SFD (10858)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 51—$00 Navarro LA QUINTA, CALIFORNIA 92253
Owner
Torres
Adti�ess P. 0. Box 772
City Zip Tel.
Coachella 92235 1 350-3337
A. 0. Torres
same
City Zip Tel.:
State Lic. City
BClassif.. 55049$ 1 Lic.# 1451
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 force and
effect. /f' ,
SIGNATURE DATE
OWNER -BUILDER DECLARAT16N
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bustness 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 signedstatement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
0iviston 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
suNects the applicant to a civil penalty 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. (Sac. 7044, Busness 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. H however, the bum7dmg
orImprovement is sold within one year of completion, Phe owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
O 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.)
❑ 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 thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
1 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: 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 abuilding permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
1 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 -of this city to enter the above-.
mentioned property for inspection purposes..
Signature of applicant Date
Mailing Address
City, State, Zip
No.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 773--1$4--003
Legal Description Lot 22 Block 121 Unit 12
Project Description SFD
ZONE: BY:
Minimum Setback Distances:
Front Setback. from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE, INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft. 1474
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Pe=.it aces
not include
black wall or
pool
Estimated Valuation
87,638.00
7'S3$•0
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
255.05
Const.
505.50
Mech.
52. 00
Electrical
124.13
Plumbing
163.50
S.M.I.
8.80
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1894.11
udriz'<�IWiZ%:?rt! tU4, ?1tYAl�f �c'i't !fir
TOTAL
33-84.09", ._ . :31.34.U.T..
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. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT, ®
CARP. SO. FT.
WALL S0. FT.
SO 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
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) METER LOOP
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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. ® c
BATH TUB
FINAL INSP. (t� / Q�
l u
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
REMARKS:
SO.FT.GAR ® 3/ac
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 41LUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING �f` ( 1NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEGOEFi OR SEPTIC TANROUGH 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. (t� / Q�
l u
FRAMING ) (1
FINAL INSP. l S ?3 (P
ROOFING ✓ �40:2L
`e c �
1 !fy
0
0
REMARKS:
-n�
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
H NG L4
MESH
INSULATIONISOUND ��✓ Z�
FINISH GRADING
FINAL INSPECTION-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Building /
Address
Owner
Mailing
Address T O
City
Ga
Contractor�^^
Address. .--
City._-.. . .
State Lic.
& Classif.
— •
Arch--,Engr.,
Designer
Address
god
o -7 7 2
Zip
I
City
i Lic. #
City Zip
_ LICENSED Cot
I hereby affirm that I am licensed and
7000) of Dlvlslo the Business ander
effect.
P.O. BOX 1504 APPLICATION ONLY
78-105 CALLE ESTADO
&Ro LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST.I�OCC. GRP.
A.P. Number
-3400.333,7 Legal Description -
Project Description
Tel.
State
Lic. #
'DECLARATION . .
of Chapter 9 (commencing with Section
Code, and my license is in full force and
,GWNER-BUILDER. DECLARATION -
I hereby affirm that I am a empt from the Contractor's License Law for the following
reason: (Sec- 7031.5,Business and Professions Code: Any city or county which the,
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 live 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.)
❑ 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 thereof. (Sec. 3800, Labor Code.)
Policy No. Company '
0 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 thg work for which this permit is Issued; I shall not
•-employ any person in any mannerso -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
Ihereby affirm that there is a construction lending agency for the performance of the
work fpr 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
BUILDING DIVISION
TOTAL I 275.
Sq. Ft. No. No. Dw.
Size �� Stories % Units
New Add ❑ Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk..Dep. l
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing -
S.M.I. ;
Grading
Driveway Enc.
frastructur
Q rte'—
' F �
1 -•
TOTAL °7
REMARKS
f�
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.
FOR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOB]LEHOME 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
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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
ROCKSTORAGE
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.
