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09051 (PLBG)P.O. BOX 1504 No, 03051 Building78-105 CALLE ESTADO . Address 78-063 AVS':. La monde LA QUINTA, CALIFORNIA 92253 Owner �qm Peart Knictht BUILDING: TYPE CONST. OCC: GRP." Mailing Address � � , A.P. Number 769-262-013 City _ Zip Tel. La Ouij 1.92253 Legal Description x;*e 12 Contractor `ti Project Description A1M1,s 9,1MT%4E--4^ C<r��M Address fn hA movrrvcaAdin . 2 w Zip - ITel. & Classif. 41,97'81 C 36 I Lic. # 11 Arch., Engr., ✓ Designer Address - Tel. City ZipState 1• • I hereby affirm t gt"Lehi licensegrunder provi'sion's of Chapter 9 (commencing with Section &0) of Division2�of�t . .Business and Professisns Code, and my license is in full force and f /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 Code: Any city or county which requires a permit to construct, alter, 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.provislons 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). p_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 orImprovement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve 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 c rtiIicata of Worker's Compensation Insurance, or a certified opy thereof. (Sed 3800, Labor ode.) Policy No. Company — p J :T 4 b5�� ❑ Copy is filed with the city. ❑ Certified copy is hereby�ed. CERTIFICATE OF EXEMPTION FROM r; WORKERS' COMPENSATION INSURANCE ,� (This section need not be completed if tri -permit is /or one hundred dp�r;y (e$100) valuation or less.) / I certify that in the performance o, h.9 worlrfor4hich tFiis'per�t j issued, I shall not =any person in "g anner o'as-to become subject4b the Workers' Compensation Laws of C�alif�orn}'� Date.N_ � lF' �Own�r 7 NOT t TOS -� 1'_1 CANT: Il, d�(te ing slhi Certlricate of emptin you should become subject to the Workers' C9mpensation provlsiohs� of the!'Labor C de, you must forthwith comply with such provlsion�s.or ibis permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby 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 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 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 't>St't1?T.tti'ity r9Y► Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Distances: Plan Chk. Bal. Front Setback from Center Line Const. 15.00 Mech. Side Street Setback from Center Line Electrical Side Setback from Property Line Plumbing S.M.I. INSPECTOR ' Grading Date Permit Driveway Enc. Infrastructure Validation: TOTAL 3O —.0 Q 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: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ � 2ND FLS SO. FT. POR. SO. FT. ® GAR. SQ. FT. ® CAR P. I S0. FT. WALL SO. FT. SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP.POLE 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. SQ. FT. @ c BATH TUB SQ. Fr. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ic HOUSE SEWER REMARKS: 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 EWER OR SEPTIC TANKI §OUGH 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL SITE PLAN CERTIFICATE OF PARCEL MERGER NO,- I AV�►IS7d, I LCAT t 3 I t �T l 4 NSW ►oct� al •,:,ti;:��.::� e I , rlew ro'xgd - �kl ST. ULLX� - I 'I •J.. CX iST. "1-•4�1K .�... I I St=t-Pp.CvG P lT Cdt-1F2�2T F;i. 2hd SmLtBY ST��.6� z Q Z W M Z _O U W U Z O U W U) 0 Z O. b - CO ,� .w,.y,_.y�,����,.. .yam..-d���.t1 a �'",��•�� . �'� - COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH A`eseO1Pa1oWNo' ENVIRONMENTAL SERVICES DIVISION rj� % — >✓ — 0/-.3 PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four co,31es of a scaled plot plan (1-20 scale) drawn to County speculations as Indicated on the attached check 118L 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 BUIL31NG & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG it t-takr, C11' :t Agent Contractor, Contact Person- / . ho Address & Fir 1� ,J owner 8f,> PEA .