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11017 (SFD)' • P.O;No: 11017 'BOX' 1504: ' •: ' Building 78-105 CALLE ESTADO ' Address 5.--420 Vallejo_ LA QUINTA; CALIFORNIA 92253 _ Owner Expectation '.Construatio'n. BUILDING: TYPE CONST: OCC: GRP. Mailing Address P. O. -Box 1$ 4 7 A.P. Number City • .. Zip - Tel. Z� Qui�ata 9253 �6�--0793 Legal Description : T+�t `:2� Bis�o�: 55 knit b Contractor Project Description SFr? .�3it"'iie Address City: Zip Tel.: ' State Lic. City r &Classif. 613j �� Lic.# 158 Sq. Ft. 1218 Size - No. No.Dw. Stories Units ' Arch.; Eng., ,<.._ ,. New ❑ Add ❑ ... Alter ❑ _ 'Repair'❑ -Demolition ❑ - < Designer Address '• Tel. k" Permit does not include patio; pool :: or any block walls, City Zip State ' Lic- # " LICENSED -_CONTRACTOR'S DECLARATION 1 herebyyaffirm that I am licensed underprovisions of•Chapter,9,(commencing with Section 7000)ofDiJJis�ion•3.of the Businesysarid Pro/fes/sio/ns�•Codeffect'e,/and my license is in full force and ; . SGNATURI$'' I if D�'- ' OWNER -BUILDER DECLARA6I0N 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 permit to file a signed statement that he is licensed pursuant to .' • the provisions o/ the Contractor's. License Law, Chapter 9. (commencing with Section 7000) of ' Division '3 o/ the Business and .Professions Cade, 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 ciw7 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 ^:L 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 -whoe, - builds or improves thereon and who does. such work himself or through .his own employees; ,provided .ihelsuchimprovements arenotintended or -offered for sale. If, however; the building or improvement is sold within one year o/ -completion, the owner -builder will have the burden- of proving that he did not build or improve for the.purpose of sale.) Estimated Valuation' i "�(� e ©Q t PERMIT - - .AMOUNT ' Plan Chk. Dep. •' t - ' y} '00 Plan .Chk. Bal. .: {. 201.69 � Const. - t - "527. � - • ti, . 00 •� �- =- - - - - Mech:.'_-' `- t �'._ 55. J0 Electrical - _,.� 2 3 t I •-. Plumbing .. I �� -. O I, 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 property -who builds or -improves thereon, and who contracts for • such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ...- • O I am exempt under Sec: B. & P.C: for this reason S. M.I.. - 7.50 = Grading Driveway Enc.. - �� . ��` _� _ �. •:. Date Owner Infrastructure 'r 1 � � � e 9n1 � ._ WORKERS' COMPENSATION DECLARATION I her`eby`affirrn that I have A certificate bf'consent to self -insure, or a certificate of -Worker's Compensation Insurance; -or.a.certified copy thereof..(Sec.,3800, Labor Code.)' _. Pol'cy No. .Company - . . Copy is filed with the city- . O Certified copy is hereby fumished.... _-,:) •�s .� 7 J �7 R "Aaii"'*-i &- s `� �' f i � �y"���-' CQ- A TOTAL n.�t. a.tri i rulrr, x1t 1��a,s �' �..- CERTIFICATE OF EXEMPTION FROM l WORKERS' COMPENSATION INSURANCE t •, 'REMARKS .. _ (This section need not be completed./1 the permit 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 person in any manner so -as to become subject to;the Workers' -Compensation' Laws of California w .. Date Owner NOTICE TO APPLICANT: •H, alter ma"d this Certificate of 'Exemption you should become subject' to the Workers' Compensation' provisions or 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.CenterLine Rear Setback from Rear Pr`.op. Line' • }' • ' 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.) - Lender's Name Side Street Setback from Center Line - �! Side Setback:from Property Line. t Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days.. 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 iof this,city city to enter. the above-. mentioned property for inspection purposes. FINAL DATE Issued by- Validated by: INSPECTOR Date Permit Signature of applicant Date Mailing Address Validation: • City, State, Zip i CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL. SO. FT. YARD SPKLR SYSTEM POR. SD. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CARP. SO. FT. ROUGH WIRING. DRAINAGE PIPING WALL SO. FT. ROCK STORAGE DRINKING FOUNTAIN. SO FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation REINF. STEEL FLOOR DRAIN MECHANICAL FEES TEMP. POLE WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER WATER HEATER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. 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 BATH TUB (6 / (D/ L SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FIRE ZONE ROOFING 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 GROUND PLUMBING %JJ1NDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMSMy ­S614I68AB,BEPTIC TAN !!!!!!//////���1 ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF.UY 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. (.