05379 (SFD)Building
Address 54-205 0A=O
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
mailing
Address p,0. BOX 2401.
City Zip Tel. .
PAW DESERT 92260346-4&14
Contractor
SME
Address . .
City lZip I Tel.:
State Lic. I City
& Classif. 352211 Lic. #
Arch.- Engr.,
Designer
Address Tel.
CityI 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 Business and,Professions Code, and my license is in full force and
effect.
SIGNATURE"" DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5, Business and Professions Gide: 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 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. If, however, the building
or improvement is sold within one year of completion, the owner-bulider will have the burden
of proving that he did not build or knprove 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 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 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I 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. 3800, Labor Code.)
Policy No. Company W
O Copy is filed with the city. O Certified copy is hereby furnished.
I
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) 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: ff. 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, Civril Code.)
Lender's Name
Lender's 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 certily 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
BUILDING: TYPE CONST:
Number ZZA_132_02e
Legal Description
Description M. -
No.
OCC: GRP.
05379
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition f❑
PERMIT
AMOUNT
Plan Chk. Dep.
250.00 -
Plan Chk. Bal.
Const.
591r. 510
Mech.
53.50
Electrical
131.98
Plumbing
157.50. "
S.M.I.
6.30
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1,984.554 J
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
Issued by: Dated /22/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLDMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. Ff. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SO. FT.
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
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S
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL 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, TEMIPERM
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/. c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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
ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
WER OR SEPTI T
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
y
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
/600FING � !
///
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S
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
CATHING —1,6
MESHth
SULATION/SOUND 7 -�
FINISH GRADING
FINAL INSPECTIO
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1
-
L
ENVIRONMENTAL HEALTH SERVICES
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
s
Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval.
\i
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' COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH , _ Asse °Or° Parcel No. 1
ENVIRONMENTAL HEALTH SERVICES
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 8 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'*
reL r, tact Pe n
Address s Phone
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Po
PAVA' L
Aate
`�6/
Jo Property Address '`Legal Dpbcriptio (PM, r Lot)
ll
La
�C E TO 141 (�`a.t .: Ql va I i4
Lot Sj�e '
ter Age ym ,
Use of Permit P/P, CU, etc. Lki Other
li Sit
wellin Prep,.etc. ,
Sig t re . Plloent
Dge
rCATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
❑ UBSURFACE DISPOSAL 1238 $45.00 „
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1 at 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)
O Site Evaluation In Conjunction with
❑ HOLDING TANK 7351 $45.00
Critical Area 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200
❑ Site Evaluation Lot Leas than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
.AL
NIT
Holding Tank Agreements Completed ❑ Yes No �I%-` L4 DATE
Certification of Existing S.D. System Required C1Yes No
WOCB Clearance required. (Attach Form ❑ Yes I I No
DOH SAN 007, Santa Ana Region Only)
Sills Percolation Report Required. , ❑ Yes No
Q
Special Feasibility Boring Report Required. ❑ Yes No
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes No
Other ❑ Yes No
Staff Specialist Lot Inspection Required ❑ Yes. No j
Lot Inspection Date.
(�
Soils boring report by' D S Project # Date
Solis Map Page Son Type Approved by Dffie
No. of Systems
Type of Systems)
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Send
`
Holding Tank El Existing
14
'New ❑Replacement
Bedrooms, Fixture Units
c I
Greeselntcp
'N�k
I � a�
y
� .
(2) Leach Line Sq. Ft
Sidewall alb
Install Lines) It. long wide with
Leach. R -
Bottom tref%h area
R ro.W sq. lt.
running It
min. inches rock below draw or
of bottom area
per
/
Leachlines/bed special design I slope:
(3) P it Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Othe�
Applicable
Inlet (BI)
r
/
N/A Overburden,factor
• ❑ 5 P§ 6
`
I
Max. Allowable Depth
No. 2 System
REMARKS:. 04111 kcllt `-t U C) /O C ad\ S
U 1A (�S'1AlL v f11��vC� lL�l,
This application is ArPrP -O- E ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated]
on the accompan, 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 1004 expansion area.
ov
(� 1P Septic tank and sewer lines must be 50' minimum from any wells
(2) Leach lines must be 100' ► minimum from any wells, including expansion area r
1 t
t w n l Cep
(3) Seepage pits must be 50' mignimum from any wells, i<ncludinlg-;�x'pansion area t]
I
��eS
Signature of Health Officialll Y -4—t P.C,
tit RECEIPT NO. I l Issued By rf Date
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
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[year Uevelopert
,
After reviewing
your y trlen �, a:�ll I�lellt tl>aterial lisIC�suUstitutlivlls
Colistlla Va.tley.
f violation of quarantine laws c�cweininy llle
defter ttun trlant n4aterial 11steJtills Office 1-imst be tivtiEied
do oc cur a,Ilc� the
Y
iunllediately .
- _ .
[or alld Tleserviny 'tile Coachella Valley's pest- ftee envirvui>ent•
you ou prvtectllly
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'September 18,'1989
Dear Sirs,,
I Rose Griebel am fully aware that my house at 54205 Ave.
Vallejo, La Quinta, CA.. I will give Joe Bowers with New
Generation Builders two weeks to install the'air.conditioner
therefore relieving the City of La Quinta of any responsibity.
Sincerly,
Rose Griebel
h