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05584 (SFD)w P.O. BOX 1504 No.. 05584 Building 53-965 VELASCO 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 - - Coachella Valley Land Mailing Address 247 E. Tashquitz Way f2 CityZip Tel. Palm. Spriligs J32262 61914;2-1020 Contractor Starr Construction Address Salve City State Lic. City & Classif. 357934 Lic. # 895 Arch., Engr., Designer Address Tel. City I Zip I State Lic. If LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 33 ofthe Business and Professions Code, and my license is in full force and effect. SIGNATURE / t' DATE OWNEWBUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's • 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 permrif to file 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 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 five hundred dollars ($500). O 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: 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 krprove for the purpose of sale.) O I;'a5 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'novappfy-to_;an. owner or property who builds or improves thereon, and who contracts for such projects. with:a contractors) 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 I hereby affirm that I have a certificate of consent to seff•insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec.'3800, Labor Code.) Policy No Company -'�' f :.,-�-1Y J ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need of be completed ff the permit is for one hundred dollars (S 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: It, 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. 3097, Civil Code.) Lenders Name Lenders Address This is a building permit when property filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 100 days. I certity that 1 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, Zip BUILDING: TYPE CONST. OCC: GRP.: A.P. Number 774-164-024 Legal Description Lot 12 Blk 238 Uoit 22 Project Description 'Sr DI REMARKS ZONE: BY: Minimum 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 INSPECTOR 3/32/89 Issued by: Date Permit Validated by: Validation: Sq. Ft. 1463 Size No. 1 Stories No.. Dw. Units New 13 Add ❑ Alter ❑ Repair ❑ Demolition ❑ 475 & uare feat Garacre 3.70 feet 6—foot Wood Fence Estimated Valuation $79,706-.00 PERMIT AMOUNT Plan Chk. Dep. :250.00 Plan Chk. Bal. 22Z.94 Const. 9-.5() Mech. 53.5u Electrical 109.20 Plumbing I57.50 S.M.I. 5.6.0 Grading 20.00 Driveway Enc. L U. . Infrastructure s" TOTAL REMARKS ZONE: BY: Minimum 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 INSPECTOR 3/32/89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SO. FT. ® $ UNITS COLL. AREA �?LAB GRADE �� _ G ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL SO. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. Sp. FT. ® DUCT WORK ROCK STORAGE FOUND. REINF. POWER OUTLET ROOF DRAINS GAR. SO. FT. ® HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. SO. FT. ® GROUT WATER HEATER DRINKING FOUNTAIN. WALL Sp. FT. FINAL INSP. BOND BEAM WATER SYSTEM URINAL Sp. FT. g GRADING cu. yd. plus—x$—=$ ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES f� TO / _ �� r ���� �� � -7 i1S� P r G jt N°J/ b G(//fCCSOVLY WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION 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 ® 1 Vi c SEWAGE DISPOSAL SO.FT.GAR ® 3/4c 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 v 'i 'OY-GROUND PLUMBI UNDERGROUND A.C. UNIT COLL. AREA �?LAB GRADE �� _ G ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTI ROUGH WIRING. DUCT WORK ROCK STORAGE 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. W./FRAMING ro �3 FINAL INSP. g:ROOFING6— f� TO / _ �� r ���� �� � -7 i1S� P r G jt N°J/ b G(//fCCSOVLY REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL qi-ATHING Q - MESH INSULATION/SOON .Z FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURBSJINITIALS GARDEN WALL FINAL -r�[7441KA' f.�i1/tta�i""'5�4� rM'`�t t!�tty:7::✓a �� �, yes �S' kt{�+�a7s,?`"�L P -t' -ria �'� Q Z O U W U) In Z O U W to 'A Z C U W " COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. ENVIRONMENTAL HEALTH SERVICES �� - d A?jz/ _ 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. VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG' # Agent, Contractor, Contact Person t ' Phone 322 -�0 G Address 8 Phone ZZ7 C iAr�l 4�u , rL r x��4 � ?