� CRY/ S�lrate (, r Zip ` ��r7 Job Pr Address 7 �J 'r.[✓ 16r1✓. Legal Description Prop. (PM, Tract, Lot) t t 1..0 ��� . ." ►if ll/f'tr Lot Sizeter Agenc , _ "� G�XJSI ilea of Permit P/P, CU, etc.O°Ga! >.�a Other 7Q•r..c*v�.r, 1 1 t .G:t=�9�� . �.��, Dw811iri�RAH.Site:f',rep,f�� G '►ter rrrr. < r-•cc.C. .� +.�s , .{� �, _ , < ep U •7 '.�Slgnatuie of Applicant Date _ CATEGORY: REV CODE FEE. CATEGORY: REV CODE FEE [J' SUBSURFACE DISPOSAL 1238 sWen& 8 G6 ❑ SITE EVALUATION UPON REOUEST 7349 $ 43.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DPASION ❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00 a. 1 at 4 Parcels (Each) 1238 $ 57.00 (Less than 1 year) b. Each Parcel after 4 7344 $ 24.00 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 ❑ Rereview (2nd review same parcel) 7344 $ 24.00 EVALUATION (Attach DOH SAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $ 47.00 Critical Area 7346 $111.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $ 87.00 IN,ITIA/L DATE Holding Tank Agreements Completed ❑ Yes l7' No� fCftf - /2- 2-Certs Certification ication of Existing S.D. System Required ❑ Yes L"No f WQCB Cleerarwe required. (Attach Form ❑ Yes O No DOH SAN 007, Santa Ana Region Only) Solis Percolation Report Required. ❑ Yes (a No Special Feasibility Boring Report Required- ❑ Yes / Detailed Contour Plot Plans Required (1 to 5 fL interval) ❑ Yes •/N�� Otter ❑ Yes E7 No i Staff Specialist Lot Inspection Required ❑ Yes 'G"40 Lot I!% selection Date Soils boring report by Date ��Prol��ect Soils Map Page Sol Type Approved by GP�{/!G Date No. of Systeme ype of Sy-tem(s) ❑ Holding Tank No. Dwel1kg•Units1 f 1 Bed.Flxture Units r ()Septic Tank Soil Rate Grease/S arsese tr>tcpecp `0 New 14Cfl4 IRO 6k.,042 1066Gal (2 Leech line Sq. Ft Sidewali allowance Instal Lines) R long wide with Coach Bed sq. rL llbrtrench arae t rpCW ft. per running R :.'ONA min.nchea below drakd'mea or -" of bol Leachlines/bed special design for slope: Appl'x:able� (3) PR Diameter / /, No. Pits PR Below Inlet (BI) Seepage PR Total Depth (TD) —q-? f , / N/A Overburden factor o s Max. Alkowabl� Depth No. 2 System REMARKS: - - �=-/ �% .I.h� ,� .t�/t� �,a i' /.1I7��/.t.� %iii?�t./i!�w_,/Li...>_ Lc ,-•Yy �� �yV U .-i(�(`!,VY �L� �..n.P E•li4I4o! .�✓y��LC.r �y'YI L. �.'vP��.%�.��.�i`F� Afyr .�%�� • ww"'<�A• �: G .�.� G2f?�-� �'/? �..��.-t.✓t.cc.C.�G1 ! i' 1` e �J•a,u (f �•r.�-s �C• � 1�d L��r r�=' •C' �1�r%. AT This app !cation is APP,. ROVEENIED for the category shed'in S CTION B above, jegarding 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. (1) Septic tank and sewer lines must to 50' minimum from any wells (2) Leach lines must be 100' minimum from any wells, including expansion /area Seepage. ((3)',1 pits must be 1!50' minimur horsany including�jexpansion or fwells, �y�L A` eC4.Si nature ofHealth Official 9 RECEIPT NO'. 7 T (asu9d By +! ��t - Date DISTRICT: • ❑ Riverside, ©!-In io 13 Hemet ❑ Perris O Rancho Calif. ❑. Blythe ` DOH -SAN -122 (Rev. 3190) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept OLDENROD - Plans/Reoords r*14 -78 -ate i� ¢iPimq%: G o / DES A//04 LA ! Ex i sin16 Cly �2oP cia 6 pp co. r) �d • Sai!J' I. �oA E27 U �i 020 �70' jjdAl eA- qz, ,;,7; - �DOQ 6A SEPT c TAa =- � • F ' �Xr5Tin16 ISEPri,c j ' (To ! aE ;� a no.✓Eol I I I I I I I I PAGE 1(To DEI f}eAadO IV ' I Pi T Z_ I. t. I tp w 11 C •n_ IRy ��'', 1 - �DOQ 6A SEPT c TAa =- � • F ' �Xr5Tin16 ISEPri,c j ' (To ! aE ;� a no.✓Eol I I I I I I I I PAGE 1(To DEI f}eAadO IV ' I Pi T