$ 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 ::1
DESERT SANDS UNIFIED SCHOOL DISTRICT o
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 5/6/92 Type of Permit I La Quinta
No. 11368 Permit #
Log #
Owner Name Alex Torres
No. 51800 street Avenue Navarro
city La Quinta
Zip 92253 Study Area 115
APN # # Lot # Square Footage 11474
Type of Development joingle Family Residence No. of units
Comments ,
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 11.58 1 X I 1474 or $ 2,328.92 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.` r
-Sz
Fees Paid By Alex Torres/Cashier Check Telephone 36U 7
Name on the check
By James E. Lively
Assistant Superintendent, Business Services
Fee collected /exempted by Vickie J. Durrett
Payment Received
Signature ems, t Check No. 255
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
MAIL TAX STATE ]KHTS Tot
T�
~oW a NagT, N-1 m
INccC
F- c v Q U c� r c3 O
C3 2 $ W
0
SPACE ABOVE THIS 1E FOR RECORDER'S USE
G R A N T D E E D"
The undersigned grantor(s) declare(s):
Documentary transfer tax Is $40.70
(X) computed on full value of property conveyed, or
( ) computed on full value less value of liens and encumbrances remaining at time of sale
( ) Unincorporated area: (x) City of La Quint a.
FOR A VALUABLE CONSIDERATION, receipt.of which is hereby acknowledged:
M
Robert C. Rich and Roma J. Rich, husband and wife, and Stephanie K. Price, trustee
of the Stephanie K. Price Living Trust dated September 22, 1989, and Walter T.
Covington and Patricia Covington, husband and wife, all as tenants in common.
hereby GRANT(S) TO
Manuel o. Montenegro and Alice D. Montenegro, Husband and wife as Joint Tenants
that property in Riverside County, State of California, described as:
Lot 21. and 22 in Block 121 of Santa Carmelita at vale La Quinta, Unit #12, as shown by Map
on.file in Book 18, Page(s) 79 thru 80, in the office of the County Recorder of Riverside
County.
Date: November 22, 1991
STATE OF CALIFORNIA )
COUNT? OF Orange )
On _November 25, 1991 before me, the
undersigned, a Notary Public -in, and for
..said state, personally appeared Robert"C.
c and Roma J. Rich
'P1e)"i0A1"1 / 1kAV*H / 1W ( r proved to • me on
the basis of satisfactory evidence) to be
the person s_ whose name s are subscribed to
the within instrument and acknowledged that
they execy�d__thesame. witness my hand and
official sal.
.Signature
Pat Faris
Name (typed or printed)
R rt C. Ric
0 1C
0.
i
tepha ie K. rice, trus ee
se. attached for signature
WalterJ T Coving
Patricia Covington
OFFICIAL SEAL
PAT FARIS
q01MY
NOTARY PUBLIC -CALIFORNIA
PRINCIPAL OFFICE IN
ORANGE COUNTY
Commission Expires Sept. 74. 1993
(This area for official notarial seal).
MAIL TM STATMUMS AS DIRECTED ABOVE
a
'
CORDER /,# . , � :1�:... '..., .`1 �r ••.j °.
EF7,CROW # 5448 -JC
WHEL7 RECORDED MAIL TO:
. H
Emanuel I. Montenegro -
68-545 Tachevah Drive
Cathedral City, Ca. 92234
MAIL TAX STATE ]KHTS Tot
T�
~oW a NagT, N-1 m
INccC
F- c v Q U c� r c3 O
C3 2 $ W
0
SPACE ABOVE THIS 1E FOR RECORDER'S USE
G R A N T D E E D"
The undersigned grantor(s) declare(s):
Documentary transfer tax Is $40.70
(X) computed on full value of property conveyed, or
( ) computed on full value less value of liens and encumbrances remaining at time of sale
( ) Unincorporated area: (x) City of La Quint a.
FOR A VALUABLE CONSIDERATION, receipt.of which is hereby acknowledged:
M
Robert C. Rich and Roma J. Rich, husband and wife, and Stephanie K. Price, trustee
of the Stephanie K. Price Living Trust dated September 22, 1989, and Walter T.
