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04990 (SFD)0446� P.O. BOX 1504 "AN >wA-� 7&105 CALLE ESTADO AIS ADEQUI,T� "� Gj� l� 98, Building '' �`� '� Address 53 b5 VsIIe j O LA QUINTA, CALIFORNIA 92253 IS REQUIRED ON THE JOB -SITE DURING Owner ALL PHASES OF CONSTRUCTION" *� GA:�ImI• �! i Tfsil 1r Mailing BUILDING: TYPE CONST. OCC: GRP.- Address 247 R. Tabga#.ta Way #2 A.P. Number 774-122-016 City Zip Tel. Pmt a Sptiaga 92262 1 322-1020 Legal Description Contractor Project Description S.F.D. Stam Construction _ Address Same City Zip Tela State Lic. City & Classif. 3 y Lic. # $95 Sq. Ft. 1 No. No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition :1 Address Tel. !i Sa` ew rt x aft a f m r+s es sa rw rs w CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section effect f Division 3 of the Business and Professions Code, and mylicenseis in full force and SIGNATURE '" " ' - — DATE OWNEWBUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors 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 We a signed statement that hes 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 (5500). ❑ I, 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. It, however, the building or improvement is sold within one year of completion, the owner-buider will have the burden . of proving that he did not build or improve for the purpose of sale.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractors 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.) ❑ 1 am exempt under Sec. R, g, P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION rf 1 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.e3800, Labor Code.) Policy No Company I r� ❑ Copy is filed with the city. ❑ Certified copy is hereby umished. 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 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. 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 properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certity 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 Address City, State, Zip Validation: Estimated Valuation $76,105 PERMIT AMOUNT Plan Chk. Dep. t; tlt4 Plan Chk. Bal. 4 Const. A tt Mech. n Electrical 24 17 Plumbing inS-nn S.M.I. S QA Grading 00 Driveway Enc. nn Infrastructure 1 A 7Q TOTAL $2,618.4 cs ''�r�•c'.�% - REMARKS f}i f 18w' is ;..irate�� S.V til,fs .t %—WAt. .L ttt7YJ•'ta 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 12/13188 Issued by: Date - Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB 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. SO. FT. ® TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO. FT. ® FINAL INSP. BOND BEAM WATER SYSTEM DRINKING FOUNTAIN WALL SO. FT. ® =$ LUMBER GR. FINAL INSP. URINAL SO. F'f. ROOFING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES I I WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FIREPLACE 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 BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ic HOUSE SEWER CERT. OCC. 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 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. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH ULATION/SOUND G ` FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL i I .. y`t`�,'�'.��`.�`f �",_�tTta `e _,�✓a..a,�a�+��:�•�,�..an�'��w+sr .a;,,v;�r -+.a-- s_7F: �'.:li�.�2.�0�f.'.*�.'9' :tiiNf�T:+ns+�P-" RECEIPT NO. : < 17 ! i Issued By �`" "" Date 4 tt_ �� � DISTRICT: ❑ Riverside, ET Indio ❑ Hemet. ❑ Perra ❑ Rancho Calif. ❑ Blythe 6 Jr DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records :a COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. ENVIRONMENTAL HEALTH SERVICES / 2- Z PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four copies of a scaled plot plan (--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 va.id 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 O Agent, Contractor, Contact Person Phone Address & Phone U S TA a -W— 60 VS 7 -Ag V0 -7-/.0J 22 2 - /o 24 Owner CoAe/f,EL c. ✓ A L Lc A,t tD. Phone Mailing Address 1� E ri4 NGV v i rz LOA Z City State 'RqLm,Sf�/ 5 r1 Zip X22GZ Job Property Address,41,FW/,jA �-r4-S ✓bL.L.A Jo Legal Description Prop. (PM, Tract, Lot) go 4f 101-Ae2.3l Gdviv- 1- Z Lot Size ` ate . `fin Use of Permit P,P, CU, etc. L 4, Nix �/ Other. % .610 f!c /040 /S>',e!