11540, 11473 (SFD)n t.v P.O. BOX 1504
'aq
Building i'N 78-105 CALLE ESTADO
Address A'vran>iaf� LA QUINTA, CALIFORNIA 92253
maning I
Address A 9; ft
City rZip ITel.
Con
Zip Tel.:
& Classif..B 638535 Lic. # 859
Arch., Engr.,
Designer Lam a, a A Age-nf!iztte_c;
Address I Tel.
n.5,ru..Any -F axe! HATE' 1 4110�1--.3J,0_0
City Zip State
San Diego 1 92119 1 Lic. # C 13333
f LICENSED CONTRACTOR'S DECLARATION eS
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
-Neffect.
'SIGNATURE AY r•' k C ,u /' l9 - DATE
p
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor s,Licerise 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 ($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, 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 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.)
D 1 am exempt under Sec.—B. 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,. ff, —Company
q,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 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
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 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
No. 11540
BUILDING: TYPE CONST. OCC'. GRP.
A.P. Number 773-063-013
013
Legal Description T.,%+- I R1 rtt+k 7
Project Description SPS
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:
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New 0 Add ❑
Alter ❑ Repair ❑ Demolition ❑
Permit does not include
black willq
or pool.
Estimated Valuation$90,923-60
PERMIT
AMOUNT
Plan Chk. Dep.
250.00'"
Plan Chk. Bal.
258.25
Const. ' .
599.00
Mech.
49.00
Electrical
126.82
Plumbing
144.00
S.M.I.
10.00
Grading
20.00
Driveway Enc.
Infrastructure
2,007.53
f"1:�r•i��.'« t,it$`'.;C.t;?—:1r:...7j__
j?
• `, -
A'a - +.. i+utt 1 Ynytr„ t .x v.v✓
TOTAL
3,464.60
3,214.60
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
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEEK
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
2ND FL. SQ. FT.T.
FORMS 3
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
TEMP. POLE fix [[[
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
SERVICE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
BOND BEAM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
FRAMING 2 l�
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
FIRE ZONE ROOFING
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. ®,
BATH TUB
LATHING�
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
1
MICRO FEE
1 . I
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE- T
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK /— v
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 3
SEPTIC TANK
! ? OUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) 713
a •7 r?
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL G
GAS (FINAL)
TEMP. POLE fix [[[
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.a�r/3
.3
FINAL INSP —Z7::2!t$--Plus-x$-=$
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING 2 l�
ROOFING 3 T�
`
_ S/bc�/` 3,L
&C
�/
[`
I Q e
,.�
q
��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING�
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION 2 dj
[
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
4
P.O. BOX 1504 .0�_,-APPLICATION ONLY
Building , ILEA 7P 7&105 CALLS CALIFORNIAESTAD9 I
Address LA QUINTA, ORNIA 92253
Owner
5
Address
City Zip
4A 4 f)Ly 4s2S3
Contractor
650
l
Address
rolleV 4<0
Y p
City
WU (077A z�r t z c 3
State Lic.
& Classif. P-5 G 3R C 3 <—
Designer L) mgt A f� ,< .
ress
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number %7 3 • 6 b ( 3
Legal Description /-O—r z 7P—L.k. -7/
Project Descriptions
Tel.
City
Lic. #
t:-:, •a or U t N V/ L ICS• Aura 1 1 is �
City IZ4 State
E, C) Z //'1 1 Lic. # C, /3
LICENSED CONTRACTOR'S DECLAP ATION
I hereby ali irr)t that am licensed under provisions of Chpoter 9 (commencing with Section
7()00) of Division 3 o the �us'ness agd,Profess'gns Cod and my license is in full force and
effect. L 1/��C /D - /;2 !12-
OWNER-BUILDECLARATION
I hero y affirm that I am exempt from a Contractor's License Law for the following
reason: Sec. 7031.5, Business and Prof. ns Code: Any city or county which requires a
permit 1 construct, after, 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 (5500).
11 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.)
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 contractors) licensed pursuant to the Contractor's License Law.)
I 1 I am exempt under Sec. B. 8 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
(� Copy is filed with the city. O 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 shalt 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 1 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
BUILDING DIVISION
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:
Sq. Ft.
Size /S3w
No. No. Dw. /
Stories Units
New ❑-- Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
,Z7 .--
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
7 `�
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
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ - $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. C�
GAS (ROUGH)
METER LOOP
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. (&
GROUT
WATER HEATER
WALL SO. FT. @
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. @
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)IDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 I c
SEWAGE DISPOSAL
SO.FT.GAR @ ?Ac
HOUSE SEWER
FINISH GRADING
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 APPIEOUIP.
