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9906-154 (SFD)Alt LICENSED CONTRACTOR DECLARATION PI hereby affirm under penalty of perjury that I am licensed under provisions of !� Chapter 9 (commencing with Section 7000) of Division 3 of the Business and iv w Professionals Code, and my License is in full force and effect. O =) c) License # Lic. Class Exp. Date UJ LO 29171? B 00112N, oZ date 4 Signature of Contractor Cr, O r- U CO CC OWNER -BUILDER DECLARATION WWd r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's U) License Law for the following reason: Z ( ) 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, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section , B&P.C. for this reason LO N Date Signature of Owner O C\I to d< WORKER'S COMPENSATION DECLARATION C� Z I hereby affirm under penalty of perjury one of the following declarations: p () 1 have and will maintain a certificate of consent to self -insure for workers' X W compensation, as provided for by Section 3700 of the Labor Code, for the O J Q performance of the work for which this permit is issued. Go Q C) ( ) I have and will maintain workers' compensation insurance, as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this d 0 Z permit is issued. My workers' compensation insurance carrier, & policy no. are: Carrier Policy No. cb � 1F,1 E1 P tP 222- �S I.TIM i' f f1r3;•13-1 C) J (This section need not be completed if the permit valuation is for $100.00 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 workers4-ompensation laws of California, and agree that if I should become 3 subjlpct,to the workers' compensation- provisions of Section 3700 of the Labors{' C9de, I shall forthwith comply with those•provisions. f 1pate,-174-&q Applicant,. , � �- f t r_ � �T Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at ? whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if 16 work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is • correct..) agree to comply with all City, and State laws relating to the building constru jio'n, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. ,Signature (Owner/Agent) i.�rf , Date BUILDING PERMIT PERMITN Ny4iPs-`t54 . DATEVALUATION $83,6&1.00 LOT �� TRACT j-�, I n 2 //14 JOB SITE/ "J3-,360 i 1 LLE i.i'Q�ktt��c+t'�'AA ADDRESS APN "]�► -�� -� t� OWNER CONTRACTOR / DESIGNER / ENGINEER D ER :° �Rl:s�', A�'.L i . l� :'1.01-1"'1 1'd' Wil c� P:, 3,�i4 1..- ,;.t�t;iik�: PO BOX 3S78 � 56900 JACKSON S`C' PALM DE:SE Wl' CA. 92261 '1.'11 R.n2AL, CA 92274 f7f1p� t99-F2QQ C,K0 :M49 USE OF PERMIT SffA14 LI13.17AMIl Y..DW.t.:I.i.NG :3l �> - i�;r��1vE1'1' f 31i`i t�r0 T 1N'C% 1? i3LtJGi: 4VAl ORP0L £'i?F,0101 AVO 1 f4.00 ,.-F (;AltAWYC;ARPOR'.V 5335 00 SF 6 FT. WOOD F ENC,7 200.00 LF 4 Y 4 .4 CONIS"TRUMIXON11' EST fiiaATED COST 0.4" PERM" FEE SUMMAKY CONSTRUC TI.ON'FF.E 101.000-4184)00 S%7.50 4 r 1'f,.!'N 101-f3fi(I-139-3fR NUEC1tANICA3. FIE 51 O & ELECTRICAL FEE $125,16 PL0MfflW;-F1X, S"ff!tn� 0Jk1t'�'3'PC)N PFR-i2F;•`OD- 101 -tiff? -241-(0) �v i9FR31 A18TRUCTU17W FEE 2125-QQ0-.iW3-342 �1,d1t3.Jti PR ..C.43F, PLAN 101.-000-141-345 ��,dst► 1707i1F (5CF`I' It►I-ffflf)•d39.