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05328 (SFD)Tjbf 4 .fwQ�r«rw P.O. BOX 1504 Building 54-440 EISMOM78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner ' CWHELLA VALLEY LAND Mailing Address 247 E. TARQUM #2 City Zip Tel. PALM SPRINGS 92262 1 322.1020 STARR CONSTRUCTION Address SME State Lic.I City , Sm Classif. & .7 / 3 Y Lic. # r i' Designer Address Tel. City IZip I State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of tension 3 of the Business and Professions Code, and my license is in full force and effect .. lam{.. ^ ,�.� SIGNATURE DATE OWNER -BUILDER DECLARATION . 1 hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,8ushess and Professions Code: Any city or county which requires a permw to conNruct, ater, improve, demolish, or repair any structure, prior to is issuance also requires the applicant for such permd to tie a signed statement that hes licensed pursuant to Ne 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 exenW on. Any violation of Section 7031.5 by "any applicant for a permit subjects the applicant to a dvv8 penaNy of not more than rive 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, Suisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds of rrproves thereon and who does such work himself or through his own employees, provided that such rrprovemeMs are not intended or offered for sale. lf, however, the building or krprovement is sold wNfift one year of completion, the owner -budder wird have the burden of proving that he did not buil 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, Buskhess and Professions Code: The Contractor's License Law does not apply to an owner of property who bu kft or knproves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. -B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION / I hereby affirm that t have a certificate of consent to self -insure,- or a certificate of Worker's Compensation Insurance, or a certified copy thereof.jSec -3800, Labor Code.) Policy No Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKED' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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: 9, after making this Certirmcate of Exemption you should become sublatx to the Workers' Compensation provisions of the Labor Code, you must forthwith campy wth such Provsiws or LNs 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 abuilding 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. 1 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. ®5328 BUILDING: TYPE CONST. A.P. Number 774-253-009 Legal Description WT 15 BLR Project Description "D OCC: GRP.- 300 MT Z7 Sq. Ft. 1414 Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ r— - r— Estimated Valuation 76,360 PERMIT AMOUNT Plan Chk. Dep. 250.00 Plan Chk. Bal. Z '.59 Const. 5 D Mech. D. 50 Electrical 10T._41 Plumbing 157.50 S.M.I. Grading 20000 Driveway Enc. 20.00 Infrastructure 1,679.b5 TOTAL f REMARKS Iii L'rtyir Y ihJYi�F_ L hi- + 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 2/7189 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS A.C. UNIT COLL. AREA (SLAB GRADE I YARD SPKLR SYSTEM 2ND FL. SQ. FT. @ BONDING HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR. SQ. FT. @ SEWER OR SEPTIC TANK ROUGH WIRING GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. DRAINAGE PIPING CAR P. I SQ. FT. HEATING (FINAL) WALL SQ. FT. REINF. STEEL DRINKING FOUNTAIN SQ FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation WATER HEATER FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LUMBER GR. LAUNDRY TRAY AIR HANDLING UNIT CFM FRAMING 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 FIRE ZONE ROOFING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 C SEWAGE DISPOSAL SQ.FT.GAR ® V4c 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 S AIR GOND. SOLAR &SETBACK— GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA (SLAB GRADE I 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 APPJEOUIP. 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. ROOFING3 / /C l I t o �( L/��`/I REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL THING ' MESH INSULATION/SOUND L FINISH GRADING FINAL INSPECTION 7-7— CERT. OCC. CERT. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS GARDEN WALL FINAL .._ _ . _ .- �...-r. r.,�r.