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10522 (SFD)P.O. BOX 1504 No. 10522 Building 78-105 CALLE ESTADO Address 51-560 Avenida `villa LA QUINTA, CALIFORNIA 92253 Sterling homes Mailing Address 7220 Trade St #245 City Zip Tel. Sari Diego 1 92121 1 819/699•-8444 Contractor BUILDING: TYPE CONST. OCC: GRP. A.P. Number 773-144--004 Legal Description Lot 11 1 <r.k ill, Tir i.t 12 Description Address 7220 Tracie St #205 City Sax( D.ieCTO Zip 92121 Tel.: 619/693-9444 State Lic. & Classif. H 330551 City Lic. # 859 Sq. Ft. Size 1536 No. No. Dw. Stories Units Arch., Engr., Designer Urbina & Associates New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address 6370 Anvil Lake Ave Tel. 619/469-3168 Permit does not include block walls or o�lL71 City San Diego o Zip 92110: State Lic. # C-13333 " 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 Busines5'and Professions Code,4nd my license is In full force and _effect f SIGNATURE a' Ae- ':r".J' DATE OWNER -BUILDER DECLARATION I hereby affirm that 1 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 Lew, 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 ($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 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.) ❑ 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 or property who builds or Improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 0 I am exempt under Sec. B. t> P.C. for this reason Estimated Valuation rc n • 9 0 PERMIT AMOUNT Plan Chk> Dep. 250.00 Plan Chk. Bal. Const. ' Mech. Electrical I i q Plumbing�d� �� S.M.I. (,� Grading ?n P4 In. Driveway Enc. 2 _ no Date Owner Infrastructure 1984.07 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 1!1 Copy is filed with the city. ❑ Certified copy is hereby furnished. _ TOTAL 3472.87 3222.87 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 the 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: It, 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 Ihereby 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 sof this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip REMARKS C►Ct f t�2� i „ 2�r 42 11 -?2 . , ;TP 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. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SQ. FT. ® CARP. SQ. FT. WALL SQ. FT. ® SQ. FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FORMSR WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FOUND. REINFj.2 GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM REINF. STEEL 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 °� KqS 2 (I/q.2. r/qn j— &a., 0/�g� "-D / / SQ.FT.GAR ® 3/ic HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE PERMIT FEE::J PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE X PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBIN 7 PNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE 'oopzROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMSR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINFj.2 GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE �1 T GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER'GR. FINAL INSP. 1:182A FRAMING 1 d1 FINAL INSP. -711 ROOFING /1�l °� KqS 2 (I/q.2. r/qn j— &a., 0/�g� "-D / / IQI 4 )0l O REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR, GAR. FIREWALL �j H N MESH INSULATIONISOUND(`� i FINISH GRADING FINAL INSPECTION --'711 -7 "1 �1 - 11 ll�` ( CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL i Building +Address 515.60 AVENIDA VILL Owner 'STERLING HOMES - Mailing• - - Y V Address 7220 TRADE ST #205 City _ + Zip Tel. - F SAN DIEGO -921211 1619%693-844 Contractor ' THE LENDEL CORPORATION ___...Address 7220 TRADE ST .#205' Zip _ Tel:.... SAN DIEGO _ 92121 91/693-8444 State Lic. _ City & Classif. B 330551 Lic. # 859 Arch Eng r (. P.O. BOX 1504 78-105 CALL'E ESTADO A I LA QUINTA, CALIFORNIA 92253 4 APPLICATION ONLY BUILDING. TYPE CONST SGL,_,FAM • OCC: GRP. A.P. Number 773-14-004 _ Legal Description LOT 21 /BLOCK 111 , UNIT 412 ' Project Description SINGLE FAMILY Sq. Ft. 15 3 6 No. 1. .Size_ ,. _ .Stories DesignerURBINA & ASSOCIATES _ Add..❑ _ Alter ❑ Address Tel. ! -• - 6370 'ANVIL LAKE- AVE -----.-- 319/469-3168-- CitSAN Side Street Setback from Center Line DIEGO... 