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SFD (10362)Builn Address 51-820 gaearre Owner Manuel O. Montenegro Mailing - . . Address P. p. Box 772 City ' • Zip • . Coachella, 92236 Contractor - k.'O. Torres' Const. Address . same' a:s above City Zip State Lic. & Classif. ' • tag 550498 Arch., Engr., Designer . Address < P.O. BOX 1504 DNQ. 132.: 78-105 CALLE ESTADO 3 LA QUINTA, CALIFORNIA 92253, BUILDING: TYPE CONST. 'OCC: GRP. ' A.P. Number. 773-184-004 TeL . 360a3337 Legal Description of 21 Blk 12 1: Project Description ' SFD City �- .l,;.Y,T.. . . . . Lic. # / °j� f Sq. Ft. 1474" !No. No. Dw. Size - Stories Units I New 0 Add O Alter ❑ Repair 0 'Demolition ❑ Tel. Permit does riot •,include block walls cr pool City Zip State ; t w Lic: # LICENSED CONTRACTOR'S DECLARATION . r' = '• - •. I hereby affirm that I am licensed under provisions of Chapter 9 (commending With Section 7000) of Division 3 -of the BusIiness and --Professions Code,•and my license isin full force and effect. l�+. .S f / ': t s .+,. /E✓ �fI /'^7 < 1 SIGNATURE - r::~! I DATE OWNER•BUILDERDECLARATION" 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 /or the alleged exemption. Any -violatlon 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). - �• "`,• ❑ 1, as owner of the property,, or my employees with wages as their sole compensation, will Estimated Valuation f �V �� V Y . PERMIT _ .. - AMOUNT - •. . . Plan Chk. Dep. - -250.00 . 'Plan Chk. Bal. - _251.35 . 'do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and581.00 Professions Code: The Contractor's License Law does not apply to an owner of property who •OOr1St. „��.^ ,c Mech.•'• Srj 5!'l e 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 [� Electrical 'i I I" 5, • 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.) • Plumbing' 163.50 ❑ 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 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 S.M.I. 8 .70 _ Grading 20.00 Driveway Enc. 20.00 Date owner _ Infrastructure 1 06.0's WORKERS' COMPENSATION DECLARATION I hereby affirm'that) have a certificate of consent to self -insure, or a certificate of .WoFkePs.Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) - Policy Noll, Company Copy is filed •with the city. ❑ Certified copy is hereby furnished. i • "� TOTAL 333.SI 3130.83. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS ,. �•x.�••e '..c n+•e ae+� .� - . �••"-t{��'\ a, • ..` • .' 1 J. • p}�{ `?, ! ed, lz.. �,.. N•i' _ (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.)•t-• I certify that in the performance of tha 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. - i a Date Owner ' NOTICE TO APPLICANT. If, alter 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. ' ZONE: BY: - .. Minimum Setback Distances:. Front Setback from Center -Line Rear Setback from Rear.Prop. Line --- CONSTRUCTION LENDING AGENCY Ihereby 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 Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR • Issued by: Date + ° ` Permit F Validated by: ~ ' 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 theabove-., mentioned property for Inspection purposes. Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ 2ND FL SQ. FT. POR. SQ. FT. ® GAR. SO. FT, ® CARP. SQ. FT. WALL SO. 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 FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) 3 l {/ ( GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 12-7 f/ 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. SQ. FT. RESID ® IVT c SEWAGE DISPOSAL SQ.FT.GAR ® 114c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK / ,2 GROUND PLUMBING / 3ERGROUND A.C. UNIT COLL. AREA SLAB GRADE Ale" ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS fEOEWR" SEPTIC TANK_�/ q ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) 3 l {/ ( METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL- / 7 91j GAS (FINAL) TEMP. POLE 12-7 f/ GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. C GRADING cu. yd. $ -Plus-X$-=$ LUMBER GR. FRAMING Z / FINAL INSP. qlul,11A10 ROOFING ,2[ &d, (B fj ,/ 1. 