✓ (20W' Q,;J t.� yf Owner Phone Mailing Address 41'1 J City State Zip Job Property Addresa_2 r,W,,.,,..,& Legal Description Prop. (PM, Tract, lot) rad Ylyp S' r�y.�rtJ�s Axa r2'16� 4- r, ,V&e 4S .4, - c -.-e 1,Z:'A4e, Ala 9,4 &'cX, Lot Size nc eII Use of PermR P/P, CU, eta y/ e, ( ('C" -f , Other -j .�vKJ/CSd f -rti) i�.t (Dwelling, MH Site Prep, etc.? Signature of Applicant Date r CATEGORY: REV CODE- �F^EE — SUBSURFACE �5.00 CATEGORY: REV CODE FEE O DISPOSAL 1238 ❑ SITE EVALUATION UPON REQUEST 7349 .$42 ❑ MULTIPLE PARCELS WITHIN SAME _ "� • ' "' (NO PLOT PLAN) 141.zw LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 a. 1 st 4 Parcels (Each) 1238 $45.00 (Less than 1 year) b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 ❑ Rereview (2nd review same parcel) 7344 $16.00 - + EVALUATION (Attach DOH SAN 53) ❑ Site Evaluation In Conjunction with , ❑ HOLDING TANK 7351 $45.00 Critical Area 7346 600' ❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 I /INMAL DATE_ _ '`/ler Holding Tank Agreements Completed ❑ Yes / Certification of Existing S.D. System Required ❑ Yes pow r WQCB Clearance required. (Attach Form ❑ Yes © No DOH SAN 007, Santa Ana Region Only) i Solis Percolation Report Required. ❑ Yes o NO/ f Special Feasibllity Boring Report Required. ❑ Yes O°�No"r Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes f�l°1No� I Other - . _ - _ T_ .► . _� — . __ -❑ Yes --- Staff Specialist Lot Inspection Required ❑ Yes No i Lot Inspection Date Sills boring report by Project # Date �} q Soils Map Page !t7 / I Soll Type 00-IC—Approved C Approved by Date 3-2 ?-f / A! No. of Systems Type of 'SWem(s) 1 No. Dwelling Units` ) i (t) Septic Tank Soil Rate Grease/Sand '-Grease ❑ Holding Tank 13 Existing 7fNew ❑ Replacement Bedrooms,F7)turerhhft J 6,0i?.M ' �� � � Gal / �! � ,�� ora, Intop ... . '(2),Leach Line Sq. Ft B&Ibrn,tench area Sidewall allowance 1t Install - Lines) ft. long ft wide with .Leach Bed sq. ft rodV running n sq. � min. ink below of bottoms 4 AW LeaChlines/bed special design for slope: (3) PR Diameter No. Pits PR Below Seepage PR Total Depth Applicable f '��5 ��-/�� f Inlet (BI) / �/If/ Max. Allowable Depth N/A Overburden factor I�. No. 2 System 11114 REMARKS: Gid !!L >- �'�-�' G` s �L`~r�i�c) .0 Dc2x•v�a� Av yi ,-Zaz This application i APPROVED ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompan p o pan, using the 'requirements seMorth in SECTION C above. A building permit is necessary for the installation of the above -designed system. No construction is permitted in the required reserved 100% expansion area. Septic tank and sewer lines must be 50' minimum from,any wells' /Li ^/ ✓�fl Ce-< * *� (2) Leach lines must be 100' minimum from any wells, including expansio ar '� - sem'- rte; Si6Z!` Seepage pits must be 150' minimum from any wells, including expansion area C � 17604 —Signature of He ---.-Official v Gt�'�I'/�%{ r � N A -r,<.?..,.• , e-'�"i' _ r RECEIPT NO. G Issued By ��. Date 3- DISTRICT: 3 DISTRICT: ❑ Riverside, Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records r -Ty Ae-4'}t+'rrr .nW��i'riF --7.Z,+�^..•gr.>.. .. Buena Engineers, Inc.wr 79-811 Country Club Drive, Suite 4 �►' :..r Bermuda Dunes, CA`92N11 (619) 345-15881328-9131. %'r•rn..l�J� +.a+�[:.+.r.-.... ..........�.� .•Y:rn•r......F^ �r i. •'�--.. �.'L.�s _.�._...—r�. `fe,.s Client Name Client Address r i i OA E TEST LOCATION } JOB NO. PROJtCT LOCATION �. CONTRACTOR, r -W, , _ _ _., OWNER..,.,____ rr Cir S WEATHER TEMP. o at t AM o at PM PRESENT AT SITE r TEST NUMBER / TEST LOCATION } LOT NO. ELEVATION FIELD TESTING REFERENCE CURVE MOISTURE CONTENT /� ° DRY DENSITY lbs./Cu. ft. MAXIMUM DRY-. DENSITY % MAXIMUM DRY DENSITY Ibslcu.ft. OPTIMUM MOISTURE CONTENT %. • -.v" ., .. +.s:.x _�'::_.-„. _._�_,.. J.'.Kt;:'Rht..t�": eX":'_�Y�t.',:-;"•:�^�'.:,,..?`.:a2^,�',.N:R"=`.-'"-.�._. v.:«+."",,�C'-": t.:',:�5,���.lfi"_' �'.;"::y%b.'}':s.'�_ ;t'Y-h;:aN;.-.•x. I- xl t ,'-r, a1� -t- M 6JL-/1.._ PrL_r REMARKS: 4;514MiA/ ,4'A/ A lrnaw 9,0� 11Z p2e •_'la 40 CLIENT REPRESENTATIVE SIGNATURE 52 TECHNICIANS SIGNATURE w