✓67" el ing,-MH 51 Prep, et— . Fy 61 rG 1.6.1 "//0'�/�� Sighature of Applicant Date -- ' CATEGORY: REV CODE FEE ©SUBSURFACE DISPOSAL 1238j 5.00 CATEGORY: REV CODE FEE ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 to ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) •O�, LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION J7348 $11.00 Q a. 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year)' U. b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE r 7352 $45.00 W ❑ Rereview (2nd review same parcel) 7344 $16.00 °, EVALUATION (Attach DOH SAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLrDING T 7351 $45.00 Critical Area 7346 $86.00 I ❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00. ❑ Site Evaluation Lot Less than SYSTEM ° 10,000 Sq. Ft. N, 7347 $86.00 t INITIAL DATE Holding Tank Agreements Completed ❑ Yes Nom 0, r 1 /-2- 7 - Certification of Existing S.D. System Required ❑ Yes mo. , WQCB Clearance required. (Attach Form ❑ Yes ❑4 DOH SAN 007, Santa Ana Region Only) Solis Percolation Report Required. ❑ Yes Special Feasibility Boring Report Required. ❑ Yes e14,e Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes L N� ❑Yes Q/No/ _ 1 ` a� Staff Specialist Lot Inspection Required ,,., .. - -- ❑ Yes -"�.Q No t -� -^ Lot Inspection Date Solis boring report by. Project # Date [ r� 7 Soils Map Page % Soil Type Approved by �• Dade r- ' r 4 U Z No. of system 1y°pe of Systems) V ❑ Holding Tank ❑ Existing No. Dwelling Units f r Eedrooms (1) Septi: Tank Soil Rate Q,resae/Serrd Grease Intcp Q Qe ew ❑ Replacement ,F�izture�linits � W (2) Leach Una Sq. Ft '�Bottom trench Sidewall allowance Install Une(s) R long fir wide wr�n� Leach Bed'sq. ft area ft nock/ sq. ft per running ft min. inches rodi drainlines or of -bottom area o ❑SNA �- Leachlines/bed special design for slope: Applicable (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage it Total Depth Oche Max. All o l' Depth �f - N/A—�Overburden factor ,No. " ID/6° ! 2 System /V %A t REMARKS:Z.l.L i .Lf } This application is PPROVED .: t=NIED�for the category checked in SECTION B above, regarding the design of a subsurface disposal 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 \z t above -designed system. No construction is permitted in the required reserved 100% expansion area. 1 —, I/},t LC, Septic tank and sewer lines must be 50' minimum from any wells% Leach lines must be 10 (2) 0' minimum from any wells, includiig expansion area/ iy"" WJ _ (3� Seepage pits.must be 150' minimum fromaan"y' wells,iincluoiingj (,I xpansion area GLQ... J%"9 Signature of Health Official riift'c -{g RECEIPT NO. : < 17 ! i Issued By �`" "" Date 4 tt_ �� � DISTRICT: ❑ Riverside, ET Indio ❑ Hemet. ❑ Perra ❑ Rancho Calif. ❑ Blythe 6 Jr DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records :a L,1 (Buena Engineers, Inc. 79-811 Country Club Drive, Suite 4 Bermuda Dunes, CA 92201 • (619) 345-1588 / 328-9131; Client Client Address Client Phone DAT TEST LOCATION JOB NO. PAOJEET FIELD TESTING LOCATION MOISTURE ''CONTENT % CONTRACTOR MAXIMUM DRY DENSITY % OWNER s r S�7RC by A WEATHER TEMP. oat AM at PM PRESENT AT SITE 7.3 TEST NUMBER TEST LOCATION LOT MO. ELEVATION FIELD TESTING REFERENCE CURVE MOISTURE ''CONTENT % DRY DENSITY Ibs1Cu. ft. MAXIMUM DRY DENSITY % MAXIMUM DRY DENSITY IbsJcu.ft. OPTIMUM MOISTLRE CONTE,4T % 7.3 t l8. v • � f:kl�Tfn,(n f REMARKS: o% ` SUS$!/dt�Ao" 41"06 CLIENT REPRESENTATIVE SIGNATURE FIEELD REPORT TECHNICIANS SIGNATURE