}� 6s FRAMING FINAL INSP. ROOFING % r L / 10H ,/`y ca// ((( e O( (6 / (D/ L REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL THING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION l� CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITU\LS GARDEN WALL FINAL sr-•�"-Tgr`�E�-"'y`'i�'•rt,i��,�•rf"�.,�ij�'1r�i�+^�' ?LAI�,�y �� 1"'Y'`�'�'j�`�"�ty��r,�r�''L '� '1:;..e;.} �J ,�y.r,y�. x+s,�,�`;y�.�E�'�- }�3 � L COUNTY OF RIVERSIDE HEALTH SERVICES•AGENCY Assessors Parcel No. DEPARTMENT OF ENVIRONMENTAL HEALTH 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. ppSbval;oF�ttiia application shall remain valid for a period not to exceed one year from date of approval. A f VERIFY ITEMSIIN SECTION A FROM ANON -FEE BUILDING & SAFETY (goldenrod) APPLICATION , t t,LOG # c . V Agent, Contra •r-, ntact arson Phone Address City State Zip s6y-o7 0. /9 W 44 L-,,; 3 wne ; Phone Address City State Zip S . Job Property Address _ city'State I Zip - Legal Description Prop. (PM, Tract, Lot) c3C� Lot Size._`�:�< '" atei AgeAcy AgencyUse of Permit PIP.CU,;etc. Other y;. / ,AT A Aft. / ,•� � wellin H Site Prep, etc. �? ldl� Grt/A Si nature.of A pli' 1.:Date'• CATEGORY ', REV CODE FEE CATEGORY REV CODE : FEE SUBSURFACE DISPOSAL (per system) 1238. $153.00 SITE EVALUATION UPON REQUEST 7349 $120.00 (NO PLOT PLAN) ❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION : ❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00 a. 1st 4 Parcels, (Each) 1238 $153.00 ❑ PRELIMINARY ELECTIVE EVALUATION 7 b. Each Parcel after 4 7344 $ 55A0. (Attach DOH -SAN -53) 7352 $ 69.00 ❑ REREVIEW (2nd review same parcel) 7344 $ 5.5.00 ❑ HOLDING TANK 7351 '$119.00 ❑ SITE EVALUATION in Conjuction'with Critical Area 7346 $197.00 ❑. ALTERNATIVE EXPERIMENTAL SYSTEM' 7345 $656.00 ❑ GRADING PLAN REVIEW DETAILED 1238 $104.00 ❑ SITE EVALUATION Lot Less. than 10,000 Sq. Ft. 7347 $172.00 _ C] GRADING PLAN REVIEW CURSORY 1238 .$ 55.00 ❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00 [I COPIES (LAND USE) 7786-81 $ .50 ITIAL DATE O Yes.' Holding Tank Agreements Completed Certification of Existing S.D. System Required ❑ Yes' : N WQCB Clearance Required ❑ . Yes No (Attach Form DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required O Yes Special Feasibility Boring Report Required ❑ Yes N Detailed Contour'Plot Plans Required(1 IDS ft. interval) ❑ Yes Grading. Handout Provided ❑ Yes Staff Specialist Lot Inspection. Required ❑Yes iP Np Maintenance Booklet Provided ❑ Yes 1G1Vo Lot Insoection Date Initial C/42 / Soils Percolation Boring Report by Lir Projjject # Date �J /J Soils Map l` Page r Soil Type I�If Approved By/�" Date . No. of Systems Type of System(s) No. Dwelling Units f (1) Septic Tank Soil Rate Grease/Sand El Bing Tank❑Replacement Bedrooms, .redjaiGs�. Greas�e9mhtt-/Uncp_ tTrap ,�• ew CI Addition /gOiLm. r1.rb Gal. , 3yp9 Gal. . ❑ Existing 144f ,0 Ft. Bo m Area otal L-ihear Sidewall Allowance ft. rock/ sq. ft. per running ft. In- Line(s) ft. long ft. wide with Leach Bed sq. ft. of �tt ArQt� ea - ••" ` - Inlet Tested Depth NA min. in%c oc below.drainlines or , Proposed Bottom Tested Depth - Leachlines/bed special design for -slope: _ (3) Pit -Diameter No. -Pits. Pit•Below Seepage Pit Total Depth Other: Inlet (BI) ' (TD) Max. Allowable gepth Applicable ,.�/► N/A Overburden Factor r^ VolT Well Review Approved: Signature Date Well Drilling Permit # Grading Plan Approved: Signature Date REMARKS: gZa This application i PPROVED/ for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the qgcompanied plo . p an, using the re uirements s2t forth in SECTION C above A building permit is necessary for the installation of the above -designed . syste rasp° 1 s (1) Septic tank,must be 100' minimum from any wells Q/ I4 . Leach lines m6st be 100' minimum from any wells, includ" g ex sion area (3 Seepage pits must be -150' minimum from any wells, incl ding pension areaQ/ /Q' f IV "4t/�'GhGt-cv, C.(/" «!� Signature of Health Official Date ' ❑ CASH C'CHECKNO. ORS RECEIPT°NO. Issued By Date DISTRICT' ❑ Riverside L`o ❑ Hemet ❑ Perris ❑" Rancho Calif. ❑ Blythe DOH -SAN -122 (Rev 1/92) DISTRIBUTION: WHITE, Office file YELLOW—Applicant PINK—Bldg. Dept. - GOLDENROD—Plans/Records rA .' .. .. : L RILE CALVIN C. KAMINSKAS + 3 DAN V Assistant Commissloner Sealer. Weights !k Meoswes (714) 2753000 „ .. (714) 275.3030 . OFFICE OF i AGRICULTURAL- COMMISSIONER JAMES O. WALLACE, Co- missloner' 83-612 Avenue 45 Suite 7 Indio, CA 92201 (.619) 34.278291 HATE o2 . �E No. �G DEVELOPER'S NAME.: A,CzAL-'_t? a ADDRESS ' � TELEPHONE : ` ) c 1 , O • , f of 9 ao4 ` r Cof i 7 0 Lo 10 014jSY 6W u u s:<a L,,4_71 BPs 9u cots�/i Mho Dear De 1_ edsA� y 12 t'071? 131o�.r's8► ;�rx�,�r eTi3 Z tr66' 0So e 8/�tc 6 V/kAs:�o cora 3 ►3c�� 3 artA o c/ h. _ 6S D I -*T'S '3 After LoT.3 6N Q/oc+lf`a14LvAl2AD0 4 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.froln plant.tmaterial listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella.Valley's pest -free environment. Agricultural Coffmissioleis Office !. cc: Indio -and Riverside 4080 LEMON- STREET, ROOM 19, RIVERSIDE, CALIFORNIA 92501 - FAX (714) 275-3012 ' `