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07969 (SFD)Building _ Owner T4'tvl 4 4 Q" P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 mauing Address City Zip Tel. - I ' Contractor Address I City Zip Tela State Lic.' & Classif. City Lic. # Arch., Engr., Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70 OO) 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 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 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 or Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars ($500). ❑ 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 or completion, the owner -builder will have the burden of proving that he did not build or Impiode. 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 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.) ❑ 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 ❑ Copy is filed with the city. 0 Certified copy is hereby furnished. 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, d shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Dati-_ Owner NOTICE TO APPLICANT: If, after making this Certificate or 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 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 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 of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City State, Zip No. 07969 JILDING: TYPE CONST. OCC: GRP. P. Number 617-I6-flfl4 !gal Description Lot 36 oject Description SAlfrtrlA Family NA-11ing Sq. Ft. Size . New ❑ Iwo Stories No. Dw. Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ (Estimated Valuation $104, 927 PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS AMOUNT 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 51 119dPermit Validated by: Validation: 1P CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SQ. FT. ® CAR P. SQ. 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 jjaOUGH PLUM BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM GAS (FINAL) 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 FRAMING SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/. c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ic 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 �o L GROUND PLUMBING -)1Z-7AAd UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE jjaOUGH PLUM BONDING HEATING (ROUGH) STORAGE TANK FORMS Lq SEWER OR SEPTIC TANK t �� Q° ROUGH WIRING q l ! c DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGHq ol�(f�J METER LOOP L rrr((( HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL , GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. gQ FINAL INSP. GRADING cu. yd. $ plus x$ =$ LUMBER GR. FRAMING ROOFING / u -U F6o N,ss OV/s�l�° `D 3090L4 Rea r � t 1011'° REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL THING lQ Q CP MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION ] L L CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL I COUNTY OF RIVERSIDE ENVIRONMENTAL Aasmwni ftmW Nm I HEALTH SERVICES DIVISION - - PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Appl t;•,a1Su`b6Mi9 form Qh four copies of a scaled plot plan (1-20 scale) drawn to County speculations as indicated on the'attached check list. A non w undable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of 0�,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 & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # Agent, Contractor, ContactrPerso Phone A dress & Firm o� o - Owner - Phone Mailing Address City State Zip Job Property Address C µ QrA� 4i6 ta,)p r Legal Description Prop. (PM, Tract Lot) Lot Size Water Agency/Well Use of PermP/P, CU, etc. Other g�A / 0,9 O.C14e6L.,9 Dwelling H Site Prep, etc. ^- 9� Signature of Applicant Date CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE SUBSURFACE DISPOSAL 1238 $ 57.00 ❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ij ❑ 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 INITIAL DATE Holding Tank Agreements Completed ❑ Yes No Certification of Existing S.D. System Required ❑ Yes I I No WQCB Clearance required. (Attach Form ❑ Yes I I No DOH SAN 007, Santa Ana Region Only) Solis Percolation Report Required. ❑ Yes No Special Feaslblitty Boring Report Required. ❑ Yes No Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes No r� Other ❑ Yes No l • t Staff Specialist Lot Inspection Required ❑ Yes No Lot Inspection Date Soils boring report by Project # Date Soils Map Page , Soll Type Approved by ( !. Gt Deka No. of Systems Type of Systems) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Send ❑ Holding Tank ❑ Existing ❑ Replacement /�B%edrrooms, Fixture Units 7"Ar p/� 4V �) V ;50 / X,& Grease IntcpNew Gar Gel (2) Leach Line Sq. Ft Sidewall allowance Install Line(s) ft long ft wide with Leech,Bed E tL Bottom trench area R sq. R min.wKtm rock bebw drainlinee or+^^""" "" ""'"�� drajp of bottom area t m�nrfing Rte/ ❑ NA / f Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Ph Tot�l Depth Other. Applicable Inlet (BI) (TD) %"i Max. Allot wale N/A N/A _� Overburden factor ❑ 5 jY 6 j No. 2 System REMARKS: / This application iAPPROVED ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompan' n, 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 wells ?2) Leach liners must be 100' minimum from any wells, including expansion area (3 Seepage pits must be 150' minimum from any wells, including expo s=on area WrG�Si Lt( 6 nature of Health Official Date -// RECEIPT NO. --,29-761 Issued By �G� otr• Date �v DISTRICT: ❑ Riverside, ❑ Indio ❑ Hemet q Perris ❑ Ranclo Calif. ❑ Blythe y DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records =2[94!1 rot , - . OF Cita, uu EI, wnta Bult(Nn'g. t I Mtjall This Certificate issued purs'lidnif to the requirements of Section 306 of the Uniform Building! Code certifying that alt the time of issuance this strUctu- re was in compliance with . 