04707 (SFD)Building
Address
Owner
44 04707
P.O. BOX 1504 �jG1v S
51-985 Villa78.105 CALLE ESTADO 1 '
LA QUINTA, CALIFORNIA 92253
Coddhella Valley Land
Address 247 E. Tahquitz Way 02
City Zip Tel.
Palm SPrings 92262 322-1020
Contractor
Address
ip I Tel.
State Lic. City
& Classif. 387934 Lic. # 89.5
Arch., Engr.,
Designer
Address Tel.
CityI Zip 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
e°force
tand
�
offeCl• _'.� ! f.f' .+!"'.-,r�,+� .r ..,r ,,..r t .✓)^ j 6.wsy fi
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
i Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the bask
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 (5500).
❑ 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 -budder 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 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.)
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 certified copy:th7'.
y `' I'jSec'3800, Labor Code.)
Policy No. company j tr,-
❑ 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 (E100) 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: 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 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
11LDING: TYPE CONST. OCC. GRP.
P. Number 773-182.424
Legal Description
Project Description St-►.
TOTAL
REMARKS
SF ..i#:n I -Lit .iifi.,, f, '.14'1.iEI
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 IN3PECTOR
10/21/88
Issued by: Date Permit
Validated by:
Validation:
1
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLOENROO • ASSESSOR'S OFFICE, HART) COPY - FILE
Sq. Ft. 1463
Size
No.
Stories
No. Dw.
Units"
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
475' Garage
174' wood
b' fa
Estimated Valuation
$79»451
PERMIT
AMOUNT
Plan Chk. Dep.
$250100
Plan Chk. Bal.
70."
Const.
373,00
Mech.
36.00
Electrical
76.19
Plumbing
105.€ 0
S.M.I.
5.57
Grading
201.00
Driveway Enc.
20.00
Infrastructure
1,755.14
,t
TOTAL
REMARKS
SF ..i#:n I -Lit .iifi.,, f, '.14'1.iEI
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 IN3PECTOR
10/21/88
Issued by: Date Permit
Validated by:
Validation:
1
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLOENROO • ASSESSOR'S OFFICE, HART) COPY - FILE
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
tST FL SO F1 y $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
A EWER OR SEPTIC•j1�
//
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO :T Gr
GAS (ROUGH)
METER LOOP
GAR SO. FT. 0
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO FT. a
GROUT
WATER HEATER
WALL SO. FT. (a
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO FT d
_$
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(AUTONDISH)
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.
SO. FT. c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID C tai. c
SEWAGE DISPOSAL
SO.FT.GAR @ 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
G UND PLUMBING �F
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
A EWER OR SEPTIC•j1�
//
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.
b plus x$
_$
LUMBER GR.
FINAL INSP,
FRAMING
FINAL INSP.
G ROOFING
� ✓
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
GAR. FIREWALL
LATHING
MESH
44
INSULATIONISOUND �� U
FINISH GRADING
INSPECTION-(
l`
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH -7 Assessors Parcel No.
73-02 -
10
ENVIRONMENTAL HEALTH SERVICES 0
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 checklist.
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 dF-te of approval.
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION. BUILDING DEPARTMENT APPLICATION LOG'*
Agent, Contractor, Contact Person
Phone
Address & Phone
_57WA2 <-1 (2e S r2(J a— 7-/ go A)
3 z -z -,00 a,
Owner
Phone
Mailing Address
city
State
Zip
Job Property Address
Legal Description Prop. (PM, Tract, Lot) Z47v,
/7
Lot Sizer
Agenic r
4!EtZ g 11-
Use of PermitP/P, CU, etc. Qa/AJ771
Other
-rv, et 7—�ellfn
,5M Site rep, eic. I
__2 IJignature
of Applicant
Date
CATEGORY: REV CODE ., FEE--,.,
CATEGORY: REV CODE FEE.
