Loading...
04826 (SFD)l-"- *T4ht 4.4 Q" Building Address Owner ,,Mailing :Address 'City Contractor 53-175 0bregern Coachella Vali, 247 E. Tahcruit Zip P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Land W, 0 3 Tel. 12i�i6in AddressSame ; City lZip I Tel. State Lic. City & Classif. 3£7934 Lia # 895 Arch., Engr., 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'bf the Business and,Profbssions Code, and my license is in full force and effect. raie.t,.d� 4e.rfAf�r.�..r.es•^+�+/J/n!. SIGNATURE f - r DATE OWNER -BUILDER 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, 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 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.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner i WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, ora certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800,kabor Code.) Policy No. Company O'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 the 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 a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 1 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 04826 BUILDING: TYPE CONST. OCC. GRP. A.P. Number 774-044--021 Legal Description Project Description Sq. Ft. 1410 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 4281 Garage 170 X 61 wood. fierce Estimated Valuation $76r105 PERMIT AMOUNT Plan Chk. Dep: .� Plan Chk. Bal. mi 10b Const. 3b iw 00 Mech. 36 a'UU Electrical 74 , 17 Plumbing 3.05.00 S.M.I. 15,36, Grading 20.00 Driveway Enc. 2.0.00 Infrastructure 479 4 U TOTAL 4iz t910.4i: REMARKS py �' 3.x`4.*` A v�x•.�j (�.i. '"i�. Ct". �.y�..,,e t F1 .y fl yr '4l ' .Y� � � t �.E iWk. 'Pi •J�'..@`.'.1+C! . 'f .:J 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: DatePermit. Validated by: Validation: 1 WHITE FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY FILE = CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO Fl (p $ UNITS COLL. AREA SLAB GRADE ROUGH PLUMB YARD SPKLR SYSTEM 2ND FL SO FT. a HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR SO FTa DUCT WORK ROCK STORAGE FOUND. REINF. I IPOWER OUTLET ROOF DRAINS GAR SO. FT. a HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. SO FT. 9 WALL SO. FT. (d WATER HEATER DRINKING FOUNTAIN SERVICE FINAL INSP. URINAL SO. FT. (p WATER SYSTEM ESTIMATED CONSTRUCTION VALUATION $ GRADING cu. yd. plus x$ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTONDISHI APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING 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 LATHING SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11A c SEWAGE DISPOSAL SO.FT.GAR @ 3/,c 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 8 AIR COND. SOLAR SETBACK GROUND PLUMBI ,�, 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 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. 0 c/ OIL' .$ REMARKS:0FING VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR, GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING JFINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS , GARDEN WALL FINAL "" ..-"y,�" ^�v�+ �-�s. "`i'�-.�•i" y:+Fz�•� �*,�'�'�`ti :,��p,r�."" ^'+Q'p` �"r`•�">;+21`'�a,"`u-i!5's"'''`s���-����� RECEIPT NO. (7 / Issued By Date DISTRICT: ❑ . Riverside,' Indio ❑ Hemet ❑ Perris ❑ :Rancho Calif.. ❑. Blythe DOH SAN 122 (Rev: 5/88) .. DISTRIBUTION:- ' WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD.- Plans/Records* • i'ir :': '.. i ���, .-:.. _. _ c. Y i' .�. t.�4 .. a'.a_. •..:.N:... ..'... _:.� __ .c,. Z �... .. s ...... ..-Y. _ x ... ...... .. .. _ ._ ...... .� .. :. _ �. w _ .:..t l� .. .,.. - .._. Asseors Pame,I No. COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH ss 7 7� ENVIRONMENTAL HEALTH SERVICES' Qy� O �/ 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. Q VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG'* Z Q Agent, Contractor, Contact Person Phone Address & Phone U Mo AJ S rAse-0-ca r- .cJ 32 z -load W � owner Phone MailingsT;I dress Ie TiQ/I/ al %2i K//¢,( 1� City �Q SP%��i)Gs State art Zip x142 Job Property Addresses � s3i 4-03RQ04) Legal Description Prop. (PM, Tract, Lot) Jit le r- F�3,r,�� s��` Lot Size f WaferAgenc ell' _ Use of Permit P/P, CU, etc. 414 Other p X✓op � GvA D wev aw- 9,% ,, - t....— 4 i G? �.1^%/�Ti6/ T elfin H Pits Prep, etc.�� Sidnature of Applicant pate CATEGORY:. REV CODE FEE CATEGORY: REV CODE FEE M SUBSURFACE DISPOSAL 1238 $45.00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 Im ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) Z LAND DIVISION ❑ • SEWER/SEPTIC VERIFICATION 7348 $11.00 O a. 1 at 4 Parcels (Each) 1238 $45.00 (Less than 1 year) ti= . b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 Uj ❑ Rerevlew (2nd review same parcel) 7344 $16.00 EVALUATION (Attach DOH SAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $45.00 Critical Area 7346 $86.00 ❑ ALTERNATIVEIEXPERIMENTAL 7345 $132.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 IIN'IT/IA1 / DATEC, r Holding Tank Agreements Completed _. r, �L' �/' 7 - ❑ Yes ❑" N' r� JS Certification of Existing S.D. System Required ❑ Yes ❑�No WaC6 Clearance required. (Attach Form ❑ Yes 0 No DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yesl,rlNc Special Feasibility Boring Report Required. ❑ Yes 0 6 Detailed Contour Plot Plans Required (1 to 5 ft-' interval) ❑ Yes Other t ❑ Yes O/ Staff Specialist Lot Inspection Required ❑ Yes No Lot Inspection Date Soils boring report by Project* Date Soils Map= r . G /LJ'� /'� Za -Page n Soil Type Approved by Date . U No. of Systems Type of Systems) No. Dwelling Unita i (1) Septic Tank Soil Rate grease/Sand Z/f o ❑,H91ding Tank ❑ Existing 'J"h7ew ❑ Replacement38a/1.b1. . Bedrooms,*Fixturall` Tilts / G ntop L /1/lgj(- Aw Gal . ca W ( Leach Line Sq. Ft trench area Sidewall allowance ft rock/ It. Install--,Une(s) R long it wide with min. inches drainlines or Mach Bed sq. R Iorrkarea per running iL Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit Total Depth Other. ApplicableInlet & (BI) I^' /F ' !�� N/A Overburden factor 1'9 /(/ T Max. Allole/Depth - No. 2 System / A REMARKS: l� v This application i . , PP OVE6 , ED 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 Oabove -designed system. ;! No construction is `permitted in the required reserved 100% expansion area. �. f 1 1) •Septic tank and sewer lines must be 50' minimum from any w,e1LS y j (2 Leach lines must be 100'' minimum from any wells, including '^ expansion area 3) Seepage pits must .be/150 in numb/fr/om any wells, including expansion.pareet �/ i Health Official-`�"'G2 C ' �� %O nature of jy l! Date RECEIPT NO. (7 / Issued By Date DISTRICT: ❑ . Riverside,' Indio ❑ Hemet ❑ Perris ❑ :Rancho Calif.. ❑. Blythe DOH SAN 122 (Rev: 5/88) .. DISTRIBUTION:- ' WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD.- Plans/Records* • i'ir :': '.. i ���, .-:.. _. _ c. Y i' .�. t.�4 .. a'.a_. •..:.N:... ..'... _:.� __ .c,. Z �... .. s ...... ..-Y. _ x ... ...... .. .. _ ._ ...... .� .. :. _ �. w _ .:..t l� .. .,.. - .._.