±(ft_$2150 1,h) SUB -TOT;' \ , CON STR? rC r -ION AND PLAN, C'Bl C:•!C � ."" LESS PRF-PAUD FEES -$250.04) -y MN P j y y pYE (j DU p. NOW* $2,97733 9fa n .r, RECEIPT DATE BY �' DATE FINALED -_ INSPECTOR e' INSPECTION RECORD 7-79 OPERATION OPERATION DATE DATE INSPECTOR INSPECTOR OPERATION OPERATION DATE DATE INSPECTOR INSPECTOR BUILDING BUILDING APPROVALS APPROVALS MECHANICAL APPROVALS MECHANICAL APPROVALS Set Backs Set Backs Underground oras Underground Ducts Forms &Footings Forms 8 Footings Ducts Ducts Slab Grade Slab Grade �( �( Return Air Return Air r 7, Compressor Insulation Q• � �% Vents Fireplace P.L. Grills Fireplace T.O. Exhaust Fans ExhaustFans Fans 8 Controls Party Wall Insulation Condensate Lines • Party Wall Firewall F.A.U. F.A.U. Exterior Lath Framing Framing Drywall -Int. lath Compressor Insulation Vents Final Final BLOCKWALL APPROVALS POOLS -.SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Party Wall Insulation Equipment Location • Underground Electric Pa Wall Firewall Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Water Piping _ Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation ' Gas Piping Gas Test 8 � Appliances F'"'� BIOCKWALL APPROVALS POOLS -.SPAS s��i Final • Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole g. Underground Conduit Rough Wiring Low Nottage Wiring FbRures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility'Notice (Perm) COMMENTS: ' ,. , - • • OPERATION OPERATION DATE DATE INSPECTOR INSPECTOR OPERATION OPERATION DATE DATE INSPECTOR INSPECTOR BUILDING BUILDING APPROVALS APPROVALS MECHANICAL APPROVALS MECHANICAL APPROVALS Set Backs Set Backs Underground oras Underground Ducts Forms &Footings Forms 8 Footings Ducts Ducts Slab Grade Slab Grade �( �( Return Air Return Air Steel Steel Combustion Air Combustion Air Roof Deck Roof Deck Exhaust Fans ExhaustFans OX to Wrap O.K. to Wrap F.A.U. F.A.U. Framing Framing 91F_ Compressor Insulation Vents Fireplace P.L. Galls Fireplace T O. Fain 8 Controls Party Wall Insulation Condensate llrces Pa Wall Firewall Exterior Lath Drywall Lath I Final F'"'� BIOCKWALL APPROVALS POOLS -.SPAS s��i Set Backs Electric BOM Footings Main Drain Bond Beam Approval b Cover Equipment Location Underground Electric Underground PI .Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste lines Waley Piping Hever Final Plumbing Final Plumbing Top Out Equipment Enure Shower Gans O.K. Im Finish Plaster Senor Lateral Pool Corer Sewer Connection Encapsulation Gas Piping c.� T� u Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole 3. Underground CaMUE R Wiring Lav Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use o! Power FMN Ub51Y,Nolice (Perm) COMMENTS: x I Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code; certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS: Use Classification: SFD Occupancy Group: R 3 51-360 CALLE GUATEMALA Type of Construction: VN Bldg. Permit No.: 9906-154 Land Use Zone: RL Owner of Building: DESERT RESEARCH & Address: P.O. BOX 3578 DEVELOPMENT Building Official City: PALM DESERT, By: STEVE TRAXEL Date: 11-5-99 POST IN A CONSPICUOUS PLACE CA 92261 P.O. BOX 1504 APPLICATION ONLY Building 78 495 CALLE TAMPICO Address INTA, CALIFORNIA 92253 Own LBUILDING: TYPE'CONST. OCC. GRP. Mailing r Address ��, iJ r 142-4 V 9K A.P. Number City Zip Tel / . Legal Description " �a J.D cr (Contractor` Project Description 1,* f 74 2.. Auur@55 I I �A ey - +r-Rry ll7 City,, lZip Tel. State Lic. City & Classif. Wf 211., 729 Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that:l"am licensed under Provisions of Chapter 9 (commencingwith Section 7000) of Division 3 of the-8usi ess and P •• fesslons Code, and my license Is in full force and effectO.