10529 (SFD)Building
Address 51-'300 Diaz
Owner
lihf44Q9114rw
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address P. 0. 1307. 366
City Zip Tel. ,
La Quinta 92253 __5£4-4832'
Contractor
City Zip
State Lic. City
& Classif. 487584 Lic. # 626
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
7000) of Division 3rof the Business and Professions Code, and my license is in full force and
effect. � -i
No. 10529
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 773--344-007,008
Legal Description Block 48 Lots 18 & 19
Project Description SFJD
(MERGED TAT911
Sq. Ft No.
No. No. Dw. ,
Size Stories Units
New Cif Add ❑ Alter ❑ Repair ❑ Demolition ❑
Permit includes 150 if of block wall:
Pool permit to be obtained seoa.ratelys
oaid 11/.2/89 ever 'THd^f1 ;:e &,m I -r :tj fir) .4.21
OWNER -81 ILDER 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
Estimated Valuation
PERMIT
_ the provisions or 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
i 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).
I O I, as owner of the property, or my employees with wages as their sole compensation, will
Plan. Chk. Dep.
Plan Chk. Bal.
Const.
j 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
Mech.',
! builds or Improves thereon and who does such work himself or through his own employees,•
p provided that such improvements are not intended or offered for sale. If, however, the building
Electrical
or improvement is sold within one year or completion, the owner -builder will have the burden
- of proving that he did not build or Improve for the purpose of sale.)
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Businesd 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
S.M.I.
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
r
Grading
Driveway Enc.
Date -Owner --- �Infrastructure
V i
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificatl of consent to stif-insure, or a certificate of
Worker's Compensation Insurance, or a certi V edcopy thereof. (Sec. 3800, Labor Code.) -
Policy No. Company
I Copy is filed with the city. ❑ Certifi d copy is' ereb urnf� its d.
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 parson 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.)
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
'e e
TOTAL —0—
REMARKS Q_.REMARKS
AMOUNT
15.70
1611 7.34
140 i
—0—
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. -Line `'Ye
Side Street Setback from Center Line
Side Setback from Property Line
Il 1. , . r
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
. r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. $
UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POR. SD. FT. ®
SEPTIC TAN K3�
ROUGH WIRING.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF. �j
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO. FT.
HEATING (FINAL)
OTHER APPJEOUIP.
WALL SO. FT.
GAS (FINAL)
DRINKING FOUNTAIN.
SO FT ®
URINAL
ESTIMATED. CONSTRUCTION VALUATION $
SERVICE
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING g ..�
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
�/�1_ ��((Oli
LAUNDRY TRAY
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
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 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 GOND. SOLAR
SETBACK
GROUND PLUMBING 1
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEPTIC TAN K3�
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. �j
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
r
GROUT
WATER HEATER
SERVICE
FINAL INSP. i
BOND BEAM
WATER SYSTEM
FINAL INSP.
$
GRADING
cu. yd.
-Plus-x$-=$
LUMBER GR.
FRAMING g ..�
FINAL INSP.
ROOFING 6 (
�/�1_ ��((Oli
101
/Of
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA HING L
MESH
INSULATION/SOUND 3
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
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COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
773- io`1— 03 Z` f
ENVIRONMENTAL SERVICES DIVISION 1
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.
,,,(1Sroyglgf tA. a�glic t' shall remain valid for a period not to exceed one year from date of approval.
?A&G # UVUJJ(c B__A -A_N UVERIFY ITEMS IN SECTION A FROM A NON -FEE BUILDING & SAFETY (goldenrod) APPLICATION
Agen njW
�Lp "6Z, State Zip
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Owner
Phone
5 t -v%, JL
Address City State Zip
15
Job Property Address • City
d 'IwaoQ Q� ►N-`rq
State
cat
Zip
Q'1253
Legal Description Prop. (PM, Tract, Lot)
U -1-S iib
tgtlq 5e"4& wolf TA
Lot Size
-tgrA9 IVWa'II
Use of Permit P/P, CU, etc. IT,Other
jK, , n
Vo
O
V ►� rj
(10 /001
ellin MH Si a Prep, etc.
ti a �A.
