001673 (SFD)Building
Address 53-580 Vlenida
Owner
P.O. BOX 1504
78.105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address
City Zip
It4LWi 92210 X46935
Contractor
. .Address
No.. 001673
BUILDING: TYPE CONST. VR OCC: GRP. R 3
A.P. Number 774-1115-- i0
Legal Description Lot 3
Project Description :qilvrin fatlrAly cNPAI ixm
City
Zip
Tela
State Lic. y
& Classif.
City
Lic. #Sq.
Ft. 590
Size ±�R 43i�...
No.
Stories �
No. Dw. T
Units
'Arch., Engr., -'
Designer
_
New ®Add ❑
a
Alter ❑
Repair ❑ Demolition ❑ .
Address
Tel.
City
Zip
State
Lic: #
_ . LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm that I am licensed under provisions ot,Chapter 9 (commencing with Section
7000) of Division,3.ot,the Business and -Professions Cbde, and my license is in full .force and
effect
^.�""�
SIGNATURE—`�. � �-'� DATE
OWNER -BUILDER DECLARATION'
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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such .permit to file a signed statement thathe is licensed *pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section. 7000) o/
' Division 301 the Business and Professions Code, or that. he is'exemp( therefrom,' and the basis
/or t/ie .alleged exemption. Any violation of Section 7031.5 by any:.applicant /or a permit
' Subjects the, applicant to'a civil penalty o/ not more than five hundred' dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will.
Estimated Valuation
tsyl ,q�
PERMIT -
AMOUNT
- k. De
Plan Chp
'
Plan Chk . Bal.
20.04
Const. -
a
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.-1/,.however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of of proving that he did not build or improve for the purpose o/ sale.) _
Mech:,;
Electrical
17
Plumbing;T��l
❑ 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.) -
O 1 am exempt under Sec. B. t. P.C. for this reason
S.M.I. -
5-7A
Grading
Driveway Enc.
20AM
Date Owner
WORKERS' COMPENSATION DECLARATION
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 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., I/, alter making this Certificate of Exemption - you should become
subject to the Workers' Compensation provisionsof 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 it 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 ,•,<'�.4-• Date—
Mailing
ate Mailing Address
City, State, Zip
HARD COPY
Infrastructure Le221. 33
TOTAL 2.147.29 1.992.2-3-8
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:
A Z 3 1 6 ^8 15. J 89'228 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. 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
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SQ. FT. ®c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING / U (�C
FINAL INSP.$
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
7
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBINGYp
1
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
I 'ROUGH PLUMB./vp ao(YP
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWE
T
ROUGH WIRING/(al
DUCT WORK
ROCK STORAGE
FOUND. REINF. 2
GAS(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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 / U (�C
FINAL INSP.$
ROOFING /O y[7J
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR��`
GAR. FIREWALL
LATHING
MESH 1
INSULATION/SOUND
V
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL.
I Un•s WUNA i unLWAII I IALb.
GARDEN WALL FINAL
op --1 w ?,i,L 11 1 15) .
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COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH
PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM
Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the
attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be
made payable to County of Riverside.
Nam e-�
Mailing Address
°Cffy ��
State
Zip Code
Phone
s,-
'Property Address
-'Cis ty Community
"Legal Description of Property (Lot, Parcel Map, Tract)
'Assessors Parcel No.
WaterrfServing Propertyy From
Lot size '
U
§ignat� licant / Date
/ 'The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
Initial Date
WQCB Clearance required Yes ❑ No ❑
Soils feasibility report required Yes ❑ No E e
Detailed boring report required Yes ❑ No Q
Detailed contour plot required Yes ❑ No 0 f
Comments:
Soils or boring report by Date
Approved by-�. (Date
�f� '6 i'Other /
Soils Map Page Soil Type Tract File No."
Number of Bedrooms
Septic Tank Size (gallons)
Rate Required
Type of System
New Addition Replacement
Leach line sq. ft. of bottom area trench /
Leach bed (sq. ft. of'bottom area bed)
Seepage Pit Diameter
Number of Pits
Seepage Pit Depth B.I. }
Total Depth of Pit
-5—� ❑ 6 r [9—--�
/ .�= f'I . /t&. /�
� / �e- /
Location of System
qL�il�l1
Additional Requirements ,,r -% r fW,
V
�� r(
h l 1 r 1i trY r/%ftr[tf: tt++/"
A permitjs proved/denied=forthe design of a subsurface disposal system as indicated on the accompanied plot plan
using the requirements set forth in Section B above. A building permit is necessary for the installation of the above
designed system.
(If J. !" — i
i/ A-
Signature of Health Official .^ Date
Receipt No.� J �/ Issued By.
r ' '
District: Riverside ❑ Indio ❑ Hemet ❑ Date r
DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File
DOH SAN 122 (Rev 10/84)
s