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 SIGNATURESIINlT1AlS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 1/8/93 1 Type of Permit I La Quints
No. 11958 Permit #
�--�
Owner Name Sterling Homes Log
No. Street See Below
City La Quinta Zip 92253 Study Area 113
APN # Tract #I = Lot # Square Footage 16144
Type of Development I Single Family Residence INo. of units
Comments 51-400, 51-440 Avenida Ramirez, 52-640 Avendia Tuarez, 51-045 Avenida
Herrera
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 6144 or $ 9,707.52 have been paid to D.S.U.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 564-1866
Name on the check
By James E. Lively
Assistant Superintendent, Business Services
Fee collected /exempted by Vickie J. Durrett
_ Payment Received
Signatures Check No. 1251
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
._..p -.•mow ��,T,wy,�-�o•s R%a 1i�i ,#; ... .. n„ r y-�,�f ear.,+v "a1n'K',o Y^oftY•!""w.'+rl�'r't�•:�ii.>•,Pr�:ivlc.'-"r4•� �'ty' ,., +`a:�
�i'•
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY i�` Assessors Parcel No.
DEPARTMENT OF ENVIRONMENTAL HEALTH
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-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.
4 G&6,t ic1'fVERIFY A SAFETY
LOG # ITEMS IN SECTION FROM A NON -FEE BUILDING (goldenrod) APPLICATION
Agent, Cont ctor, ntact Person ,`%��
Phone
Address Ciry State Zip •. A
DEL
¢•ie6�
/?o.r3oX4a�a "e?i/Arxi CA Szzxs t
Owner
Phone
Address City State Zip "
SVS -e .( 04
S4 4•/8
•o •$cic45 o GA uf,07A CA • lzzS
Job Property Address City
State
Zip
Legal Description Prop. (PM, Tract, Lot)
S ams,;,4 V6 . j A �( NTA
CA
22S --Z
0T 2 &X 7/ 5q� .•('4nA4
Lot Size
rwater Agenc M
!%+cc
Use of PermitPIP, CU, etc.
_ A0Ir467 ArQf
Other AT- �i-j 1A�
/
X) OQ
U4_M✓P_ tys-T,
of
Iling, MH Site Prep, etc.
��/T � •r
-
�ne..
l
:
n �; : Si nature of Applicant t.
Date.+
CATEGORY REV CODE FEE
�L: �' ' CATEGORY [A REV CODE FEE-
!
S URFACE DISPOSAL (per system) % 1238
j
❑iSI.TE EVALUATION UPON REQUEST 7349 $120.00
LOT PLAN)
ElLTIPLE PARCELS WITHIN SAME LAND DIVISION 1
(N <.
4 1
C3SEWE ,;SEPTIC VERIFICATION 7348 $ 58.00
a. 1st 4 Par'cels,(Each) 1238 $153.00
55.00
❑ PRELIMI�N� Y ELECTIVE EVALUATION
DOH• '
-- 7344 $
b. Each Parcel after 4--_1_1
(Attach AN -53) 7352 .$ 69.00
❑ REREVIEW (2nd review same parcel) 7344 $ 55.00
Ya�
O HOLDING TANK ^'" a 7351 z $119.00
❑ SITE EVALUATION in Conjuction with Critical Area 7346 $197.00
❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345` $656.00
❑GRADING PLAN REVIEW DETAILED 1238 $104.00
❑ SITE EVALUATION Lot Less than 10,000 Sq. Ft. 7347 $172.00
❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00
❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00
❑ COPIES (LAND USE) 7786-81 $
a
.50
�-+ ITIAL DATE
Holding Tank Agreements Completed O Yes 2' No Q
Certification of Existing S.D. System Required ❑ Yes Y "0
WQCB Clearance Required ❑ Yes N� O
(Attach Form DOH SAN 007, Santa Ana Region Only)
I Soils Percolation Report Required " ❑ Yes N�o t
Special Feasibility Boring Report •Required ❑ Yes :NNoo
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑Yes
� r"
Grading Handout Provided ❑ Yes PNo,
Staff Special istiLot. Inspection Required ❑ Yes N9 .'