�,.� SIGNATURE r 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 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). l: 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 thatsuchimprovements 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 1 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! 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 sell -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company n Copy is filed with the city. 0 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 ($100) valuation or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives ,of this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip Sq. Ft.No. No. Dw. Size r•�9G Stories Units l-3co 6u PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS AMOUNT '=J C,J ZONE: 1999 Minimum Setback Distances: Front Setback -from Center Linil '1 Rear q_9Wack,frbm-R$a��rop�Line ,.. Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION 711 Order 'No. 2130637 Escrow No. Loan No. 614 WHEN RECORDED MAIL TO: LA QUITNA MORTGAGE P.O. BOX 5132 LA QUINTA, CA 92253 �-/ - 3 �o �w-� SPACE ABOVE THIS UNE FOR RECORDERS USE DEED OF TRUST WITH ASSIGNMENT OF RENTS (SHORT FORM) This DEED OF TRUST, made APRIL 5, 1999 , between W; L. SHIELDS herein cafied TRUSTOR, whose address is P.O. BOX 3578 PALM DESERT CA 922Q1 (Number and Street) (City) (Siete) FIRST AMERICAN TITLE INSURANCE COMPANY, a California corporation, herein called TRUSTEE, and LA QUINTA MORTGAGE , herein called BENEFICIARY, WITNESSETH: That Trustor grants to Trustee in trust, with power of sale, that property in the CITY OF L.A.QUINTA County of RIVERSIDE State of California, described as: CONSTRUCTION SINGLE FAMILY RESIDENCES, LOT 19 OF DESERT.CLUB TRACT UNIT 2, BLOCK 5, APN:769-113006 LA QUINTA CA, RIVERSIDE COUNTY, CA together with the rents, issues and profits thereof, subject, however, to the right, power and authority hereinafter given to and conferred upon Beneficiary to collect and apply such rents, issues and profits for the purpose of. securing (1) payment of the sum of $ 7 0 ,. 0.0 0.0 0 with interest thereon according to the terms of a promissory note or .notes of even date herewith made by Trustor, payable to order of Beneficiary, and extensions or renewals thereof, (2) the performance of each agreement of Trustor incorporated by reference or contained herein and (3) payment of additional sums and interest thereon which may hereafter be loaned to Trustor, or his successors or assigns, when evidenced by a promissory note or notes reciting that they are secured by this Deed of Trust. To protect the security of this Deed of Trust, and with respect to the property above described, Trustor expressly makes each and all of the agreements, and adopts and agrees to perform and be bound by each and all of the terms and provisions set forth in subdivision A, and it is mutually agreed that each and all of the terms and provisions set forth in subdivision B of the fictitious deed of trust recorded in Orange County August 17, 1964, and in all other counties August 18, 1964, in the book (continued on reverse side) 11580,94) Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 6/25/99 No. 18933 Owner NameDesert Research & Development No. 51-360 City La Quinta Tract # B5, DC2 Street Calle Guatemala Lot # 19 Type of Development Single Family Residence Comments APN # 769-113-006 Jurisdiction La Quinta zip 92253 . Square Footage Permit # Log # Study Area 1,296 No. of Units 1 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 1.93 X 1,296 or $ 2,501.28 the property listed above and that buil.ding'-� • 1..";:.. N' (1, , - permits and/or Certificates of Occupancy for this square footage in this proposed project er.ay nowal�e issued '% Fees Paid By ccNIB/James H. Daughtry T61 one (2399-1K200 Name on the check , �y By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green Payment Received $2,501.28 Check No. 195152 Signature i����Q NOTICE: Pursuant of Asse bly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identifiedabove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting K^ ASSESSOR'S PARCEL NUMBER COUN* OF RIVERSIDE HEALTH SERVICES AGENCY 96 9 _ //3 _ �( DEPARTMENT OF ENVIRONMENTAL HEALTH , AERMIT 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 as indicated on the attached check list. A non-refundable filing fee is required when the application is submitted. Check must be made payable to the County,of,River�g�id�eApproval of this applica- tion shall remain valid for a period not to exceed one year from date of payment. t � i 44—yY 14:27COJ)2 4! LMS # I rY of (A OQ,,y l 5135 $214. nr Agent, Contractor, Contact Person Address City State " Tip Teleptlone. -f 1—. _w qLD S -": 1 -7 a U AtiJr G�Ukrs Vr 1J3Q01t\NF1 C-01 7t,-5 $220. CHECK BOX IF REQUIRED If any box is checked, this application shall be considered rejected until the information is provided and the fee paid. Resubmittals later than 90 days after date noted below may require repayment of fees. m ❑ Holding Tank Agreements Completed Z 0 ❑ Certification of Existing S.D. System Required U❑ WQCB Clearance Required LU (Attach for DOH -SAN -007, Santa Ana Region Only) U) ❑ Soils Percolation Report Required ❑ Special Feasibility Boring Report Required ❑ Rereview Required Initials Date, ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) ❑ Staff Specialist Lot Inspection Required Thomas Bros. Page Grid ❑ Date Lot Inspection Completed: Initials Remarks: ❑ Maintenance Booklet Provided ❑ Final Inspection by Department of Environmental Health is required. Please call 24 hours PRIOR to inspection. C/42 / Soils Percolation Boring eport by Lic/Project # Date Soils Map Page �+i f Soil Type:; 4A Approved By Date No of Systems je!of Systems) No. Dwelling Units r% (1) Septic Tank Soil Rate kGrease/Sand eIding Tank ❑ Replacement Bedrooms, FixMre--Vfirtsr ase ihtcp Lint Trap xisting EJ Addition •N �x It/OO Gal. /10-- E" r0." t• s 0� ak Sq. Ft. Total Linear Sidewall Allowance Leach Bed sq. ft. of B ttom Area 'Ft. Bono Ar ft. rock/ sq. ft. running ft.. Install �e(s). long ft. wide withInlet Test. epth ❑ NA min. below drainlines or 0 Proposed Botto Tested'Depth Z Leach lines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Pit Maximum Othe O Total Depth Allowable 1- Applicable (/ { /Depth � d N/A Overburden F Factor WS' C �O TD Well Review Approved: Date: Well Drilling Permit # SIGNATURE Grading Plan Approved: Date: sl A Sewer Verification Approved: Date: Plan Check Only Approved: Date: REMARKS:.