003579 (SFD)Building
Address
Owner
52-765 Diaz
Tucker s Sattley
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address
City Zip Tel.
1
Contractor
ress
lZip
State Lic. I City
& Classif. 248823 Lic. #
Arch., Engr.,-
Designer
Address I 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 3 of the Business and Professions Code, and my license is in full force and
effect.
,1 r �. z. a.!
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 of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
O 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 or 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 -builder will have the burden
of proving that he did not build or Improve 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. O 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 ($100) valuation
or less.) -
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers" Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
No. 003579
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 773-311-017
Legal Description
Project Description Gzingie Famijky Dwelling
Sq. Ft. 1420
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation��,$�
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
S
-40.79
Const.
364& „0i1
Mech.
36.00
Electrical
75.77
Plumbing
105.00
' S.M.I.
5.43
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1„690.76
TOTAL
sijt7 '�5
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 1/21/ Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
ifiSLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
?1/-ORMS >_
SEWER OR SE TAN
UGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
a$
WATER PIPING
NOTE: Not to be used as property tax valuation
/G FRAMING7 -F�FINAL
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
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, TEM/PERM
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 ® 1% c
SEWAGE DISPOSAL
INSULATION/SOUND z
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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
A.C. UNIT
COLL. AREA
ifiSLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
?1/-ORMS >_
SEWER OR SE TAN
UGH 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
FINAL INSP.
!
GRADING
cu. yd.
$ plus' x$
a$
LUMBER GR.
/G FRAMING7 -F�FINAL
INSP.
I��OOFING—
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE'
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND z
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
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COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION
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 specifications required on the attached check list
A non-refundable filing fee of $40 is required when the application is submitted. Check must be made payable to the County of Riverside.
Building Department Application Log #
Name (Owner. Agent. Contractor Etc)
Mailing Address
City
Slate
Zip Code
Telephone
'Job Properly Address
'City or. Community
-Legal Description of Properly (Lot, PM. TR)
'Assessors Parcel No
Water Agenc)"ror Well
Use of Permit f k' � t. • • �"Planning Case.#
Lot Size
Ty
SFD. MH Site Preparation Etc _
Signature of Applicant Dale
'The above information must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
Initial Date
Certification of Existing S.D. System required, ❑ Yes ❑ No
WQCB Clearance required. ❑ Yes ❑ No
Soils feasibility report required, ❑ Yes ❑ No
Special feasibility boring report required. ❑ Yes ❑ No
Detailed contour plot plans required. ❑ Yes ❑ No
Staff Specialist approval required. ❑ Yes ❑ No Lot Inspection Date _
Soils/boring report by Project # _ Date
Soils Map Page Soil Type L �- Approved by - '-:�I - Date —-
Type of System:
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
ElExisting ❑ New ElAdditional ❑ Replacement
3Yyt
: i.� r; Gals.
(2) Leach line sq. ft.
Sidewall allowance
Install Line(s) Ft. Long,
Leach bed Sq
(Bo tom trench area)
ft. rock/ Sq. Ft.
,_-Ftrkv 0e with min. inches
Ft of bottom
�.._
per running ft. '❑'N/A
rock below drain lines' ' -
area
Leach lines/bed-special design for slope:
(3) Pit Diameter
No Pits Pit BI
Seepage Pit total depth
Applicable
(�j'ya ❑ -6'
r ; ,-
Max allowable depth
p
N/A t- Overburden factor
This application is approve_dldeelresdtor the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
set forth in Section B move A building permit is necessary for the installation of the above -designed system.
Septic tank and sewer lines must be, 50' from any wells ; w r�i . �Kti - ', ' ✓ y
(2). Leach lines must be 100' min. from any wells including expansion area
(3) Seepage pits must be 150' min from any wells including expansion area '��; ' ram_: L •� ' ��
Signature of Health Official Date
RECEIPT NO _ . — -' Issued by_ Da —
District: ❑ Riverside ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE —Office file YELLOW —Applicant PINK —Bldg. Dept. GOLDENROD —Pending File
DOH SAN 122 (Rev 8/87)
of
N Q
o '� v
,
aJ �
qr9, 189
DATES—%--��
DEVELOPER'S NAME-
ADDRESS:
AME:
OFFICE OF
AGRICULTURAL CUAMISSIONER
AND
WEIGHTS & MEASURES
49-613 Hwy 86, Suite B-12
'Coachella, CA 92236
619-342-8291
E. LEON SPAUGY
CO%tu15510`ER
JAMES 0 WALLACE
ASS;S*,A'.t f:0.1N115S10%ER
CLEMENT BENVEN STE
SEALER
CASE NO. 1? F 7 a 5 01 0 7 A
ADDRESS: '7. y --O 5--�o _
TELEPHONE: (I
Dear Developer:
3 YO - 13 6
U -At f7/
.- U a -L
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 material listed, this office must be notified
inmediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
hl
Agricultural Cormiss'o er's Office
cc: Indio and Riverside Office
Received
Address:
Accountl
Service A
Meter
1 Servic
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check (s)
❑ Meter Surcharge
Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
i _ 98if
❑ Customer Deposit
❑ Other
Remarks
TOTAL
❑Copy to:
Servi
Cash
Check
_
,
•;'
Water
Cashier /
Money
Order•
fir.
H A'.
CVWD-438(11/89)