Covington and Patricia Covington, husband and wife, all as tenants in common.
hereby GRANT(S) TO
Manuel o. Montenegro and Alice D. Montenegro, Husband and wife as Joint Tenants
that property in Riverside County, State of California, described as:
Lot 21. and 22 in Block 121 of Santa Carmelita at vale La Quinta, Unit #12, as shown by Map
on.file in Book 18, Page(s) 79 thru 80, in the office of the County Recorder of Riverside
County.
Date: November 22, 1991
STATE OF CALIFORNIA )
COUNT? OF Orange )
On _November 25, 1991 before me, the
undersigned, a Notary Public -in, and for
..said state, personally appeared Robert"C.
c and Roma J. Rich
'P1e)"i0A1"1 / 1kAV*H / 1W ( r proved to • me on
the basis of satisfactory evidence) to be
the person s_ whose name s are subscribed to
the within instrument and acknowledged that
they execy�d__thesame. witness my hand and
official sal.
.Signature
Pat Faris
Name (typed or printed)
R rt C. Ric
0 1C
0.
i
tepha ie K. rice, trus ee
se. attached for signature
WalterJ T Coving
Patricia Covington
OFFICIAL SEAL
PAT FARIS
q01MY
NOTARY PUBLIC -CALIFORNIA
PRINCIPAL OFFICE IN
ORANGE COUNTY
Commission Expires Sept. 74. 1993
(This area for official notarial seal).
MAIL TM STATMUMS AS DIRECTED ABOVE
a
Assessors Parcel No.
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH
ENVIRONMENTAL SERVICES DIVISION At.� 7�3_ _
a•
PERMIT APPLICATION FORA 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'jhis'application shall remain valid for a period not to exceed one year from date of approval.
�.pp �f
140 td' A SAFETY
LOG # VERIFY ITEMS IN SECTION A FROM NON -FEE BUILDING & (goldenrod) APPLICATION
Agent, Contrac' 6ftbntact'-Person
Phone
Address : ; . City State Zip
i a -'q C��u S i • r
�I`i-3� 333
-0 svw�ow� c �2Esf
Owner
Phone
Address City State Zip.
s �
4 a u ►A,
Job Property Address', city
5'1- foo
State
Zip
Legal Description Prop. (PM, Tract, Lot)
Lot Size
'
ater.Agen G el
Use of Permit P/P, CU: etc.
Other _,L
cc'( (/u�GC� wraof
Is 19
ellin H Si e P ep, etc.'
G ,.
g 2 -
Si nature of Applicant
Signature
Date
CATEGORY REV CODE FEE
CATEGORY REV CODE FEE
SUBSURFACE DISPOSAL (per system) 1238 $153.00
❑ SITE EVALUATION UPON REQUEST 7349 $120.00
' t - �
❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION
(NO PLOT PLAN)
❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00
a. 1 st 4 Parcels (Each) 1238 $153.00
❑ PRELIMINARY ELECTIVE EVALUATION
b. Each ParceVafter4 7344;,,,x,,•$ 55.00
(Attach DOH -SAN -53) 7352 $ 69.00
❑ REREVIEW (2nd review same parcel) 7344 $ 55.00
❑ HOLDING TANK ' 7351 $119.00
r. #
❑ SITE EVALUATION in Conjuction with Critical,Area 7346 $197.00
❑ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00
b i '•
❑ GRADING PLAN REVIEW DETAILED 1238. $104.b0
❑ 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
El COPIES (LAND USE) 7786-81 $ .50
INITIAL DATE
Holding Tank Agreements Completed ❑ Yes 03 /No/ AAA -
.f I
Certification of Existing S.D. System Required ❑ Yes 20,
a
WOCB Clearan Required T " I O Yes
(Attach Form DOH SAN o07, Santa Ana Region Only)
+Required
Soils Percolation Report ❑ Yes N�o
;N
Special Feasibility Boring Report Required" ❑ Yes
. i.74 b, ^ a(
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes N,
r r
Grading Handout- Provided ❑ Yes f��N,
Staff Specialist Lot Inspection Required ❑ Yes
Maintenance Booklet Provided ❑ .Yes Lot Inspection Dae Initials
C�
C/42 / Soils Percolation Boring Report by, Lic/Project # Date
��nA �y
Soils Map Page l� Soil Type /V/��, Approved By:� Date
No. of Systems
Type of System(s)
No. Dwelling Units 1
(1) Septic Tank
Soil Rate
Grease/Sand
❑ F otding Tank ❑ Replacement
Bedrooms, Fixtrrre.aits
Gr Intcp/Lint Trap
ErNew ❑ Addition
❑ Existing
�D/1ry1 —
filial.