Signature of Applicant
Date
CATEGORY REV CODE FEE
CATEGORY REV CODE FEE
IJ' SUBSURFACE DISPOSAL (per system) 1238 $153.00
❑ SITE EVALUATION UPON REQUEST 7349 $120.00
❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION
(NO PLOT PLAN)
❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00
a. 1st 4 Parcels (Each) 1238 $153.00
❑ PRELIMINARY ELECTIVE EVALUATION
b. Each Parcel after 4 7344 $ 55.00
(Attach DOH -SAN -53) 7352 $ 69.00
❑ REREVIEW (2nd review same parcel) 7344 $55.00
❑ HOLDING TANK 7351 $119.00
❑ SITE EVALUATION in Conjuction with Critical Area 7346 $1197.00
❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00
/
10,000 Sq. Ft. 7347 ($172.00
❑ GRADING PLAN REVIEW DETAILED 1238 $104.00
❑ SITE EVALUATION Lot Less than
1
❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00
❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00
❑COPIES (LAND USE) 7786-81 $ 50
'1 c INITIAL DATE
Holding Tank Agreements Completed �1 Yes No
•.
o
Certification of Existing S.D. System Required ❑ Yes :�No
WQCB Clearance Required ❑ Yes
(Attach Form DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required ❑ Yes PN9/� oSpecial
Feasibility Boring Report Required ❑ Yes
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes
Grading Handout Provided ❑ Yes N
Staff Specialist Lot Inspection Required ❑ Yes /No'
Maintenance Booklet Provided ❑ Yes ❑ No Lot Inspection Date _ Initials"
C/42 / Soils Percolation Boring Report by Lic/Project # Date
Soils Map Pagel Soil Type Approved By Date
No. of Systems
Type of System(s)
No. Dwelling Units )
(1) Septic Tank
Soil Rate'
Grease/Sand
i;re tc tTrap
1
❑ bAing Tank ❑ Replacement
LWNew ❑ Addition
Bedrooms, Fixture*t1n1
einem /U
A*+_\
3 B 17A ,$A7N 4CIZ(
T
d
Gal.
❑ Existing
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a� rG�
Ft I
q. Ft.
Bom Area
Total Linear
F�Install
Sidewall Allowance
h. rock,_sq. h. per running ft.
Inlet Tested Depth NA
I
��► Line(s) K. long —ft. wide with
min.inchesk below or1°':
Leach Bed sq. ft.
df•B,.ottom Area
Proposed Bottom Tested Depth
�.
Leachlines/bed special design for slope: y
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Applicable
,/
f '
Inlet (BI)
(TD)
Max. Allowable Depth
N/A Overburden Factor
. 6
D1
10
/S
��
(30%
Do>,
Well Review Approved: Signature Date Well Drilling Permit If
Grading Plan Approved: Signature Date
l�
� m-19
REMARKS:Al of !�►� i � c.. , l2 r7>- u, � /,� �.a. �►- G� Ems._
i ,1! /jC ICS . fi'fJ t�Gf� rJ►. �cz , .. o -
la J to a �ct�L
d4GuL:F'r v� Q
This application i PPROVED/ l3NTED for the categ6ry checked in SECTION B above, regarding the design of a subsurfa a disposal system as indicated
on the accom a 'ed_ pl�q�t p,�p, using t e equetseJ,LoSECTIO N C�abov�e� A building permit is necessary for the installation of the above designed
system. u
1� Septic tank must be 100' minimum from any welley / 0
(2 Leach lines must be 100' minimum from any wells, inclding xpansion area
Seepage pits must be 150' minimum from any wells, including expansion areeaaC/
Signature Health Official �.
of Date O /
❑ CASH P CHECK NO. 16114
RECEIPT NO. Issued By 44— DateOR
DISTRICT ❑ Riverside C Indid ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev 6/91) DISTRIBUTION: WHITE cattle YELLOW—Applicant PINKfe!dlg apt. GOLDEN OD—Plans/Records
JAMES O. WALIACE
Aprlculheol Commisslonnr
Proctor of Welphl/ ✓R?,ledsures
DA'L'E
OFFICE OF
AGRICULTURAL COMMISSIONER
AND
WEIGHTS & MEASURES
4080 LEMON STREET, ROOM 19
RIVERSIDE, CALIFORNIA 92501
(714) 787-2561
49613 Highway 86, Suite B12
Coachella, Ca. 92236
(619) 342-6291
CALVIN C. KAMINSKAS
Asslsfonl Commissloner
CLEMENT BENVENISIE
Sealer
CASE NO. PG I,'_ L S 1 CA, Z
DMWPER' S NANE II
ADDRESS II U 3 60
TELEPI ICM t (to(q)
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 from plant- rieterial listed, this office crust be notified'
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free enviroment.
;!
Agricultural ComnissioneiVs Office
�j
►i cci Indio and Riverside Office
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