�Z.:!.Ge. 44_04._ /LzG rt�Y il/-lF .t u��+Y✓}�K.t�L /�. GfiG l �`J2/t �/L Ir This application isoAPPRO� VE DENIED;for�the,catego y cheekedMnTSECTION:B- above; regarding emthe design of a ubsurface disposal system as indicated on the acompanied plot plan, using the requirements set fortt in SECTION C above. A build- ing permit is necessary for the installation of the above -designed system. No con - 1 struction Is nermltted In the required reserved 100% expansion area. (1)' Septic Tank must bed100 minimum from any wells4 Id V ^' Fr/G�/ (2) Leach lines must be 100' minimum from any wells, including expansion area. 0 (3) Sewer lines must be 50' minimum from any wells. Z(40) Z(4) Seepage pits must be, 150' minimum from any wells, including expansion area. U °"Y /i� M rN • / 'i fi�v ! +Y,.% i � �+'t%Q �Vr /�iQ//�f W 0 %) Signature of Health Official 4-,2 2,.9 Date DEH -SAN -122 (Rev 9/98) FOR OFFICE USE ONLY Revenue code al 1J Fee,$�Qv ❑ Check # Date %!i'„?�" �7 Initial 1;t NK—Bldg. OwnerAddress STA>1 a G�rf' City State Zip Telephone (7W Q ��' ' MAi1/AGCME,tIt .Z"dc • R 0, (36Yt e M 7 $ DF-: esRZr CA"- - 'V 4 9' 7 C Z Job Property AddressCity �W TE �?At A Zip �°--►ems n WLot Sizer �r Agency ,eir U„se of Permit, P/P, SUP, PUP, etc. 'Ef 1.A4 w,a 72� 6,9/14(,,,' Legal Description -T t q .a %;1�1�.. n �/ SM07 C t tr,R M(7.41n 1 t G ft Dwelling, MH Site:P a F9F, j„t . Signature of Applicant r (, 1 *•�� Date CHECK BOX IF REQUIRED If any box is checked, this application shall be considered rejected until the information is provided and the fee paid. Resubmittals later than 90 days after date noted below may require repayment of fees. m ❑ Holding Tank Agreements Completed Z 0 ❑ Certification of Existing S.D. System Required U❑ WQCB Clearance Required LU (Attach for DOH -SAN -007, Santa Ana Region Only) U) ❑ Soils Percolation Report Required ❑ Special Feasibility Boring Report Required ❑ Rereview Required Initials Date, ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) ❑ Staff Specialist Lot Inspection Required Thomas Bros. Page Grid ❑ Date Lot Inspection Completed: Initials Remarks: ❑ Maintenance Booklet Provided ❑ Final Inspection by Department of Environmental Health is required. Please call 24 hours PRIOR to inspection. C/42 / Soils Percolation Boring eport by Lic/Project # Date Soils Map Page �+i f Soil Type:; 4A Approved By Date No of Systems je!of Systems) No. Dwelling Units r% (1) Septic Tank Soil Rate kGrease/Sand eIding Tank ❑ Replacement Bedrooms, FixMre--Vfirtsr ase ihtcp Lint Trap xisting EJ Addition •N �x It/OO Gal. /10-- E" r0." t• s 0� ak Sq. Ft. Total Linear Sidewall Allowance Leach Bed sq. ft. of B ttom Area 'Ft. Bono Ar ft. rock/ sq. ft. running ft.. Install �e(s). long ft. wide withInlet Test. epth ❑ NA min. below drainlines or 0 Proposed Botto Tested'Depth Z Leach lines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Pit Maximum Othe O Total Depth Allowable 1- Applicable (/ { /Depth � d N/A Overburden F Factor WS' C �O TD Well Review Approved: Date: Well Drilling Permit # SIGNATURE Grading Plan Approved: Date: sl A Sewer Verification Approved: Date: Plan Check Only Approved: Date: REMARKS:.