05578 (SFD)P.O. BOX 1504
Building153 760 VALMEJO 7&105 CALLE ESTADO
AddresLA QUINTA, CALIFORNIA 92253
Owner
Coachella Valley Land w
Mailing
Address 247 X. Tahquitz Way 42
City Zip Tel.
Prim Sprint . 92262 619/322-1020
Address
Starr Construction
t. Ue
Tela
State Lia la #
& Classif, 3879341 Li895
Designer
Address
City( Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Busin�erss and Professions Code, and my license is in full forceandeffect. , i1�^. e c'IH �J..
SIGNATURE r - DATE
OWNER•BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and PhAessions 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 of the Contractors license taw, 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).
❑ 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 Contractors 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 idended or offered for sale. ll, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not build or irprove for the purpose of sale.)
❑ I, 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) ficensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. R_ & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATIOW' i
I hereby affirm that 1 have a certificate of consent to self•insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof f(Sec. 3$00aLabor Code.)
Policy No Company i .� , IL -W
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(Ibis section need not be completed if the pemd 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.
Date Owner
NOTICE TO APPLICANT: ff, after rnaavhg this C utiftate 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 shad be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
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 1130 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 ,of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 45578
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 774-163-002
Legal Description Lot 23 Blk 237 Utkit 22
Project Description SYD
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
3/31189
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft. 1409
Size
No. 2
Stories
No. Dw.
Units
New El Add ❑
Alter ❑
Repair ❑ Demolition ❑
430 sorsa
feet garage
170 feet 6 -foot Wood Pence
Estimated Valuation
00
$76060.00
PERMIT
AMOUNT
Plan Chk. Dep.
•
Plan Chk. Bal.
2,"
_ 212.
Const._
Mech.
Electrical
'u
�s
10.6-5,0
06.5 0Plumbing
Plumbing
S.M.I.
3.3*9
Grading
20.00
Driveway Enc.
20.00
Infrastructure
TOTAL
, t
REMARKS
�
j3(�++ w i tt'.�FT�I ie stir ai+tJ-i fiw'' y? xr „�,.a 7 % ..t..r• w e:
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
3/31189
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
`
e//4LAB GRADE r // D
ROUGH PLUMB.
BONDING
YARD SPKLR'SYSTEM
2ND FL SQ. 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. SQ. FT. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SQ. FT. ®
=$
LUMBER GR.
FINAL INSP.
URINAL
SD. FT. @
ROOFING
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(AUTOXDISH)
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINAL INSPECTIO j
SQ.FT.GAR @ V4c
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
i ETBACK 5-- /1 d
GROUND PLUMBIN4T�
UNDERGROUND
A.C. UNIT
COLL. AREA
`
e//4LAB GRADE r // D
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 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.
FRAMING
FINAL INSP.
ROOFING
G✓` f� -7
l
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LtLATHINGT-5`--s Cl
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIO j
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
/p
? i °- �� OFFICE OF. E. LEON SPAUGY
tp COMunS OMR
1 s AGRICULTURAL COMMISSIONER
T lo1 )AMES 0 WALLACE
O AND -[
U AWSIANI 1:9W6115510R
" 00 AWEIGHTS & MEASURES CLEMENT BE`VENISTE
SEALER
49-613 Ilwy 86, Suite D-12
ll
h
'Coacea, CA 92236
Mgr91 �8qa •
619-342-8291.
DATE ►M �4-1M�C� �� 6 CASE N0.
r
DEVELOPER'S NAME t S% a e Q Cm .y 3 r2tJc ri o
ADDRESS e .2 -Y 7 ?�fJQcc i YL t?�f' '�•
P-41ZOW S.o.a/,-)G 0,4 r'z z � z�
TELEPHONE t (G 9) 3 2 7-- i o L d'
a
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 frun plant material listed,. this office must be notified
imnediately.
Thank you -for protecting and preserving the Coachella Valley's pest -free environtmnt.
el ;
Agr c tural Cannissioner's Office
cc: Indio and Riverside Office - «.
• „S334S '„�/NZ -
i
F COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assomm Parcel No.
ENVIRONMENTAL HEALTH SERVICES 163 —
k
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.
VERIFY ITEMS IN SECTION A FROM BUILDING 8 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG-*
Agent, Contractor, Contact Person
PhoneAddress
8 Phone,
S Y /2 C7m n ,./ /10
3 2 2 -I D Z.D
,
Owner
Phone
Mailing Address
a y7 Zr rAAfQO rs-z 4004 ZJ
r City
State
Zip
Job Property Addr�ess�
Legal Description Prop. (PM, Tract, Lot)
V���
U,d.Y z''
Lot Size
Wafer Agenc iNWI'
Use of Permit P/P, CU, etc. <A t r'¢-= k"'? ..
Other
S� X /o d
cc3 7e
<� ,r c1 t� 90_1 11v_v
"�� �s 9ld ��
DwelliiSg 'fr1H Site Prep, etc. n
Signature of Applicantp f
,.*'� CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE
O SUBSURFACE DISPOSAL 1236$4109 _ t ❑ SITE EVALUATION UPON REQUEST I 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN)-t� ,
LAND DMSION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a.., 1 at 4 PwDds (Each) 1236 $45.00 (Less then 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 1` ❑ 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 $86.00
I` 'INITIAL t DATE
2. 7-19
�-�.� 9
Holding Tank Agreements Completed ❑Yes NO r ;*/ -? a
Certification of Existing S.D. System Required ❑ Yes A "No`. 1 r
WQCB Clearance required. (Attach Form ❑ Yes No
DOH SAN 007, Santa Ana Region Only) '
Sella Percolation Report Required. ❑ Yes
Special Feasibility Boring Report Required. ❑ Yes
.,� Detailed Contour. Plot. Plans Required (1,to 5 R interval) ❑ Yes
.� w-it
—•.-=....-.r+�- -..- _.,,__,re... w.i—.....-..._ —..r_ .. _.....,y
Other ❑ Yes
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection Date
Soils boring report by Project #) Date k '
Soils Map Page �y'7i (% Sop Type '�.. Approved by �L/�(_, D� d� 74 f
-
'
No. of Systems
T ,�f System(.)
No. Dwelling Units f /
(1) Septic Tank
Soil Rete
Grease/Sand `
❑ H$Iding Tank ❑ Existing
❑-New ❑ Replaoernent
Bedrooms, FJxture-dr><ts',f
r.'
„MG
3 6 017 6P1•
( '(2),Leech Line Sq. Ft
do_ftVftVnch area
Sidewall allowance
R ft.
Install Lines) R long ff wide with
Leach Bed sq. ft
rock/ sq.
per running ft. •
min. orches d lines orf
tx>>torrk area
Leachlines/bed special design for slope: '
(3) Pit Diameter
No. Pita.
Pit Below
Seepage Pit To Depth
Other. I'
App licabler"
11116
Inlet (BI)�,%��
i
,.
N/A Overburden factor'
s
Z
!
Max. Allowable Depth
yo
No. 2 System" 1 r.
REMARKS:
P7 -
T
I�
This application APP°' RO D HIED 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
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 wells4jb
(2), Leach lines must be 100' minimum from any wells, includirig.,expa sro area
r (�3••)] Seepage pits must be 150' minimum from any wells, including expansion area
rt %0 , , G r %�.@ +Lo /rye o
y✓Ci.-�C?n,¢.e�i
Signature of Health Official�W,HIG�c,,
l RECEIPT NO. t r" Issued By I� Date ` c.2 �> ,
i DISTRICT: ❑ Riverside, . ❑�dio ❑ Hemet q Perris " ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
l
4