--:-g, -i M:r -`.-, ti.::-�••.---��,.•.�s.'wl'eFt9.i-Y.t�r-^yi*• �`S��s:r'�,. �ti'`v.1�" � `�t`'- t+•-f+z..ti�"'n� '+J . �•'":w . ,-: •t Q z O U W M z O U W A z 0 U W z 10 LU a A W �D COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Asses om Parcel No. Z S-3 — �� ENVIRONMENTAL HEALTH SERVICES 9 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. VERIFY ITEMS IN SECTION A FROM BUILDING 6 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG- # Agent, Contractor, Contact Person Phone Address 8 Phone S � GeJ5Y-0_1Jc7-1C1A_) 322-/c7 .-' Owner Phone Mailing Address .2 E T.?A4©u,-rT_ t2�� City P!-�L✓Y/ $ poeiAjas State Zip zGZ..S'•/s� Job Property Address �lS�.rJnbau legal Description Prop. (PM, Tract, Lot) �'L.s /S E� UuiTrZ Lot Size -WaterAger c I Use of Permit P/P, CU, etc. -,(a>- Other eeling,AH D Sitd Prep, etc. f 3/ 8 Signature of Applicant / Date ,/ CATEGORY: REY CODE FEE CATEGORY: REV CODE FEE 0, SUBSURFACE DISPOSAL 1238 ,-A5.00 ❑ SRE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME . " (NO PLOT PLAN) LAND DIVISION ' -EI -SEWER/SEPTIC VERIFICATION 7348 $11.00 a. 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year) b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE ' "-' 7352. $45.00 ❑ Rereview (2nd review same parcel) 7344 $16.00 EVALUATION (Attach DOH SAN153) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $45.00 Critical Area 7346 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 JNITIAL DATE Holding Tank Agreements Completed ❑ Yes l�.f.r �IL- A` a �zo Certification of Existing S.D. System Required ❑Yes WOCB Clearance required. (Attach Form ❑ Yes D No DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑Yes © NoO Special Feasibility Boring Report Required. ❑ Yes tO N Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes , N 011i er ❑Yes %� Staff Specialist Lot Inspection Required ❑ Yes ❑ No --A Lot Inspection Date a Soils boring report by' 'Project # Date Soils Map Page Soil Type `-ter Approved by �%fd/� .;2 - a Date No. of Systems Type of System(.) ❑o(ding Tank ❑ Existing No. Dwelling Unitstel Bedrooms, Fixture4Jnb (1) Septic Tank Soil Rate Grease/Sand Besse Intop , 0 New ❑ Replacement�j/ZAiX // `Gal �t 7 �� Gals Une Sq. Ft x(22om trench area Sidewall allowance R R v � Install �sL,k*s) R long ft wide with Leach Bed sq. f Leat rode/ sq. per running R hne min. hes rade bebw�� lines or of dottomaarea Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit atal Depth Other Applicable r Inlet (BI) l` N/A Overburden factor - Max. All �e Depth No. 2 System/- vL' t i�� Ct��,, f�Ze— �RIEMARKS: J/ This application 1 PPR ENIED4or 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. A building permit is necessary, for the installation of the above -designed system. No construction is permitted in the required reserved 100% expansion area Septic tank lines be 50' from (1) and sewer must minimum any wellsA)", Leach lines must be 100' minimum from any wells, including expansionrea (3 Seepage pits must be 150' minimum from any wells, including/ expansion area/ l Si nature of Health Official .c - Ci�✓�! +�v •11�. �t C"u7' p Date RECEIPT NO. f / Issued By a/� Date DISTRICT: ❑ Riverside, ndio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑. Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept . GOLDENROD - Plans/Records 14, 7'r:. ,.l��'F����"•1;'�'?����,.w'i7G'.•is3.{�m'i}"�•'iii;.�w...GFl1.•r"Yid'"wM'�L"�YJ:.:7f�,r.'".'1�6Vrrijd{r.�%"-i'���r��i..'�.,•.ir.,,,1+�Mr.�vAM17YY'+I•ri.5.1{'si�•i!T?F'r�M t r ti Buena Engineers, Inc. 79-811 Country Club Drive; Suite 4 Bermuda Dunes, CA 92201 - (619).346-1588 / 328-9131 C*64 Name /7 i G�,r�✓ Clierit Client Phone DATE TESL LOCATION LOT NO• JOB NO. PROJECT / REFERENCE CURVE LOCATION DRY DENSITY IbsJCu, ft. MAXIMUM DRY DENSITY % CONTRACTOR OPTIMUM MOISTURE CONTENT % OWNER WEATHER TEMP, 0 8T AM Qt PM PRESENT AT SITE r 70 6 TEST NUMBER TESL LOCATION LOT NO• ELEVATION FIELD TESTING REFERENCE CURVE MOISTURE CONTENT % DRY DENSITY IbsJCu, ft. MAXIMUM DRY DENSITY % MAXIMUM DRY DENSITY IbsJcu. ft. OPTIMUM MOISTURE CONTENT % 70 • 5 �' (f " d : i. ,N,. .r. _ i?j[.�{Y''61?. hLr'rt' M� ; � '• lw ' _ t.�r�l ':.r1 �• S".•i � i :_F1h; �.a'M"r' " .. .. ,., REMARKS: riv c / !� 7 /7 fl....• M1� I ��vrw • t•....�._.; A -41 CLIENT REPRESENTATIVE.. 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