10804 (PLBG)Building
Arlrlracc 51--351 Navarro
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Owner
Mr/Mrs Fenady
Mailing
Address saMe
City Zip Tel.
La Qui.nta 1 92253 1
Contractor I
Dateiand Construction
305 -Highway 111
City Coachella Zip 92.236 Te139$--5544
State Lic. City
& Classif. C42 396698 Lic. # 31
Arcn., tngr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I ytiereby affirm,that I am licensed under provisions o .Chapter 9 (commencing with Section
7 ) of Divisioni of the if6iness and Professions C e, and my license is in�f 11 (force and
effect. f � . i V J 2.
_SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires•the applicant for such pemtit to fife 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 penaity 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 Contractors 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.)
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 properly who barbs or improves 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
ke
kl hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worr's Compensation Insurance, ora 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 ff 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: N, 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 shag be deemed revoked. -
ti
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, CW 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
No. 10804
LDING: TYPE CONST. OCC: GRP.
P. Number
;gal Description
oject Description_ _Abandon existing € ept c/seep.3gE
and install new one
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. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
4-,000
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. t. w
63.00
Mech:
`
Electrical
Plumbing
S.M.I.
.40
Grading
Driveway Enc. ,
Infrastructure
TOTAL
63.40
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. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMSOUGH
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPIEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
REMARKS:
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
FORMSOUGH
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 SIGNATURESIINITIALS
GARDEN WALL FINAL
i
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1
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11111JR 1 M ' /
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APt\j 773 -1 3 -n0 7
FENADY RES. ' ROOM ADD.
SCALE: (� 1_ ZQt
APPROVED BYt
DRAWN BY -:5 E
DATE: 3
REVISED
51-351 NAVARRO LA QUINTA CA.
PLOT PLAN SEPTIC SYS_
ORAWINO NUMBER
AWNTANY 100%
Ml 10, E)CDAMOPOM
IA
N y %Rv q- AnvA, MIN,
*r
E D E
EPARTWEPP' 01F ?U,,jUC
IS VALID FOR
FROM0) YEAR
FROM DATE OF APP �
I ------ �-"RDVAL I
RMMME COUNTY IMPARYURNT OF PUMUC HULTH
MIXON OF 0011-ROMMOEMAL HUM
hod EdMOrwot So -me -v Dispml
Trailer Park
Septic Tank
ip 7 q. R. of Leach Line
2C -Y-Q�smjmm Pit
CIM-111.00za to Omar
NO On-SItO FaW-.;VZt4fr, t
T!D n? t-.- j,2 smge Ispaw
Nd 1.-,'-,eP d
Won hers virt;'. awout'.11 "ff,7j.
�"," " r C'�,x-MY
Water sup,,Pj VYo,
All wM-Q 5P
Unift-m P1unt',,jjjS Loft
Any wtWW or 43 t,.0 md-N3P �w 6sprml approval.
APProv31 has ttwn @btained
dist %-A". Con,rull Vaird for instaRetim of the "wgq
Thisis to portly that the ftw&Wa Cmm.'y DZ�Xftw't Or Pubfic H&IM &PPn;m =
far CPar-q, amstrwtim )r
fts"m the itemsdwA-.d ebm
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COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH AssessParcel No.
�%�'`� —��3 � — ®�%
ENVIRONMENTAL SERVICES DIVISION
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Appllcant: 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.
d0�G�3WKoval?pf t�iis-iptit°ation shall remain valid for a period not to exceed one year from date of approval.
LOG # VERIFY ITEMS IN SECTION A FROM A NON -FEE BUILDING & SAFETY (goldenrod) APPLICATION w
Agent ntFactor, Contact�PeraQ1)
Phone
Address City State Zip
e AMD r_0 cryo Co. /NG',
319-5501
SO -3 &S- 9194 ja Go 6W.Ioj C-4 9'2. 7- > y�
Owner
Phone
Address City State Zip
MA¢ Mes F"rAlA1Dv
$_/-35_/ 4(U AIA1400 k Qlewnf Ca 92253
Job Property Address
Add' AIWWAO
City
A �UiN1"�i
State
Zi
�as
Legal De ription top. (PM Tract, t)
�
..S/-351
✓ '4c — L 4r/�iv9� rr� /H
Lot Size
Water Agency/Well
Use of Permit PIP, CU, etc.