92119 ` .__.'. Lica# CZ -r3331•. _ I- IINSPECTOR =•�- . -- - LENDEL �Ll ENSED CONTRACTOR'S DECLARATION P I hereby affirm that'I @G icenseWunder provisions of Chapter 9 (commenci with Section 7000) of Division 3 of )he Busin7fi and Professions Code, and my license n full force and effect.. J/ L/ —SIGNATUREO, _ Validated by: HE 5 1 LWENTDATE OWNER -BUILDER DECLARATIU _" I hereby o,ff irm that I am exempt from the Contractor License Law for the following reason: (SecJ7031.5,Business and Professions Code: An city or county which 'requires a permit to co�lrrstruct, after, Improve, demolish,. or repair anytstructure,. prior to Its.lssuance 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 (commenclrig 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 ($500). . _ ❑ 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 butcslor 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 ,., ofproving that he did. not build or Improve for the purpose of sale.) . Validation: - Estimated Valuation $55,000 - PERMIT Plan Chk. Dep. - $2T5 • CO Plan Chk. Bal. Const.- -Mech. - - ' - Electrical Plumbing O 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct-the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property *who builds or Improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - - I ❑ I am exempt under Sec: - - - B. & P.C. for this reason - - S.M.I. - Grading Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certifiedQ1pH�et�gof. (S$rvNttgO, Labor Code.) Policy No: Company.. ��+ rr 1111 11JJ ❑ Copy is filed with the city. ❑ 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_th� 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 JO -APPLICANT. If, -after making, this Certificate of. Exemptlon 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 Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) I - 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 DIVISION Driveway Enc. Infrastructure - - TOTAL P275. REMARKS 4 No. Dw. Units s Repair Cl..-..-Demolition.0. . At S AMOUNT `n 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 T FINAL DATE IINSPECTOR Issued by: Date Permit . Validated by: 77-7�- Validation: - CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. S0, FT. ® POWER OUTLET ROOF DRAINS CAR P. S0. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. OTHER APP.IEOUIP. DRINKING FOUNTAIN SO FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. 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 GAR. FIREWALL SO.FT.GAR ® 3/ic HOUSE SEWER LATHING 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 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 x$ _$ 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 DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 2/4/92 Type of Permit I La' Quinta No. 111164 Permit # 110522 Log # Owner Name Sterling Homes No. 51-560 street Avenida V illa City La Quinta zip 92253 Study Area 113 APN # 1773-144-004 Tract # Lot # 21 Square Rootage 11536 Type of Development No. of units Single Family Residence Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways; residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: - EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.58 X 11.536 1 or $ 2,426.88 have been pF-id to D.S.0 S.D. for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Sterling Homes Telephone 693-8444 Name on the check gy James E. Lively Assistant Superintendent, Business Services Fee collected /ezem ted by K'. thleen Emme lin `t 3 Payment Received Signa check No. 0620 Collector: Attach a cop county or city p c eck application form to district copy for all waivers. Embossed Original- Building DeptJApplicant Applicant/Receipt Copy - Accounting ,. - • r 1'ICy,U11iU11YtA ffCUUC.71 CU DT I _ a M AND WHEN NECOflDEO MAIL THIS DEED AND UNLESS OTHERWISE SHOWN BELOW , �f J MAIL TAX STATEMENT TO: �'�• �� Name Sterling Homes (D street CIZddress 7220 Trade St. #205 Ctya San Diego Slate CA 92121 MAIL TAX Name Sterling Homes street 7220 Trade St. #205 Address San Diego c'" CA 92121' state TITLE ORDER NO. 1913 2 0 0 ESCROW x0.6 7 0 4—JC M SPACE ABOVE THIS LINE FOR RECORDER'S USE GRANT DEED 773-144-004-8 . THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX