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003770 (SFD)Building Address Owner Mailing Address City Pal .1 Contractor Address 53-905 Diaz Coachella Va Zip w 4 P.O. BOX 1504 No.. 003770 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 rings 92262 '�' " .322g2020 BUILDING: -TYPE.CONST-.-, OCC: GRP. A.P. Number Legal Description Project Description ` •� • WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of con`sent:to�self-insure, or a certificate of Worker's Compensation Insurance, or a certified copylheieofr jSec. 3800, Labor Code.) Policy No' - Company � •- V'"-' '•- ❑ Copy is filed with the city.. ❑ Certtiffiied opy is-hereb jfurnis iLcl. 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 lhg 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, alter 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 slate 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 TOTAL S2,609.53 09,.53 REMARKS -k!(* .,. riLjx tx .+jri7y >•VSl +. .. ..N,V vi f A ZONE: BY: Minimum Setback Distances: City .. Zip - Tel. Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property. Line FINAL DATE INSPECTOR Issued by: A Date Permit State Lic. City Validation: & Classif: 387934 Lic. # 995 Sq. Ft. 1410 No. No. Dw. Size - Stories Units Arch., Engr., .. Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. 1709 of 6 1* wood fence City Zip State 4281 Garaae 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 mylicense in full force'and .- eis effect. A -' � � /.» � ?�:� ' !' l< SIGNATURE'✓' (+=-"*' - "/`21)ATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following Any reason:4(Sec. 7031.5,Susiness and Professions Code: city or county which requires a. permit to construct, atter, Improve, demolish, or repair anyi�structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to - PERMIT - - AMOUNT the provisions of the Contractor's License Law, C_ hapten ' 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 Any -violation Section 7031.5 'any.appkcant for Plan..Chk: Dep. - alleged exemption. of -_by a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal., .$230.00 - . 39 , 34 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will _ do the work, and the structure is not intended or offered for, sale. (Sec. 7044, •Buisness and Const. 3s Professions Code: The Contractor's License Law does not apply to an owner of property who builds or. improves thereon and who does such work himself or through his own employees, Mech. •4> 3� provided that such improvements are not intended or offered for sale. If, -however, the building •� or improvement is sold within one year of -completion, the owner -builder will have the burden Electrical �, �'1 of proving that he did not build or improve for the purpose of sale.) „ ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing .y G n}� 105. 0 .� struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law �'- does not apply to an owner or property who builds or improves thereon, and who contracts for S. M.I. _ •, such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - Grading VIA() ❑ I am exempt under Sec. B. 8 P:C. for this reason Driveway Enc. 20.00 Date owner Infrastructure �,,�$ • i? WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of con`sent:to�self-insure, or a certificate of Worker's Compensation Insurance, or a certified copylheieofr jSec. 3800, Labor Code.) Policy No' - Company � •- V'"-' '•- ❑ Copy is filed with the city.. ❑ Certtiffiied opy is-hereb jfurnis iLcl. 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 lhg 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, alter 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 slate 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 TOTAL S2,609.53 09,.53 REMARKS -k!(* .,. riLjx tx .+jri7y >•VSl +. .. ..N,V vi f A 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: A Date Permit Validated.by: Validation: HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA SLAB GRADE L0 ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SQ. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) DRAINAGE PIPING CAR P. I SO. FT. ® GAS (FINAL) TEMP. POLE WALL SQ. FT. Q DRINKING FOUNTAIN SQ. FT. p WATER HEATER URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES GRADING cu. yd. -plus-x$-=$ WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER ROOFING S' GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM VENTILATION 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER INSULATION/SOUND GAS PIPING PERMIT FEE FINISH GRADING 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 PL BING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE L0 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS Of EWER OR SEPTIC TA77 ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. %1 / 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 7 ��/� FINAL INSP. ROOFING S' /jam /J p�(j � �'C ✓✓JJ /(j/ f REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL OC LATHING `d 6 MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS, GARDEN WALL FINAL 4 4 " , z rI P.O. BOX 1504 APPLICATION ONLY Building �.3 10 �� 78-105 CALLS CALIFORNIAESTAD9 Address /� Z LA QUINTA, ORNIA 92253 Owner I �; I %9llAcfi�'LG,a %l4LL E -V ZA.v a Ge mailing • �' I Address,2_e/7,d �%fifi�!