Other
�
V L.a
Dwelling, MH Site Prep, etc.
,�<.• k� �a . , ` � .��
A47V. 0 CoN.S'TR#r_jVgl ca lye_ 6q WtAf
Si nature•of Applicant Date"
CATEGORY REV CODE FEE
CATEGORY REV CODE FEE
)0' SUBSURFACE DISPOSAL (per system) .. 1238 $153.00
)0 SITE EVALUATION UPON REQUEST 7349 $120.00
❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION
(NO PLOT PLAN)
❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00
a. istA.Parcels(Each) -+. 1238 ,$153.00'
❑ PRELIMINARY ELECTIVE EVALUATION `
b. Each Parcel after 4 7344 $ 55.00
(Attach DOH -SAN -53) 7352 $ 69.00
❑ REREVIEW (2nd review same parcel) 7344 $ 55.00
❑ HOLDING TANK 7351 $119.00
❑ SITE EVALUATION In Conjuction with Critical Area 7346 $197.00
❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00
❑ 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
. I INITIAL DATE
Holding Tank Agreements Completed ❑Yes ❑ No
Certification of Existing S.D. System Required ❑l Yes O No
i I V
WQCB Clearance Required ❑ Yes O No
(Attach Form DOH SAN 007, Santa Ana Region Only) E
Soils Percolation Report Required ❑ Yes ❑ No
1 i
Special Feasibility Boring Report Required ❑ Yes O No
^" 1
Detailed Contour Plot Plans.Required (1 to 5 ft. interval) ❑ Yes ❑ No
Grading Handout Provided ❑ Yes O No
i
Staff Specialist Lot Inspection Required ❑ Yes O No
Maintenance Booklet Provided ❑ Yes ❑ No Lot Inspection Date Initials
C/42 / Soils Percolation Boring Report by.. LiLic/Project # Date
`V
Soils Map Page Soil Type C` Approved By - U Yu! = `t� Date l%-
No. of Systems
Type of System(s)
❑ Holding Tank heReplacement
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand
f❑
New ❑Addition
Bedrooms, Fixture Units
5 O
�
Greaselntcp/Lint Trap
❑Existing
? U��I rno rr� ,e sr>�i�y 1
/coo Gal.
0 a� hil,
P Gal.
n
Sq. Ft.
Total Linear
Sidewall Allowance 4
Leach Bed sq. ft.
Bottom Area
Ft.
ft. rock/ sq. ft, per running ft.
Install Line(s) ft. long ft: wide with
of Bottom Area
Inlet Tested Depth O NA
min. inches rock below drainlines or
Proposed Bottom Tested Depth
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Other:
Applicable
Inlet (BI)
(TD) /.,/
Max.!towable Depth
N/A Overburden Factor
❑ 5 IR 6
q0L
Well Review Approved: Signature Date Well Drilling Permit #
Grading Plan Approved: Signature Date
REMARKS: 1' xr s-fi.'� Sy r-f/.,v be 4,,i&1 /vC-Ixe) I r�
',ro
This application is APPROVED/DENIED 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. A building permit is necessary for the installation of the above -designed
system No construction is earmitted in the required reservad 1004 axnansinn area
(1)) Septic tank must be 100' minimum from any wells
(2) Leach lines must be 100' minimum from any wells, including expansion area
(3)) Seepage pits must be 150' minimum from any,wells, including expansion area
il�•%✓-
Signature of Health Official/..� ,� z� K� `�lS Data 9" f
❑ CASH W CHECK NO. ? 2 7,
RECEIPT NO. J 1 -7 A% J r! �✓ <z,�
Issued By..�..-•�, f-�d Date 41- i - ri
c
DISTRICT- ❑ Riverside ❑ Indio ❑ Hemet . ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH-SAN-122(Rev6/91) DISTRIBUTION: WHITE --Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Plans/Records
tl