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003489 (RER)T ih.� �QKrw Building Address 78-121 La Fonda Owner Monique Jean Piere Mailing Address City I Zip ITel. Contractor P.O. BOX 1504 NQ. UU-54OU 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 769-262-026 Legal Description Project Description Remodel kitchen area aary t. Psi Construction BY: Minimum Setback Distances: Address 53--615 Mendoza Front Setback from Center Line City La Quinta Zip 92253 Tel.' 564-1309 Side Setback from Property Line State Lic. & Classif. 510776 � City Lic. # A9...> Sq. Ft. 1408 Size - No. No. Dw. Stories Units ' Arch., Engr:, - Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. Validation: City • Zip • ' State Lic. # v~ LICENSED CONTRACTOKSL,DECLARATION I hereby affirm that I am licensed under provisions of -Chapter 9 (commencing with Section 7000) of Division 3 of the Business and P�rrofessifons:Code; and my license is in ful(force and . . effect. . °b i ?0 7 SIGNATURE •+"'w..! DATE OWNER•BUILDER DECLARATION r hereby affirm that I am,exempt from the Contractor's License Law for the following . reason: (Sec., 7031.5,Business and Professions.Code: Aly city or county. which requires a permit to construct, alter, improve, demolish, or epair any structure, prior to .its issuance also requires the applicant for such permit to lila a signed statement that he'is licensed pursuant to the provisions df 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.) 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 contractor(s) licensed pursuant to the Contractor's License Law.) 0 1 am exempt under Sec. B. & P.C. for this reason Estimated Valuation s1 PERMIT c• AMOUNT Plan Chk.. Dep. Plan Chk. Bal. S4A .42 COnSt. "� .Q Mech. !MwA i n a AID Electrical In -nn Plumbing S.M.1. - ^• y{� Grading Driveway Enc. Date owner Infrastructure 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'. 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 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. TOTAL $183.52 J REMARKS Dale Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workeis' 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 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 sof this city. to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip HARD COPY 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 1/13/8Permit Issued by: ~ Date Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. ® POR. SQ. FT. ® J GAR. SQ, FT, ® CAR P. SQ. FT. WALL SQ. FT. ® SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVG N 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 a FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac 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 FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ -Plus-X$-=$ LUMBER GR. FlAAL INSP. FRAMING FINAL INSP. ROOFING s 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 4 9° �J DA11' OCT -16 1987, , TO: County of Riverside Department of Health DESERT DISTRICT : INDIO E=nvironmental' Health Sen6ces Division 5575* Eleventh Street N1311 P.O. Box 1.370 ; R)*verside, CA 92S0' T Attn: land Use Section " ti ' g Suhiect: Certifyin• the F Subsurface,Sewa e Disposal System - , AXi3'�� g P at_`78 1 Z� L.A LA (Property Address) Z.• ��& IL, q• 240• o •7Z . cfoT• 3 (Legal Description and/or APN) for 'AA /n►. it .r;t ,G - i G A- k.�j -C-2, c 1".7, j7 L -- (Applicant) (Applicant) f Shop des,,, and location (to scale) of the sewage disposal system in relation to d�;ellings;'structures, wells, etc. J examined the existing subsurface sewage disposal system at the,abo-ve location on =_ and certify that the septic tanl: size is _tCn(>C gallons and the. Date leaching area consists of sq. ft. of leach line/bed or seepage No. of plts, pits,�� ft. diameter and L}{� ft. below inlet ( ft. total depth). It is my opinion that the system appears to be in good working order and can be expected to function,properly with proper maintenance.' If there are any further questions, feel free to contact the undersigned at t � ATELANID CONSTRUCTION CO. Telephone No.