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03997 (SFD)03907 S 3 96 0 (/ I LCA P.O. BOX 1504 Buildingax�,t ..� 78-105 CALLE ESTADO Address. �.�—�� LA QUINTA, CALIFORNIA 92253 Owner Mailing Address P. 0. 13ox 1379 City Zip Tel. La QuintA 1 92253 5 4-7411 Contractor lds Address 1>. Q« Box 807 City Zip Tel. 1600 Palms 92275 343.2673 - State Lic. City & Classif. 469157 Lic. # 1114 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) effecof Divislon,3 of the Business and Professions Code, and my license is in full force and SIGNATURE g. i DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors 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 rile 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). ' O 1, 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 of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) O 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 contractor(s) licensed pursuant to the Contractor's License Law.) ❑ I 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 O Copy is filed with the city. ❑ Certified copy isohereby 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 tho 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 BUILDING: TYPE CONST. OCC. GRP A.P. Number » 774-055-011 Legal Description Project Description 81ngle ra ily Dwfl ing Sq. Ft. 1441 No. 'No. Dw. Size, Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Itstlmatea valuation $78t152 PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.1. Grading Driveway Enc. Infrastructure AMOUNT r U! U Yi tY r �Y I ai rv'.a'er 36r4rV 5r4 :05rV0 J r :Y Lf Cil • tl '1r � ill r tJ' Cr ir71tr21 r i7 TOTAL N sir r v r v j e. A/1,r+a} REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR; 514-:310 Issued by: Date Permit Validated by: Validation: WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD 7 ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT rp S UNITS SLAB GRADE ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. R FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FT. a GAS (ROUGH) 'METER LOOP GAR SO. FT. @ POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO FT. id GROUT WATER HEATER WALL SO. FT. Q FINAL INSP. DRINKING FOUNTAIN BOND BEAM WATER SYSTEM URINAL SO FT td =$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES , WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOKDISHI APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING ILAUNDRYTRAY AIR HANDLING UNIT CFM FIREPLACE 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 SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID !g t w c SEWAGE DISPOSAL SO.FT.GAR rg 3/.c 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 8 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.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus xS =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING , REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR- , GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 7d I Z O F- 0 W U) `1 cc Q W fr X .""'""nF":+air:=t;.:�,y..•}�4'"'r.�.�i'Ss�P'-Mi�'�Yr�K+'w�lyi��F.abiC 7�'a�-.WrY-,r-�•i-'..+t 1'Y 7'� � ,..� r•ti4'N� '�!"a�w`' ay�.Nra t,.; -.M�i �t :: � ;. �:; ,»� .^�;,F COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION QSS 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 S40 is required when the application is submitted. Check must be made payable to the County of Riverside. VL1,S'�'1_� } WU\ 1`• !.� e 4.�i 4� ( w S I Building Department Application Log # Name (Owner. Agent. Contractor. Etc.) Mailing Address' E�c� 'l✓,tb %l� �"l✓til.!-� Y1 ( � t/� ..ti. C..a"'i t s. � ( C� � )�% L� � 1 �� City Slate Zip Code _ Telephone 'Job Property Address c v ` L *City or. Community - 'Legal Description of Properly. (Lot. PM. TR) -Assessor's Parcel No Water Agency or Well Use OI Permit Planning Case # Lot Size Preparation SFD. MH Site Etc. ,Z tSignalure of App6canl .Date 'The above information must be verified from Buiiding Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial •Date Certification of Existing S.D. System required. ❑ Yes No WOCB Clearance required. ❑ Yes No r © Soils feasibility report required. ❑Yes 4 No Special feasibility boring report required. ❑ Yes M No / Detailed contour plot plans required. ❑ Yes No i Staff. Specialist approval required. ❑ Yes t No Lot Inspection Date Soils/boring report by �� ,r Project # Date Soils Map Page Soil Type Approved by Date Type of System: No. of Bedrooms (1) Septic Tank PGals. Soil Rate Required ❑ Existing Q�ew ❑ Additional ❑ Replacement OV Sc. (2) Leach line sq.. ft. / trench Sidewall allowance ft. Sq. Ft. Install Line(s) Ft. Long, Ft. wide min. inches Leach bed q. Ft. of bottom (Bottom area) rock/ wit per running ft. ❑ N/A rock below drain lines y area r/ Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI t Seepage Pit total depth Applicable ❑ 5' 2^6' 1 y Max. allowable depth N/A Overburden factor %J ( CSD /. �)(94kACf w`(`G This application is app eor vv d/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. (05) Septic tank and sewer lines must be 50' from any wells (2) Leach lines must be 100' min. from any wells including expansion area _ `` � �U`�^i�11. (3) Seepage pits must be ,150' min. fromlany{wells includ lig expansion area Signature of Hearth Official '' - �- Dale RECEIPT NO._ _1��C a Issued by Date S / ( 1 C,C District: r-1 D; ❑Indio . ❑Hemet ❑Perris ❑Rancho Calif. ❑Blythe' Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH SAN 122 (Rev 8/87) w rn r lr.E of E: LEory 5rnEn . r. AGRICULI URAL COMMISSIONER CU•�����i�0 •n )W IES 0 WALLACE AND �Sssia�rr,).LaRcu)`EP. CIE�IEv ,..� 1,VLIG1 ITS b.NICD\SU(ZLS i CENVENISIEsc�EEn 49-6t3 Ilwy 86, Sulte fi-12 qr 9r�1,a.•' Conchel.lm,CA 92236 'q� 619-342-8291 6NIE - CASE `Ri. DEVELOPER' S NAME: ADDRESS . D .� . 13 7,* TELL•"PI IONS:: 41 Dear Developers After reviewirrg your Landscaping plans, Bill: plant naterial.listed is not in violation of quarantine laws governing tl+e. Coaclrella.Valley. If substitutions do occur and .they di) ter frcan plant _Material listed,- .this office must be not if led imnadiatoly. Thank you for protecting and preserving the Coachella Valley's pest=free envirorur nt. Agriculhural Calrlu sion ' Office cc: Indio and Riverside Office