� �Q
��Gal.
Sq. Ft.
Total Linear
i Sidewall.Allowance
Leach Bed sq. ft.
B'• ttq OR1 Area
\\\1
F .
ft. rock/ sq. ft. per running ft.
Install ft. long ft. wide with
rock*below
of Bottom Area
Inlet Tested Depth Cr
min. inches drainlines or
�_,
-
Proposed Bottom Tested Depth'
Leacmines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below'
Seepage Pit Total Depth
/
3
Applicable
/6
Inlet (BI)
/
(TD)
Max. Allowable Depth
f
'
`f(J
N/A _ Overburden Factor
T
Well Review Approved: Signature Date Well Drilling Permit #
Grading,Plan Approved: Signature Date
REMARKS: /'ti^
,1 -
This application ' PPROVED -NIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanietl'p of p an, using there uirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed?
syste No conc_tr�ction is nermitied in tha required reserved 1004 expansion arae '
Septic f
t tank must be 100' minimum from any wells (Yf U �
Leach lines must be 100' minimum from any wells, inciudni"g a ansion area ,1 s
3� Seepage pits must be 15p' minimum from any wells, including expansion area 4' L ar ct�
..
Signature Health w' 7`4 7CP1"
of Official Date 1.
RECEIPT NO. / J w Issued By ",%, �L�-- '
DISTRICT. ❑ dio- 11Riverside 2 InHemet ❑ Perris ❑ Rancho Calif.
DOH -SAN -1 22 (Rev 6191) DISTRIBUTION: WHITE—OBioe file YELLOW—Applicant _ 'PINK—Bldg. Dept.
O CASH HECK W
Date —f-9
r
❑ Blythe
t`:
ans/Reoords e
Of it,
CALVIN C. KAMINSKAS
Assistant Commissioner 0
.(714) 275-3000
41
OFFICE OF
AGRICULTURAL COMMISSIONER
JAMES O. WALLACE, Commissioner
83-612 Avenue 45 Suite 7
Indio, CA 92201
I C-1 Q I 342-8291
DATE CASE NO.
DEVELOPER'S NAME: A)L,< l aeR E
ADDRESS: 071 bJ S\.Yw 0 1,14 Q1 C:,&i
TELEPHONE: (61cD 3 4 o 3 7
t (5 ek 121
Dear Developer:
DAN RILEY
Sealer, Weights & Measures
(714) 275-3030
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ from plant material listed, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
T5HcLjftura1 Commissioner's Office
cc: Indio -and Riverside
I
4880 LEMON STREET, .ROOM 19, RIVERSIDE,CALIFORNIA 92501 TAX (714) 275-3012
I
OF
iN of- 14a Vuinta''
i !JI
This
� - •• �ut�.�ttrt �n� ��'�t�P� �t�rr�t�u.: . - ' I'; ;�
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building! l i;
Code certifying that at the time of issuance this structure was in compliance with the various.'-
ordinances of the Cit regulating building construction or use. For the following:
Y 9 9 9 9: i
BUILDING ADDRESS 51-800 Navarro l (• r
i Use classification Single Family Dwelling Bldg. Permit No. 10 8 5 8 I ;
Group R3 Type Construction 17M Fire Zone Use Zone SR
l jl'.I�� it ; • I j i;
i Owner of Building Al Px Tarr, --q Address 4n�gp;��2
City Coachella, CA Lonnie Day
By;
Dote;Jan»ar�F�1g99
Building Official POST IN IN A CONBPICUOUy PLACE - -