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06404 (SFD)•a 4 4Q Am P.O. BOX 1504 Building- 7&105 CALLE ESTADO Addres54-060 Villa LA QUINTA, CALIFORNIA 92253 Owner Mailing Address 247 E. Tahquitz Way 32 City Zip Tel. Palm Spring's 52262 322-:1Q20, . Tel.: State Lic. City & Classif. 387934 Lic. # 895, Arch., Engr., Designer Address' Tel. City IZip 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 Contractor's License Law for the following reason: (Sec. 7031.5,13Iu$hess and Professions Code: Any city or counly which requires a permit to construct, after, erpmve, demolish, or repair any structure, prior to its issuance also requires the appricant for such permit to Me a signed statement that he is licensed pursuant to the provisions of the Contractors 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 civa penalty of rat 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, Suisness and Professions Code. The Contractors 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 erproverments are not intended or offered for sale.. H, however, the building Of improvement is sold within one year of completion, the owner -budder will have the burden of proving that he did not build or irpove 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 contracter(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec_ R. & 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 Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, labor Code.) Policy No. Company I ❑ Copy is filed with the city. ❑ Certified copy is hereby fumished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be canp/eted H the. permit is for one hundred dollars ($100) valuation or less.) I certify that in the perfomhance 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 Cal ifomia. Date owner NOTICE TO APPLICANT: Il, after making this Cedfficate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provsions or On pemut 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 Lenders Address This is a building permit when property filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that 1 have read this application and state that the above information is correct. Iagree 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. 45404 BUILDING: TYPE CONST. . OCC: GRP. A.P. Number 774--224-003 ,Legal Description Project Description Sq. Ft. 1410 No. No.,Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ 170' 6 T mood fenee Estimated Valuation $76,36fl PERMIT AMOUNT Plan Chk. Dep. $x50.00 Plan Chk. Bal. •59 Const. 3 Mech. 3.50 Electrical 106.41 Plumbing 3x..50 S.M.I. 5.39 Grading 20.130 Driveway Enc. 20.00 Infrastructure s, 9• .. TOTAL $3*041.Z4 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 1,I)S2Pf�,TOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE �� ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL SQ. FT. FORMS OR SEPTIC TAN ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE Q �0 DRAINAGE PIPING CAR P. I SQ. FT. GROUT WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN. SQ FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation , ROOFING& n' ./. 'rI� 44A 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 LAUNDRYTRAY 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL FINISH GRADING 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 SETBACKOUND PLUMBIN�1.UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE �� ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS OR SEPTIC TAN ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE Q �0 GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. FINAL INSP. /!j �� $ GRADING cu. yd. plus x$ =$ LUMBER GR. FRAMING `V/ 9 '?? , ROOFING& n' ./. 'rI� 44A { /��/d l..J (t f I „� REMARKS: VENTILATION FIRE ZONE ROOFING , FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING Yoftl MESH INSULATION/SOUND/ FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 3© of F ICE.OF E. LEON SPAUGY cbius:ro�ta 1 AG(iICUI. f fJftAL COti1h11SSI0NEfZ )a,�IES O WALLACE p I . o y AND ASsiSiaiI P)MMISsro411 W06 -1 -ITS, F.c: MEASURES CLEMENT BE* 49-613 Ilwy 86,, Buite D-12 •Coachella, CA 92236. M,1 vq� 619-342-829`1: CASE N0.: C� C DEVELAPER'S NAMEt $Tftleg ae.'0.3,e r -r o.J ADDRESS o :2,1/ 7 ?Af/Qa i T'L AJ TELEPI ZONE a ( 6.19 13z z Dear Developers After reviewing your landscaping plans, all plant material listed is not in violation of quarantine laws governing the Coachella Valley. If -substitutions do occur and they differ frcan plant material listed, this, office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free envinoF>nent. 1 Agricultural codinissiioners off -1c cce .Indio and Riverside office �. 