M4 SUBSURFACE DISPOSAL 1238 Cf$�45.00
0 SITE EVALUATION UPON REQUEST 7349 $42.00
b MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
0 SEWER/SEPTIC VERIFICATICIN 7348 $11.00
a 1 st 4 Parcels (Each) 1238 $45.00
-iach
(Less than, 1 year)
b Parcel after 4 7344 $16.00
0 PRELIMINARY 7352 $45.00
0— Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
,P Site Evaluation in Conjunction with
0 HOLDING TANK 7351 .$45.00
Critical Area 7346 $86.00
0 ALTERNATIVE/EXPERIMENTAL 7345 $132.00
0 Site Evaluation Lot Less than
SYSTEM
1.0,000 Sq.. Ft. 7347 $86.00
OL
INITIAL DATE
Holding Tank Agreements Completed 0'Yes11 PO /0
Pp �1�
Ceitification'of Existing S.D: System Required 0 Yes ON 1
WQC13 Clearance required. (Attach Form. O,Yes No
-.DOH SAN 007, Santa Ana Region Only)
Soild Percolation Report Required. 0 Yes 10
Special Feasibility Boring Report .Required. 0 Yes C?rN
Detailed Contour Plot Plans Required (11 to 5 ft. interval) 0 Yes
-Other 0 Yes
'Staff Specialist 1_61"inspection Required 0 Yes No
Lot Inspection Date
Soils boring report by' P elect Date
Ails Map F%6 Soil Type Approved by Date.
No. of Systems
Tyll of System(s)
No. Dwelling Units
(1) Septic Tank
Soil Rate
G?base/Sand
0 _yolding Tank 0 Existing
Bedrooms, FixtureUnits.—
Grease
WNew 0 Replacement
- hmftal
Leach Line Sq. Ft.
Bofti� trench eareain.
Sidewall allowance
Install Line(s) fL long a wide with
Leach t@ed sq. ft..
tL rock/— sq. ft.
m
of bottom ar
per running ft.
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit B610m
Seepage PilTo I Depth
Applicable'
J_
lntet-(Bl�
N ' L
/A Overburden factor
0 5 04
maxi Allowable Depth
No. 2,System V/w
REMARKS:
V
This application `ijg• OVEDEMEMD for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied plot plan, using the requirements set forth in SECTION C above.0 A building permit is ne--essary for the installation of the
above -designed system. No construction is permitted in the required reserved 100% expansion area.
Idqn Septic tank and sewer lines must be 50' minimum from any wells
Leach lines must be 100' minimum from any wells, including expansion re
i
Seepage pits must be ).§0' minimum from any wells, including ex ansion area 410
Signature Health Official- 0 0;6atto
of _710-021-Afflek,
RECEIPT NO. 112
Issued By Date
DISTRICT: 0 Riverside, 0 --Indio El Hemet 0 Perris 0 Rancho Calif. 0 Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant , PINK - Bldg. Dept GOLDENROD - Plans/Records
cc
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Q% t Q AGRICULTURAL COMMISSIONEfZ`Ep
)AME-3 0 WALLACE
1
AND
CLEMENT
C�LSES�SiEay�1�r$pEW`VVl5E51UrI`SETR
EW-IIS &NEASURES
Bruen .
.. 49-613 Ilwy 86,. Suite B-12
,k°���..,;w:•' Coachella,' CA- 92236
q ► 0 16q� . 619-342-829.1
DATE " I CASE NO.
DEVEWPER' S `IAM s �' T R fz R
ADDRESS:. 7 7' 9/II,Qcc r T
PALrA spit iAje' S d'g 9 z.2-4,Z.
TEL,EP110NE: /`% 1 3 Z 2 " j0 2, G9
�lc.r. 4
Dear Developer: 3 - 8 Z- - m i .
After reviewing your landscapuig plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If. substitutions
do occur and they differ fran plant material. listed, this office must be notified
imnediately.
Thank you for protecting and preset-m iuig the Coachella Valley's, pest-free environment.
•
Agricultural Canniss' 's" 0E.fice
cc: Indio and Riverside Office