-- (5lgnaturt C-42 State Licence -t-'--, Septic 'Tank Contractor State License T I� ....,- 'i�r•;:j'�'klrr'�;'3-y.';+-�*.'�4�7�r�����,:',yyy+sY��--w '^'`�i ,�{ `a''«,tt;:+..'Y�i't'r'r.v=t<��y R�^a�'{.�.,�ti-T,.sc'.,..i.,=..�+:.:rr . _+f' t�::.-„rs`.--wrrr ” r f r� ! G,YISI �6) COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM 7E 9 —d 6,;- — Oa 6 t Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County specifications±required on the attached check list. A non-refundable filing fee f% 7 is required when the application is submitted. Check must be made payable to the County of Riverside. f `Building Department Application Log #_1 Name (Owner, Agent, Contr�tra''ctto-off�, Etc.) 1*0 ..�•^" Mailing Address City State Zip Code Telephone: 0 �^ F7-,2,. Job Property Address - %4- /o? /A f/%AJ/moi A moo,✓ tiA . 'City or community, j h7 ui n/7 xl Legal Description of Poperty. (Lot. PPM, TR) SF 4" V07F G*!C t OT s / <� c/frn r' L c crr�i Tif { ; l 'Assessor's Parcel No.+•s (,1J -• �?G � - U / a.. '769 "Water Agen . eMNell � X � r "`l7�„ Use of Permit .. IiaQ/if ! P-,jC/. Planning Cae p Foal f`•fcrcrTr Lot Size r SFD, MH Site Preparation Etc. �S /rI1� Cf F A//?7 r 1014 (- t Signature of Applicant "t Date f •:The information be above must verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE r Initial Date P / ❑ Certification of Existing S.D. System required. Yes O,�,,��Noj /.•,f(/// /(J -T6 El WOCB Clearance required. Yes 2r'No"_ ,� l Soils feasibility report required. ❑ Yes 2N� w . Detailed boring report required. ❑ Yes ©�N0 . Detailed contour plot plans required. r El, Yes Ao_ Staff Specialist approval required. ❑ Yes © No Lot hspection Date Soils/boring report by �' I. _� �• Project # Date � Soils Map Page Soil yp _ - t ' Approved by Date !2,* - ?�of-Bedrooms) (1) Septic 'dank-» Soil Rate Required -ft—Type—'of System: (/ !,y? ' ' 01? � •'r ❑ Existing ❑,New Additional ❑Replacement ... s,= a (2), Leach line sq. ft. ) Sidewall allowance � ins fal Lines) Ft. Long, .6ach bed Sq. (Bott�orrntrenc� h area) ft. rock/ Sq. Ft. Ftwi a min. inches Ft. of�bottom ' :'^*w s per running ft. ❑O'N/A rock below drain lines are Leach lines/bed-special design for slope: (3) Pit Diameter E'X,15riA16 No. Pits Pit`BI Seepage Pit total depth 47Xi57x„/r, /�,r) rE Applicable, - N/A tom/Overburden factor „+' , IS 5' ❑ 6 X/57140 f�✓Sx/,_ 1 [ ` , Max. allowable depth rr Xecr,w//. 14", f• _< ,.. �J _J_. / ''"u ;�Tfl/(u< Ur.f5 i� N�.�f'..Q�C.P� �-i•, iY1.--r..i0 _i' �f . � _t�riw 1 �r G�nY'f./ .s• r9..+f.I'A.�1 fir,,...) +/J/�P'/ A i, .• .s ./�.r /�� j/�/ /�f �j/d.6 %�J /// 1 ,y n� � .'f^ ll•' .!_,.r Yf//.fii ' lA / !-s►'-�/ � /--i+G"/>i.-!: � .F/C• �-C-�7G �`� ��l.A�. n-C=-l-+i7��t - .� i�../ �T`i �L.�f e. isM �i li�l t �w/-,1Lri�1C� �,�. n l�iy� ��r�,.rrt��` � �i���st..@ /11%%-,47tr �Li7_�,I�+Ludt/17�C�►��IL[++Cl.�tw.,P"i-tf,- %11411 � . r -a xA k4ra�t� .f�,i ss.t ir.�rr.rjr`/. w ny:L .P1� ir�l-tw.rr. 1r�+n�ffl��,„texas,.. t.,..e. _.c.� This application i roN v ..denied for the design of a subsurface disposal;system as mtllcated on the co pa plan using the requirements` a set forth in Section B' a<'r"ovoe' A building permit is necessary for the installation of the above -designed. G AV ti4�'a1SF'C'VreRr.rva4 M,N (1 Septic tank and sewer lines must be 50' from t,�imasystem. S&. any wells..i.�f.0 ce+,.7�t�a�<ItLY sS&. (2) Leach lines must be 100' mini. from any wells including expansio (3) Seepage pits must be 150' min. from any wells including expansion area Signature of Health Official �' • D.te RECEIPT NO. 1 � `f” f Issued by_ .;.: �xib f ! Date Ml V 6 • /2 07 �t t District:. ❑ Riverside P Indio [],Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe . r J Distribution: WHITE—Office file YELLOVi�-Applicant PINK=Bldg. Dept. GOLDENROD—Pending =ile DOH -SAN -122 (Rev. 6/86) `v •« r _ r