064. LST 1-7 2 Z�—. ao3 ir� - j"����,' �'/.��'�` � �- �.�•'{�,�.{��•.. (: S�.y...�'�.�,`ir" �, •"'�Yx _T��{}..�,r'+ry �,Y•`-•Si � '.I�}i�j�y��nyy_� .�, F"' � • -1U r'Y��"�Ir_.,",.r.,,tr�i} tl'.,' O4 & iii7'i ^"7) t+. 4,I'((• '�r''f'.r',� l `�l'''!� - ♦.l t'Mi�IL`� „iR '� 3; wry Ile RECEIPT NO. S F 29' Issued By 1-1 . C• Date - r DISTRICT: ❑ Riverside, I-" Indio ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDEMROD - Plans/Records' COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Panel No. ENVIRONMENTAL HEALTH SERVICES 1 -7711-1- a2 - �o 3 PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County speculations ac indicated on the attached check list A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval. Q VERIFY ITEMS IN SECTION A FROM BUILDING d SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'* Z 0 Agent, Contractor, Contact Person Phone Address 8 Phone % U (2, e!) S7'.�GL Co Owner Phone Mailing Address `111z cWn X z z -/o aQ 2 F114 40 w TZ- d1 til City State Zip Job Property Address Legal Description Prop. (PM, Tract, Lot) P4 Af$ f7k Al S CR 9ZZG SAI c4, o 1/ 4,t y Gra -7 AILAe -2 !s Z Lot Size Water Agency/Well Use of Permft P/P, CU, etc. Other eV wprE� rs r,e le- 7— Dwelling, H Site Prep, etc. I S ZZ L 81r` Signature of Applicant Date CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE SUBSURFACE DISPOSAL 1238 $45-00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME 7 - (NO PLOT PLAN) m LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 2 0 a. 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year) U b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 Uj ❑ Rereview (2nd review same parcel) 7344 $16.00 EVALUATION (Attach DOH BAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $45.00 Critical Area 7346 $66.00 ❑ ALTERNATIVE/EXPERIMENITAL 7345 $13200 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 INITIAL DATE Holding Tank Agreements Completed ❑ Yes No Certification of Existing S.D. System Required ❑ Yes No I WOCB Clearance required. (Attach Farm ❑ Yes No DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yes No Special Feasibility Boring Report Required. ❑ Yes NO Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes No Other ❑ Yes No Staff Specialist tot Inspection Required ❑ Yes No Lot Inspec m Dale Soils boring report by Project it Date Soils Map Page Soll Type Approved by Date U No. of Systems Type of Systems) "filling Units (1) Septic Tank Soil Rate Grease/Sand Z ❑ Hoding Tank ❑ Existing Bedrooma„Fixture Units Grease Intop 0 :Ylqew ❑ ReplacementGal - Gel U W 0) (2) Leach Line Sq. Ft Sidewall allowance install Une(s) R long_ --ft wide with Leach Bed sq. ft Bottom trench R rock/ sq. R min. inches rode below drelnlines or of bottom area per runninng,ft` ❑ NA Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below,. " Seepage Pit Total Depth Other. Applicable Inlet (BI) Max. Allawable Depth N/A Overburden tactor ❑ 5 O -V c / y No. 2 System REMARKS: c, This application isAPPR/DENIED for the category checked in SECTION B above, regarding the design of a su surface disposal system as indicated • on the accompanied_p plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the Oabove -designed system. No construction is permitted in the required reserved 100% expansion area. ((f)> Septic tank and sewer lines must be 50' minimum from any wells (2) Leach lines must be 100' minimum from any wells, including expansion area IU Seepage pits must be 150' minimum from any wells, including expansion area I--, Signature of Health Official Date RECEIPT NO. S F 29' Issued By 1-1 . C• Date - r DISTRICT: ❑ Riverside, I-" Indio ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDEMROD - Plans/Records'