Maintenance,Booklet Provided ❑ Yes Lot Inspection Date Initial
C/42 / Soils Percolation Boring Report by Lic/Project # ' Date
Soils Map Page Soil Type G Approved By /r'W/1--- Date
No. of Systems
Type of System(s)
No. Dwelling Units /
(1) Septic Tank
Sol) Rate
F7i7
G ase/Sand
Gra
I-1 Hei3'Ing Tank c3Replacement
ew ❑Addition
Bedrooms, e-6%ls
/*S
/UntTrap
3 �1 QA/N . ��e-
� Gal.
��
9 Gal.
❑ Existing \,.
q. Ft.
ttom Area
Tal Linear
Ft.
Sidewall Allowance, ".
n. rock/ :- sq. ft. per running ft.
Install Line(s) ft. long ft. wide with
Leach Bed sq. ft.
of. Bottom Area
Inlet Tested Depth A_
Proposed Bottom Tested Depth
min. in below drainlines or
l
Leachlineslbed special design for slope:
;verbu
(3) Pit Diameter
NO. Pits
-�;
Pit Below
Inlet (BI)
Seepe Pit Total Depthag
(TD) "' 3
Max. Allowabr Depth
6 r
AApplicable
N/A +// Orden Factor
Well Review Approved:,` — Signature Date Well Drilling Permit #
Grading Plan A rovedzSignature --_� Date
REMARKS: -
This application s AP�,�.for"the_takegory checkedn SECTION B above, regarding the design of a subsurface disposal system as indicated
on theaccompanie peA et forth in SECTION C above. A building permit is necessary for the installation of the above designed
SyPt 4L 000 y ;
1- , Septic tank must be 100' minimum from any, wells R/ring
teach+line must be 100' minimum from any wells,`inclx sion area
(3) eepagevpI 'ust be 150' minimum from an wells, including pansion area qt �p
n
Signature 'Health; 'cLla, w • i�.G I �"�r
ofQ„ Date
•. Vis! ❑ CASH 916FIECK NO.1/ Y_
4'4 +
RECEIPT N0. f0 / Q ,: Issued By Date
DISTRICT - ❑ t Riverside 2T IAdi0 ❑. Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH•SAN-122 (Rev 1/92) DISTRIBUTION: WHITE 7 Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Plans/Records } t
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
. .. . 9. . . . . I
Na 420 , 0
Address:
eT
t,n'
/0
Account NoZ�to 10
Lot(s)
Tract
Service Address
Code
Meter(s)
$
�Servlce(s) 77
0 Backflow(s)
C? House Laterals)
0 Detector Check(s)
0 Meter Surcharges
0 Sanitation Capacity Charge
0 W.S.B.F.C.
0 Temporary Construction Meter
0 Turn on Charge
0 Uncollected Account -Name
0 Inspection Fee - Tract -
Fee -
0 Plan Check Fees Water / Sewer -
Tract -
0 Bond Payment - A.D. -- Bond —
Assmt.
0 Customer Deposit
0 Other
I _1 —
Remarks: /
OCOPY to:
Cash
Check
7—
Money
Order
TOTAL $ _-� � OD, !!5;0
Water Service
Cashier
CVWD-
ti Y
.if 14a ut�t
This Certificate issued pirsuant to the requirements of Section 306 of the Uniform -Building!
Code certifying that, at the'time of issuance this structure was incompliancewith : the'iiarious
ordinances of the City regulating building construc ti6, n -or use. 'For the following;
BUILDING,- ADDRESS 51-045 Avenida Herrera
Use dlossification Single Family Dwelling Bldg. Permit No. 11473
Group R3 Type Construction VN Fire Zone use zone SR
Sterling Homes P.O. Box 450
Owner of Building Address
City La QiAnta, CA 92253 Mark Harold
By.
Date; August 12, 1993
Building Official 'POST IN A CONSPICUOUS PLACIE
Client Narne
Client Address
—p–
SYSTEMS CONSULTANTS S.C.
BUENA ENGINEERS DIV.
79-811 B Country Club Drive
nuda Dunes, CA 92201 • (619) 345-1588
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DATE
3//2-/9-5
TEST LOCATION
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JOB NO.
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PROJECT
LOCATION
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CONTRACTOR
MOISTURE
CONTENT
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0 at PM
PRESENT AT SITE
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NUMBER,
TEST LOCATION
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NO.
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
%
DRY
DENSITY
Ibs./Cu. it.
MAXIMUM
DRY
DENSITY
%
MAXIMUM
DRY
DENSITY
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CONTENT
%
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REMARKS:
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FIELD REPORT
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CLIENT REPRESENTATIVE SIGNATURE TECHNICIANS SIGNATURE N?
5378