Loading...
07116 (SFD)4 7 P.O. BOX 1504 /7 ilding / O 78-105 CALLE ESTADO dressJ_f LA QUINTA, CALIFORNIA 92253 Owner ,,Beiair Develooment Address 34-116 Date Palo Dr. #6 City Zip Tel. Cathedral tity 32234 374-7767 Contractor Sam r City lZip State Lic. City & Classif• 82 $58181 1 Lic. # Engr., ler Design for Living Address Tel. Same City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION 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 - 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,Buskress 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 4A' requires the appicant for such permit to rde a signed statement that he is licensed pursuant to the provisions of the Contractor's license taw. Chapter 9 (commencing with Section 7000) of Mftbn 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 civi penahy of not more than rive hundred dollars ($500). ❑ 1, 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 Contractors 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 safe. 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 appy 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 Workers 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 (nas sermon need not be completed N 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 N017CE TO APPLICANT: ff, after making this Certificate of Exemption you should become suNect to the workers' Conpensatron provisions of the Labor Code, you must forthwith copy with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 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 if work thereunder is suspended for 180 days. ' 1 certity 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 thereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. 071.16 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 774-155-001 Legal Description LQt 1, 81k . 203 Project Description S.F.D. Sq. Ft. 1536 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation s009 PERMIT AMOUNT Plan Chk. Dep. Y:3.ftC# Plan Chk. Bal. Cat. a2 Const. biz.UU Mech. 53.50 Electrical 1 jO, Jt Plumbing 157. bu S.M.I. 5.95 Grading Z61.00 Driveway Enc. 20. Uu Infrastructure _1{.r,✓ �•i�t] TOTAL 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 2/9/90 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE9�l ROUGH PLU B. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS E R K ROUGH WIRING. MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN, L BOND BEAM WATER SYSTEM URINAL SQ FT ® =$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. 0 WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING: LAUNDRY TRAY AIR HANDLING UNIT CFM FIREPLACE 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1 V. c SEWAGE DISPOSAL SQ.FT.GAR ® V4c 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 & AIR COND. SOLAR SETBACK 8 �� �� BI� UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE9�l ROUGH PLU B. BONDING HEATING (ROUGH) STORAGE TANK FORMS E R K ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL Mee /A01 GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. 0 FRAMING FINAL INSP. ROOFING/(j REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING f N ?)Y" ul/o MESH INSULATION/SOUND 8 / FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS ' GARDEN WALL FINAL 'Js.. Q Z O U W (n M Z O UH W (n' U Z O U w U) n Z O U W (n ems`^;''a��'^S!.�h°,i J�"+.,•?�t'-:jirl•f`'�•:'t't..�t.''^-.y-.s ^' _ ��'j.�+,t-j:. �`-1.^�"-•'`•y:P.'cw-h'�FSf 'r'.^'"�'`rv= :r .a• y.r --:s i Aft"em ftMel Mm COUNTY OF RIVERSIDE ENVIRONMENTAL _ HEALTH SERVICES DIVISION 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 flat 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 # � or, Contact Person ,�A 'Phone Address & Firm,,,,,/ /rCih �G CC Owner Phone Mailing Address City State Zip Job Property Ad�d � Description Prop. (FJ Tract. Lot) 0 Lot Size Water Agenc/W II use of Pennfl P/P, CU, etc. Ot r SA\AJJR CM AC -LA Dwelling, M Site Prep, etc. Ii QU)N.�A [ Signature of Applicant Date a GORY: REV CODE FEE CATEGORY: REV CODE FEE 51_r SUBSURFACE DISPOSAL 1238 $ 57.00 ❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348• $ 17.00 a. 1 at 4 Parcels (Each) 1238 $ 57.00 (Less than 1 year) b. Each Parcel after 4 7344 $ 24.00 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 ❑ Rereview (2nd review same parcel) 7344 $ 24.00 EVALUATION (Attach DOH SAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $ 47.00 Critical Area 7346 $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 ❑ Yes C No :T. T Certiflcatlon of Existing S.D. System Required ❑ Yes No WOCB Clearance required. (Attach Form ❑ Yes I No DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yes No Special Feasibility Boring Report Required. ❑ Yes No Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes No Other ❑ Yes No Staff Specialist Lot Inspection Required ❑ Yes No Lot Inspection Date Soils boring by � Project S Date report Soils Map Page Soa Type Approved by _�_ Date No. of Systems Type of System(s) No. Dwelling Units (1) Septi: Tank Soil Rats Greeee ❑ Ing Tank ❑ Existing Bedrooms, Fixture Units /�S FfX G New ❑ RepFaCenwm 8�G1u,M 2 D A+A UL.W*s) / OOOG D Y[ / 1 Gd (2) leech Line llowance S:�� Install � wide with Leach Bed Bottom rea sq. R min. indicts drainlines or _ f per run ❑ NA - Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Ph Below Inlet (TD) Seepage Ph Tot Pep�th Other. Applicable ` �1 ❑ 5 6 (BI) Max. Allowtplepepth N/A �rden factor \ 1 No. 2 System REMARKS: This application i APPROVE /DENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompa 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 perj%ed in the required reserved 100% expansion area. (1) Septic tank and sewer lines must minimum from any wells Leach lines must be 100' minimum from any wells, including expansion area /(3}� Seepage pits must be 150' min' um from any wells, including expansion area / Signature of Health Offx;ial Date -1// i Q RECEIPT NO. 4 4 ( 6 Issued By / Date III AO iv or DISTRICT: ❑ Riverside, Indio ❑ Hemet q Perris ❑ Rancho C ❑ Blythe DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records FN M COACHELLA VALLEY WATER DISTRICT p ' S +� 3 79 , CASH RECEIPT DETAIL JO t�t-�S E N yew/ 77/-05/1 Date:y —.Z7- Y Received From: Address: �" 3 /2 /� /O L G [ / r �^ �� `p� Account No. (006,13711 3 40 P Lot(s) Tract SG Service Addreas S #O 2 uQ O br w 5 *A- G.A. Code o Meters) — 5 $ w PlService(s) 5 .. ;2 ❑ Backflows) O House Lateral(a) ❑ DetectorCheck(s) ❑ Met Surcharge 3 �j �- 15 / S .+y/ o nitetlon Capacity Charge ❑ WS.B.F.C. O Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - f ❑ Plan Check Fees Water I Sewer - ) Tract - ❑ Bond Payment - A.D. - Bond 1 Assmt. i O Customer Deposit O Other • c- � j TOTAL $ Q r 5 .Z 0 oT EL 3 17M S i Remarks: 60ro Sax 0 torr / VUk. zo 3 IM- S C_ ❑ Copy to: 111i� Cash Check O , Water Service Cashier • Money \� D 1199) . Order " 138 M t .. Page of American Engineering Laboratories, Inc. INSPECTION REPORT Project Name (per plans) kA r Inspection ,Date f r � ..-7 r(o Ul ! �i� e !r�`t ,J�' � 1 Lar", L ell �C>�` I V C r 3 5� rvrvtr , ... 2,� Q� to „4���1 I • � I 1 I I I I 1 1 f