//Tz WRy �Z City Zip JTel. uL I 3Z2-iOzo Contractor Cary Zip Tel.. ;ll/cS2G7— LG State Lic. City & Classif. 3 eS 7 3 Lic. # C?9,5 - Designer Address I Tel. CityI Zip I State I 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 f �k � �/// ��� 7 4 Z+�. SIGNATURE _ _ /�/ DATE OWNER -BUILDER DECLARATION 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, atter, 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 (8500). ❑ 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, Bulsness 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 or 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 properly 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 certify copy7the act. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Ce' fie copy =hereby furnished.� 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 the work for which this permit is issued, I shall not employ anyperson 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 ateMailing Address City, State, Zip BUILDING DIVISION BUILDING: TYPE CONST. OCC. GRP. A.P. Number 7 %�4 — //1/ — n2 / Legal Description Let ,QL.4 /!F2-yurr I Project Description _AVE/"C, Sq. Ft. Size / New`,[Q No. Stories No. Dw. Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ �7o of e e_- — stimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. .ILI Const. L4 ev-5 Mech. Electrical fi Plumbing L p p0 S.M.I. (e Grading 0•.00 Driveway Enc. "ZO . Oa Infrastructure ( (� /11ALI --L- 5.. o � r CSO .�3 TOTAL -77%;7 qC�i REMARKS nnSl u? in QAQA n7 -?Q -9R 47 n rAKH 4 1 nTA1 1 27S-00 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. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® DUCT WORK ROCK STORAGE GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEOUIP. DRAINAGE PIPING CAR P. I SQ. FT. TEMP. POLE WALL SQ. FT. ® GROUT DRINKING FOUNTAIN SQ. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM 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 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,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB GAR. FIREWALL SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 C SEWAGE DISPOSAL MESH SQ.FT.GAR ® 3/ac HOUSE SEWER INSULATION/SOUND GAS PIPING PERMIT FEE FINISH GRADING PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEECONST. 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 APPJEOUIP. 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 SIGNATURESIINITIALS GARDEN WALL FINAL ? {��� OFFICE OF E. LEON SPAUGY Q(0 1%"" % S;ER o AGRICUL'I URAL COMMISSIONER (0 o u.nLtlNcE d AND AS5;S;^T CI)MMISSIONER WEIGHTS FMEASURES CLEMENT BE`VENISTE SLALER 49-613 Ilwy 86, Suite 11-12 M��,,,_ �•'� 'Coachella, CA 92236 q r o, e9 619-342-8291 DATE 3 — CASE NO. 'r 03 2 9 C. DEVELIOPER' S NAME - ADDRESS: 2 Y 7 L� . '.e1� ,. ,., t! %z. _ 2_ TELEPI ZONE s 14/7) 3 2 2- —/O 2OZ G - • j' 3 -7o s Aro 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 frun p1wit nnaterial listed, this office nest be notified i.innedia tely . Thank you .for protectiuig and preserving the Coachella Valley's pest -free enviroFunent. Agricultural Caimis ier's Office cc: Indio and Riverside Office . - c 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 y,7� %�rH��,�z ►�, � z City1 P State /��y Zip Code ! Telephone Telephone 'Job Property Address 'City or. Community' Legal Description of Property (Lot. PM. TR) -1-3 70 014 Z. A .a 4 o r y ,&W 19" z *A 'Assessors Parcel No Water Agency or Well Lot Size / /1e_ y Use of Permit Planning Case M SFD MH Site Preparation Etc gnature of Applica Date ' The above information must be venlied from Building Application STAFF USE — 00 NOT WRITE BELOW THIS LINE Initial Date Certification of Existing S.D. System required. ❑ Yes f 7 No 1 I -r 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 "'J Approved by L Date Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required E) Existing D New C3 Additional ❑Replacement , / > > Gals. S (2) Leach line sq. ft. Sidewall allowance Install Line(s)—Ft. Long. Leach bed Sq. (Bottom trench area). " ft. rock/ Sq. Ft. Ft. wide 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 N/A Overburden e�etor ❑ 5' CSI 6' Max. allowable depth r P i i74 f i �//cam 1h�1'� r — f . r i— .-�n.y h •_ / f , This application is approve?/denied for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B above. A building permit is necessary for the installation of the above -designed system. t(1) Septic tank and sewer lines must be 50' from any wells Leach lines be 100' from including (2) must min. any wells expansion area �(3) Seepage pits must be 1150' min. from any wells including expansion area fr 1/�AI'1 / ./ 'i ' - y V Signature of Health Official F Date J Blythe DENROD—Pending File C;