1 �- p P / 2 /4 q 4 e ( ( (�C n�7 t5 / REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL THING �$fl l� MESH INSULATIONISOUND 3� FINISH GRADING FINAL INSPECTION - CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESfINMALS GARDEN WALL FINAL r DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 1214/91 ; Type of Permit La uinta No. 111030 Permit # Log # Owner Name Manuel O. Montenegro ' No. 51820 Street Navarro City La Quinta Zip 92253 Study Area 115 APN # Tract # Lot # Square Footage 11474 Type of Development Single 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: This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of F1.58 x, 1474 or $ 2,328.92 have been paid to D.S.0 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 Alex Torres/Cashier Check/American Name on the check ]By James E. Lively Assistant Superintendent, Business Services Telephone 360.3= Fee collected /exempted by Vickie J. Durrett 1; . Payment Received , Signature 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 Q Z' 0 E W U) M Z O 15 W U) U Z O W to COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH f P1f°'I Nm ENVIRONMENTAL SERVICES DIVISION 1773 — 1X V — 0O 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 IIsL 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 & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # '-,Agent, Contractor, Contact Person ; Phone Address & Firm WIM/£%✓��Yo M /✓ �I-'_0) /q� /� Pho 3 L �S b I Marling Address ) � �O . tw n 7 % Z City cl&AC4���r- State GA Zip -Y ZZ Job Property Address :5/- Y20 /i/4011(ry Legal Description Prop. (PM, Track Lot) dot 2,1 1Z4 Lot Size Water Agency/Vllell iUse of Permit P/P, CU, etc. Other ' _ YELLOW Applicant PINK •. Bldg. Dept GOLDENROD - Pland/Records ; Dwelling, MH Site Prep, etc. Date Signature of Applicant CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE ti SUBSURFACE DISPOSAL 1238 -57%(_ O SITE EVALUATION UPON REQUEST 7349 $ 43.00 ❑ MULTIPLE PARCELS WITHIN SAME S V (NO PLOT PLAN) LAND DIVISION . ❑ ' SEWER/SEPTIC VERIFICATION 7348 $ 17.00 a. 1 st 4 Parcels (Each) 1238 $ 57.00 (Less than / year) b. Each Parcel after 4 7344 $ 24.00 O PRELIMINARY ELECTIVE 7352 $ 23.00 O Rereview (2nd review same parcel) 7344. $ 24.00 EVALUATION (Attach DOH SAN 53) O Site Evaluation in Conjunction with O HOLDING TANK 7351 $ 47.00 Critical Area 7348 $111.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ Site Evaluation lot Less than SYSTEM 10,000 Sq. Ft. 7347 $ 87.00 INITIAL DATE Holding Tank Agreements Completed O Yes No t Certification of Existing S.D. System Required ❑ Yes No WOCB Clearance required. (Attach Form ❑ Yes No DOH SAN 007, Santa Ana Region Only) Soils"Nrooletion Report Required. ❑ Yes No Special Feasibility Boring Report Required. ❑ Yes No Detailed Contour Plot Plans Required (1 to 5 R interval) - ❑ Yes No OBier ❑ Yes O No Staff Specialist Lot Inspection Required ❑ Yes No Lot Inspection Date .a Soils j� boring report byt Project Date Soils Map Page SOA Type Approved by t Date No. of Systema Type of Systeme) No. Dwelling Units (1) Tank Soil Rate Grease/Send p ming Tenk OReplacement �j Bedrooms,W,xture Units /Septic Uv 7�/ L_F /,�0 GramInOcp �V a �r Gd (2) Leach Line S�gsEt� Sidewall allowance Install Lme(s) ft kxV 11 wide with ,,,RL"eacir Bed s'q R Boftom trench area h rock/ ft min. incfres rock below drehi-Imes of bottom area per running It. v NA Leachlines/bed special design for slope: (3) Pit Diameter No�Pits Pit Below � �� (TD) Seepage Ph Tq Other. ADPI kj[� - O 5 6 Inlet (&) '� /9 Max. Albwble 9epth f \ — - N/A Overburden tactp" _ No. 2 System REMARKS: - - This application isPPROVE ^ /DENIED for the category chgdited in SECTION B above, regarding the design of a subsurface disposal system as indicated :. on the accompanied b 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 10096 expansion area Septic tank and sewer lines must be 50' minimum from any wells ?2) Leach lines must be 100' minimum from any wells including expansion area,,- 3) Seepage pits must be 1§P,' minimum from any ells, includingdleexx�psannsan are `�f�A• Si" nature of Health Official .(/t!iXiv `. pate 1l RECEIPT NO Issued ey ► (;ll -3 DISTRICT: ❑ Riverside, r© Indio 0- Heniet 1 0 Perris "'_ ❑ Rancho Cali D8te ❑; Blythe r�'o`{�Wl ifJt%It'f ' DOH -SAN -122 (Rev _3196) -DISTRIBUTION: WHfTE - Office fib YELLOW Applicant PINK •. Bldg. Dept GOLDENROD - Pland/Records ; CALVIN C. KAMINSKAS +'. DAN RILEY e Sexier, Weights & Measures Assistant commissioner -3030 ° C (714) 275 (714) 275-3000 V ' J • OFFICE OF AGRICULTURAL COMMISSIONER JAMES O. WALLACE, Commissioner 83-612 Avenue,45 Suite 7 Indio, " CA 92201 s (619) 342-8291• DATE Z I CASE NO. C C DEVELOPER'S NAME: 6 D;r "C 5 C1.15Ns f ADDRESS : 120 13ax' 772- Cj6itL�fE�/�a 22_j L TELEPHONE: Dear Developer: 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. Agricultural missioner's Office cc: Indio and Riverside • s 4080 LEMON STREET, ROOM 19, RIVERSIDE, CALIFORNIA 92501 — FAX (714) 275-3012 �� na