4he various ordinances of the City reguldfin' building construction or use. For the following: BU I LDING ADDRg§S' 46-280 Jefferson Street Use Closslficotion SPI) Bldg. Permit No. 07969 Group R3 type 'dohs4vd6ti6 --VN Firs Zone Use Zone SR Owner of Building • Bruce-41'lva-nic Addreis . ' city - Lonnie Day 7. By D*f#; 12120/90 Building Official POST M A COW9*1606,us OLAte W P.O. BOX 1504 APPLICATION ONLY Building 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Mailing AddressV- City Zip Tel. �- Contractor h .p Address J _ �I r0 o I City Zip Tel. / State Lic- City & Classif. 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 Contraclor's License Law for the following reason- (Sec- 7037.5.Busaress and Professions Cade: Any City nv county which requires a permit ro construcf, after, improve, dernurah, Or repair any sfructure, prior to its issuance aiw requires the aopiicam for such paring to Me a signed stalement that he Is licensed pursuant to The provisions of the Contraclot's License Law, Chapfer 9 {commencing with Section 7000) of Ohdslon 3 of the Busditaw and Professions Cada or that. he Is exempt therefrom, and the basis for the a7eged examptkm. Any rfWatfon of Sectlon 7031,5 by 'any applicant for a permit subjects the appfrcanl fa a civil penally of nor more fhw Ova hundred dollars ($500). FI I, as owner of lho 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, 6uisness and Professions Code: The Contractars license Law does nut apply fo an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such Improvemanls are not intended or offered for safe. It, however, the buNding or improvement is sold mirMirr one year of corrVlbtion, the owner bulkier will have the burden of provlrig that he did nor txlftd or igiprove !or the purpose W sofa -) l 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the praleoL {Sec- 7044, Business and Prolossionr. Cade: The Contractor's License Law does nal apply to an owner al pruprdy who txdrt or Improves Ihereon, and who contracts for such projecis with a cordrAdot(aJ fiCBhsed pursuant to the Contractor's License Law.l ❑ I am exempt under Sec. B. & P.C. f 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 — El Copy is filed with the city. ❑ Certified copy is hereby furnished. c 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 the work for which this permit is issued, I shall not employ arty person in any manner so as to become subject to the Workers' Compensation E avis of California. DateOwner NOTICE TO APPLICANT: If, after mating vim CerhWeate of Ftorrpban you should become sub%ect to the Workers' Compensatdoo provisions of the Labor Cade, you must forthwith comply with such provsions or this permit shall lze deemed evoked - 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, Civr7 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. menitoned property for inspection purposes. Signature of applicant— — Date. Mailing Address_ City, State, Zip, BUILDING DIVISION BUILDING: TYPE CONST. OCC. GRP. A.P. Number i r7' Legal Description 0 / 36 Project Description 01A-/o4T,4 Sq. Ft. No. No. Dw. Size Stories Units New 1-1 Add ❑ Alter Repair Demolition Aimated ValuationV', - r LAMOUNT PERMIT Plan Chk. Dep. "-L j p 0 0 Plan Chk. Bal. e l , —2 Const. 2 7, C�<:) Mech. i 1 . e� Electrical j Plumbing e3 S.M.I. Grading . 00 Driveway Enc. Abp Infrastructure Z 1 ti 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: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE GROUND PLUMBING NO. ELECTRICAL FEES NO. P' NG FEES $, t UNITS BONDING IST FL SO. FT. r STORAGE TANK FORMS _ ROUGH WIRING DUCT WORK ROCK STORAGE YARD SPKLR SYSTEM 2ND FL. SQ. FT. METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) IMOBILEHOME SVC. BAR SINK FOR, SQ. FT. Ci ,ZO WATER HEATER SERVICE FINAL INSP. + POWER OUTLET I ROOF DRAINS GAR. SO. FT, r@ 1 =$ LUMBER GR. FINAL INSP FRAMING DRAINAGE PIPING CAR P. SQ. FT. © ROOFING !O DRINKING FOUNTAIN WALL SQ. FT. @ VENTILATION FIRE ZONE ROOFING URINAL SQ. FT. @ ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation LATHING FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINISH GRADING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSPECTION LAUNDRYTRAY AIR HANDLING UNIT CFM CERT. OCC. 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 SO. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR @ 3/4c (7 e) HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FFF 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 APP./EQUIP. 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 IkSPECTOR'S SIGNATUREV INfTIALS GARDEN WALL FINAL