IS $ .19.80 $] computed on full value of property conveyed, or ❑ computed on full value less value of liens or encumbrances remaining'at time of sale. ❑ unincorporated area KI city of La Quinta , AND FOR A VALUABLE CONSIDERATION, receipt of which is. hereby acknowledged, James Caleb Thompson III and Cynthia. Louise Thompson, husband and wife, as Joint Tenants hereby GRANT(s) to Sterling Homes,'a General Partnership the following described real property in the City of La Quinta County of Riverside , State of California: Lot 21 in'Block 111.of Unit #12, Santa Carmelita at Valle La Quinta, as shown in Map Book 18, Pages 79-80 of Maps, Records.of Riverside County, California I Dated July .22, 1991 mes' 'Calf H Thom � on III STATE OF CALIFORNIA I' ss. _ _ COUNTY OF L c>S On this L !/ day of �ir �� in the year 19 J V before me; the undersigned, a Notary Public in and for said State, . Cynth a Louise Thompson personally appeared -4- \/!9 M e 5 C50'TN, 4,1'6a !� n- 1 J 0 i'_. jilt 7,-t ! !1 40 k6 e % ,' f d> Al P5 1) A) ` "I personally known to me (or proved to me on the basis of satisfactory evidence) to be the 111 person whose name J !'' subscribed to the within ' " OFFICpIAL. NOTARY SEAL instrument, and acknowledged to me that 4- he �[_ executed it. '''. TES„ E A ALNIEf; `ICY i, Notary PucliC — C;NitotniB WITNESS my hand and official seal. \,'; LOS ANGELES COUNT' My'Comm. Exp;w'S NOV:?! C�, Signature _ CO -441 (REV 4/85) NOTARY PUBLIC IN AND FOR SAID STATE MAIL TAX STATEMENTS AS DIRECTED ABOVE. (This area for official notarial seat) 11616 C CL C� ry�Uj W d am UUUj M �Z> 1 Ck 0 °c C45 it IW�aW0 Q M SPACE ABOVE THIS LINE FOR RECORDER'S USE GRANT DEED 773-144-004-8 . THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX IS $ .19.80 $] computed on full value of property conveyed, or ❑ computed on full value less value of liens or encumbrances remaining'at time of sale. ❑ unincorporated area KI city of La Quinta , AND FOR A VALUABLE CONSIDERATION, receipt of which is. hereby acknowledged, James Caleb Thompson III and Cynthia. Louise Thompson, husband and wife, as Joint Tenants hereby GRANT(s) to Sterling Homes,'a General Partnership the following described real property in the City of La Quinta County of Riverside , State of California: Lot 21 in'Block 111.of Unit #12, Santa Carmelita at Valle La Quinta, as shown in Map Book 18, Pages 79-80 of Maps, Records.of Riverside County, California I Dated July .22, 1991 mes' 'Calf H Thom � on III STATE OF CALIFORNIA I' ss. _ _ COUNTY OF L c>S On this L !/ day of �ir �� in the year 19 J V before me; the undersigned, a Notary Public in and for said State, . Cynth a Louise Thompson personally appeared -4- \/!9 M e 5 C50'TN, 4,1'6a !� n- 1 J 0 i'_. jilt 7,-t ! !1 40 k6 e % ,' f d> Al P5 1) A) ` "I personally known to me (or proved to me on the basis of satisfactory evidence) to be the 111 person whose name J !'' subscribed to the within ' " OFFICpIAL. NOTARY SEAL instrument, and acknowledged to me that 4- he �[_ executed it. '''. TES„ E A ALNIEf; `ICY i, Notary PucliC — C;NitotniB WITNESS my hand and official seal. \,'; LOS ANGELES COUNT' My'Comm. Exp;w'S NOV:?! C�, Signature _ CO -441 (REV 4/85) NOTARY PUBLIC IN AND FOR SAID STATE MAIL TAX STATEMENTS AS DIRECTED ABOVE. (This area for official notarial seat) Cwt, OF 78-105 CALLE ESTADO LA QUINTA, CAfLIFORNIA, 92253 (619) 564-2246, January 29, 1992 Coachella,Valley Water District 85-820 Coachella Heights Coachella, CA 92236 ;�•' Re: 51=560 Avenida Villa ,• r La Quinta, CA 92253 TO WHOM IT MAY-CONCERN.- The AY•CONCERNi'The property mentioned above is under construction and does not have sewer available in that area. Because the. sewer will not' -be available,in this area for at least six months, -it is unreasonable for the builder. to -pay the' sewer permit fee until• sewer:. is available. We request that you issue the .builder a permit for a water-meter,•waiving the sewer hookup fee until the time that the property ties into the sewer. Very truly yours, BUILDING AND SAFETY DEPARTMENT ; Tom Hartung Building and Safety Director TH : es • a LTRTH25 a MAILING 'ADDRESS P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 w , '1 . ifsara., Qra '_ 'i,C :. , - - vt ' ': ' W1. -r r jl' "3.r - t-' 4-1 . 