�Z.:!.Ge. 44_04._ /LzG rt�Y il/-lF .t u��+Y✓}�K.t�L /�. GfiG l �`J2/t �/L Ir This application isoAPPRO� VE DENIED;for�the,catego y cheekedMnTSECTION:B- above; regarding emthe design of a ubsurface disposal system as indicated on the acompanied plot plan, using the requirements set fortt in SECTION C above. A build- ing permit is necessary for the installation of the above -designed system. No con - 1 struction Is nermltted In the required reserved 100% expansion area. (1)' Septic Tank must bed100 minimum from any wells4 Id V ^' Fr/G�/ (2) Leach lines must be 100' minimum from any wells, including expansion area. 0 (3) Sewer lines must be 50' minimum from any wells. Z(40) Z(4) Seepage pits must be, 150' minimum from any wells, including expansion area. U °"Y /i� M rN • / 'i fi�v ! +Y,.% i � �+'t%Q �Vr /�iQ//�f W 0 %) Signature of Health Official 4-,2 2,.9 Date DEH -SAN -122 (Rev 9/98) FOR OFFICE USE ONLY Revenue code al 1J Fee,$�Qv ❑ Check # Date %!i'„?�" �7 Initial 1;t NK—Bldg. i1 1 PLI Leda! Description: �: L ct / LOGK,`f l I ; "d-* LOT .# -. -• - ; • i TRACK # 7IeS�r APN# 769—/13-009 C -- ADDRESS,.. ►- 1' 1 /-360 (,4cCL(4MMAc t. LEGAL _ a a I b , moved- lZ9 C. v �F. �0%, o r- CL 6 :, 9,y: r' nP) N . 5P�� ' s F 8 8 C'a��E'�'clgr�j�cq-•• ;;. PLOT PLAN n � I � MOD�1_ l2`rCi• Y . w i GI .. ,. • ' 5 il� m 000 6A�+ R SF3ri raMc ;. o wa ((iP� II + T*� Wit OE /0 --- - 61. I, AiaiE4= SFPTiC T1rJK d Sf_FPA6E Old '� i4.✓, i ,-tgee g (50A t�`. 9EDOA9 Pir ' i l00% EXPAdfion► C'a��E'�'clgr�j�cq-•• ;;. PLOT PLAN 1 w v{!- ,nil V��+•41. 'y. i`�• .T� x' �" .'""r'� 5 ' C 9 �,c�'� �r�` ai'• �.�I�I ��C I � i •'� „COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY --DEPARTMENT: OF WVIRONMENTAL -HEALTH Food A Searle Disposal Trailer Park O G,,;:'Ssptic Tank Motel, Apt., Hotel Sq. Ftrof Leach Lirie . I [Iwelling' 3 f�Dn� ^�`' ZNo. �Dia4 _BIN 3 TO �3 MD Seepage Pit Commercial Building Connoction to Sewer Swimming Pool Connect to Existing S.S.D.S. _4"o on-site regenerating water softening devices may be discharged into the individual sewage disposal system herewith approved without clearance from the Water'a4-t�,l,,�,miri6i,Board. Water supply "rvin this installation must be from an approved e`(Cy utDj ,� All sewage dispo§'�afl+�n must conform with requirements of current.'uniform Plumbing Code., ��Any cutting, grading or filling in excess,of two(2) feet will 'nullify'sewage disposal approval. ' /Approval ftas._tieen obtained from the Regional Water Quality Control 86ard for instatfation of t4 sewage disposal system." Tbo is to certify that the Riverside County Environmental Heafth Sennas approv" tt subsurface sewage. disposal plot plan to obtain building permit for • staflation, const r ' ion: OATS �? _a Y_" 9 1 By Mu�iV1AINTAIN"I— F.A. MIN. ANYNWANY TFWE OR W -MAIM *240-q/ATTft Septic tank and ewer Ones nog:�' 50 0, �,, �,•� from any �Vellsr� • Iuding expantian a ompap- pits mug# its 150 it, jwnimum .ftin 1 ony wells. Al /f�i %�`1.G.�-e'�� � „!'c/v`_e�v' G2'-�C"_' • 'lire x ., /., ; I:. X!,0, i. 'Anmw of ametplans kW.W DOMMM at FaW - FFFROM PARTMENT; OF PUBLIC HEA LT Us" of Riverside Coanti, dose not ielien th%a offla IS, VALIQ j .FOR ONE :i'(1) : YEAR ewer Architect of tare res 'onslwlititis ib• 4 , or Arebiteetarsl DATE OF APPROVAL fir 1' ' ' I ;l' r ei• 1�. r?,, -.� i " -sasr,r •18.. UBC' SEC. 2324 -IN OPEN BEAM CONSTRUCTION`. PROVIDE STRAP TIES ACROSS THE BEAMS AT THE RIDGE SUPPORT,AND PROVIDE TIES AT WAIL PLATES.: . CEILING JOISTS- AND 19. UBC SEC.231771 & •INCH MINIMUM...' CLEARANCE REQUIRED FROM GRAD TO • n�•rr�i� �c rr nen •�ic.•rn •.- - - -- " - - " `•""