 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, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® I Vi c SEWAGE DISPOSAL SQ.FT.GAR ® V4c HOUSE SEWER FINAL INSPECTION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK LJ O Au _' / l j LUMBINGAV UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE L� P v/ ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER O E ROUGH WIRING DUCT WORK ROCK STORAGE ��,""" n A FOUND. REINF. © y� //w! GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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. �� QP FRAMING �IrAv FINAL INSP. ROOFING' � y?� /`�/ all— /* o � ✓ / r REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING yl�o MESH INSULATIONISOUND /6 O FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESrINITIALS GARDEN WALL FINAL lot RECEIPT NO. 14 `- ya 2' Issued Byy Date 12-'l 2 DISTRICT: ❑ Riverside, M -Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe DOH -SAN -122 (Rev. 7189) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records '' ' COUNTY OF RIVERSIDE ENVIRONMENTAL Ase"Wn PBMW NO. HEALTH SERVICES DIVISION I irfy— I6S'— Afoos- 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 list 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. 4. VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # Z O Agent Contractor, Contact Person Phone Address & Firm 340-6807 P.O. BOx M. Palm Desert Ca. 92261 U Owner Phone Mailing Address cwn Ia Qumm Fniterprises / Contact: Dean 5641205 78-401 Hw. 111 Suite G La Ca. 92253 City State Zip Job Props Address Lot 5, Blodc 239 — St. I.Descri Pr (P ,Tract, Lot) ta, ar% f iiinta #22 C3. 92253 Lot Size Water Agency/Well Use of Permit P/P, CU, et . ` ` v Scv Other 5000 sq. ft. w-rJ =Dwelri Site Prep, etc. /Z�l� 9 — Signature of Ap pate CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE ❑DISPOSAL 1238 $ 57.00 ❑ SITE EVALUATION UPON REOUEST 7349 $ 43.00 (n - /SUBSURFACE MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348, $ 17.00 Z O a. 1 st 4 Parcels (Each) 1238 $ 57.00 (Less than 1 year) b. Each Parcel after 4 7344 $ 24.00 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 U.1 ❑ Rereview (2nd review same parcel) 7344 $ 24.00 EVALUATION (Attach DOH SAN 53) U' ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $ 47.00 Critical Area 7346 $111.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $ 87.00 INITIAL DATE Holding Tank Agreements Completed ❑ Yes No _�9 Certification of Existing S.D. System Required ❑ Yes No WOCB Clearance required. (Attach Form ❑ Yes No DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yes No Special Feasibility Boring Report Required. ❑ Yes C No Detailed Contour Plot Plans Required (1 to 5 ff. interval) ❑ Yes C No Other ❑ Yes E No Staff Specialist Lot Inspection Required ❑ Yes ❑ No Lot Inspecicn Date Soils boring report by Project Date Soils Map Page Sol Type Approved by 5;1-• hi- Date U Z No. of Systema Type of Systema) NoDwelling Unita (1) Septic Tank Sal Rate Grease/Send ❑ Holding Tank ❑ Existing Be Fixture Units Grease Intop Waw ❑ ReplacenwM �[ U Ga U) (2) Leach Line Sq. Ft Sidewell allowance Install Lk*s) f . long k wide with Leach Bed sq. it Bottom trench area _ R rook/�R per running tt min. inches rock below dreinlirm or of bottom ales / ❑ NA Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit Total Depth Other. Applicable Inlet (BI) (TD) � � 19 Max. Allowable Depth N/A Overbu�factor ��/�/ ❑ 5 — U�� (y a No. 2 System REMARKS: // / t 1 / WAle4 aiN /W fL6�C o /'tiS•'®/+c ` SQ � /fit' /,-J- This application ' PPS ROV lyyggE�NIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accomp�ied—ploYpa�using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the Z above -designed system. No construction is permitted in the required reserved 100% expansion area. O Cly Septic tank and sewer lines must be 50' minimum from any wells U(2) Leach lines must be 100' minimum from any wells, including expansion area W Seepage pits must be 150' minimum from any wells, including expansion area X`"z—, Signature. of Health Official Date RECEIPT NO. 14 `- ya 2' Issued Byy Date 12-'l 2 DISTRICT: ❑ Riverside, M -Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe DOH -SAN -122 (Rev. 7189) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records Of +4 OFFICE ,OF s ` AGRICULTURAL COMMISSIONER AND �• e°'� WEIGHTS & MEASURES �` •'' CALVIN C. KAMINSKAS JAMES O. WALLACE 4080 LEMON STREET, ROOM 19 Assistant Commisslonor Agricultural Commissioner RIVERSIDE, CALIFORNIA 92501 CLEMENT BENVENISTE Dlrec fix of Weights a MeasuresSeater - (714) 787-2561" 49613 Highway 86, Suite•B12 Coachella, Ca. 92236 (619) 342-8291 DATE -I;"'�a CASE No. R�4 �2G 1�2Z DEVELOPER'S' NAME: ADDRESS: `� - `f ( �t �-�, l ` �-''� c TELEPHONE: (G L 1) ' S (9" Dear Developer: 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 from plant material listed, this office must be notified' immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment.- Agric tural Commissioner's Office cc: • Indio and Riverside Office