1��i r � " { - . , iya�y � Ij.gn. }{"wpr.� { � ��. ' •='t, .t �.n4. � c;�a � . , y I '� - ,y Mi•�-stLY �.. . ... Y _ ^ t�,C,fii.tf: t• t: rT . A Nr;E (.� .yttlaA,- ! � •-1. :tt-::... .. {'-_ �'t'I•J,Ml:.T .- r;;J'� IL:^ '.�t! _ :i�9U:;"7.' 7i'D'T t i ,' � '3t�it: (4.ltr` t'i r 1 `�y7 tL; ��{�+"114t • P.: � t. .,..,� � f � . �iM;'r�c„rr-t;--r,- .• y tp1';'�'{ S ,� 1* �."L.. %� trtl ' t ''' ' . � Tn'.i:7• - 4 �lti�t{: t j•..i .7L•� !L bE:Z Q/ . 0 d aC P' � w { t`.I. t:.L It i "t tlr � -��Ri1 j01 � ..�+ � - _= + C. fiv 7 "•. -ti {itl t3�t ::J S1 rtC wl �.a r .• Ml "�' r t{� ' y`"� tSi^'tiCi R4 , ` t 1 tY n nh .4' y z YTit O fit" 1. �. +..,...�......� ._ � ^.h-.�.. -- -- -.. ... .. _ .,. mss........_.._...�.......�.,........,......,,.. t 1 ZY/ COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. ENVIRONMENTAL 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 speculations as indicated on the attached check list. . A non-refuridable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riverside. A roval of this appli tion shall remain valid for a period not to exceed one year from date of approval. sq—U MV TER I 4�003��S o 8Q QQ.< �OG # 8Z;21 VERIFY ITEMS IN SECTION A FROM A NON -FEE BUILDING & SAFETY (goldenrod) APPLICATION Agent,Co ntract�tContact Person Phone (c/ ti Address City State . Zip �I �Z G7' H Owner Phone Address City State Zip co Job Property Address City / State 11 Zip y'�Z$3 Legal Descriptior Prop. (PM, Tract, Lot) L 1C 5I S<� N/� i�c G� Ju. 7 2� ���� r/�V/ Lot Size Water Agency/Well Use of Permit P/P, CU, etc. Other Coe --v I; �41 04 f (lu LF /(/00� Dwelling, MH Site Prep, etc! 'ey,,1ACf LN Owl -le -4 . , /�,�°`, �•// . /� .l . � �///.tom%��v��v �'� :fi / i r�'L oey$i nature of AlIpucint `� Date CATEGORY REV CODE FEE CATEGORY REV CODE FEE [SUBSURFACE DISPOSAL (per system) 1238 $153.00- ❑ SITE EVALUATION UPON REQUEST 7349 $120.00' m / ❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION (NO PLOT PLAN) ❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00 Z a. 1st 4 Parcels (Each) 1238 $153.00 ❑ PRELIMINARY ELECTIVE EVALUATION 0 H b. Each Parcel after 4 7344 $ 55.00 (Attach DOH -SAN -53) 7352 $ 69.00 W C] REREVIEW (2nd review same parcel) 7344 $ 55.00 ❑ HOLDING TANK 7351 $119.00 Cn SITE EVALUATION In ConJuction with Critical Area 7346 $197.00 ❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00.0 656.00 . .0 ❑ SITE EVALUATION Lot:Less than 10,000 Sq. Ft. 7347 $172.00 ❑GRADING PLAN REVIEW DETAILED 1238 $104.00 ❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00 ❑ :SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00 ❑COPIES (LAND USE) 7786-81 $ 50 INITIAL DATE Holding Tank Agreements Completed ❑ Yes No T. Certification of*Existing S.D. System Required ❑ Yes - No WQCB Clearance Required ❑ Yes No (Attach Form DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required ❑ Yes No _Special-Feasibility_Borina_Reoort_Reouired ❑ Yes No w , '1 . ifsara., Qra '_ 'i,C :. , - - vt ' ': ' W1. -r r jl' "3.r - t-' 4-1 . 1��i r � " { - . , iya�y � Ij.gn. }{"wpr.� { � ��. ' •='t, .t �.n4. � c;�a � . , y I '� - ,y Mi•�-stLY �.. . ... Y _ ^ t�,C,fii.tf: t• t: rT . 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A 1,- EARTH,SYSTEMS CONSULTANTS S.C. ,/ 'BUENA ENGINEERS DIV. 79-811B Country Club.Diive.-.- - = Bermuda Dunes, CA 92201 • (619)•345-1588 Client Name Client Address Client Phone DATE aI.TL JOB NO. -7- 37��-P/ PROJECT 5/ -5&o ��Ew�ow r/llp LOCATION L� QufNTYa CONTRACTOR STE RL/ �Ilo OWNER WEATHER TEMP. o at AM ° at PM PRESENT AT SITE k0 — pP16. / �Sre6 17 v AlloA V,/1)4 21 Pro 7, ► TEST NUMB ERn TEST LOCATION // $ £ 'i � o LOT NO. t 'ELEVATION FIELD TESTING REFERENCE CURVE MOISTURE CONTENT % DRY DENSITY Ibs./Cu. ft. MAXIMUM DRY DENSITY % . MAXIMUM DRY DENSITY Ibs./cu. ft. OPTIMUM MOISTURE CONTENT % / �Sre6 17 v AlloA V,/1)4 21 Pro 7, ► /ID'S ,� -- 2• lQ�� isrZ 112 c 9 13 51-S4b � R P�111n1L ALL. • - Q� 6AT.Q: NNiTLIL + St -590 .~ O'+A oxlmRiL EYr UC tt`�S REMARKS: E E17 %BENS/T rF$%S Od .4 X24 /` t/.5p- Ac. (/5/A/G. OF WS. p ACTH Tf S75 WEIt6 %6 71, FIELD REPORT CLIENT REPRESENTATIVE SIGNATURE TECHNICIANS SIGNATURE QfloOf r :. ra