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06397 (AR)P.O. BOX 1504 No. 06397 Building 78-105 CALLE ESTADO Address 78-005 14ga Ur. LA QUINTA, CALIFORNIA 92253 Owner _ Me FolAxle BUILDING: TYPE CONST. OCC: GRP. Mailing ,t Address �Same - A.P-Number --400-03 City Zip Tel. L quinta 92253 , � Legal Description Contractor Project Description Seepage rat addition Aims Undargrlauad 0 mat. _- Address 69-775 vrnnate Lane CityZip Tela Cathedral it• �G�?� 324-1911 State Lic.City y & Classif. 482180 Lic. # : „ 9 Sq: Ft. .No. No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair.,"IQ -Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION *L 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7(100) of Division;3 of the Business and Professions Code, and my license is in full force and effect. /W y r SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation 4 ,, I hereby affirm that I am exempt from the Contractors 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 rile a signed statement that he Is licensed pursuant to PERMIT AMOUNT 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 thereimm, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permN Plan Chk. Dep. subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. ,$ 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, Mech. provided that such Improvements are not intended or offered for sale. If, however, the building orimprovement is sold within one year of completion, the owner -burbler will have the burden Electrical of proving that he did not build or improve for the purpose of sale.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 22.50 • 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 S.M.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading ❑ I am exempt under Sec B. 8 P.C. for this reason 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 In urance, or a certified copy thereof. Sec. 380p .Labor Code.) Policy No�� ; J y jCoIn any-�'iro t- "t, ".A i" ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE EXEMPTION FROM REMARKS • WORKERS' COMPENSATION INSURANCE }�r� t (This section need not be completed if the permit is for one hundred dollars ($100) valuation ;0`- 4L A3A`1 � Taj rY� (Aq„ j}j R . t)t) or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any personnia in any manner so as to become subject to the Workers' Compensation Laws of Califor Date Owner NOTICE TO APPLICANT, If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions or the Labor Code, you must forthwith ZONE: BY: comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: Front Setback from Center Line • Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lenders Name Lenders 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. FINAL DATE INSPECTOR 9/26/89 1 certify that I have read this application and state that the above information is correct. Issued by: Date Permit 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. Validated by: Signature of applicant Date Mailing Address Validation: City,. State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEIES IST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL. SO. FT. YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. ® DUCT WORK DRAINAGE PIPING WALL SQ. FT. DRINKING FOUNTAIN SO FT ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ 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(AUTOHDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ plus LAUNDRYTRAY AIR HANDLING UNIT CFM 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 VENTILATION SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL FIREPLACE SQ.FT.GAR ® 3/ic 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 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 LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING L Q REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION 6 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS ' GARDEN WALL FINAL 1 �C' �- ' '�Y �� � h� ,,y}�Fyr' _ iF �.-, � {.e t • k{�� . l+*+�1iYIM ` -in"i.:i'-�::!ii�,�+ 't',; . , �' � * i�j+�°t�1` � w.�..a) .�'�h:�''.'Ai;'y It l��r'��+•'w.f .�:��'. k, ��• �`t.,. . �>./�n.'� � L �.�.. •n w } X. y;. :�... •�y,�i h. p. , � T i i. Z 0 LU U) m Z O H U W U) Z 0 U W I�_ 0 Z O 1— U W COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No. ENVIRONMENTAL HEALTH SERVICES 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. ' VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # Agent, Contractor, Contact. Person Pyone Address &Phone 47-' n M; PhoneMailing Address 7tfoor La �r Z olPr City State Zip Job Property Address L I Description Orop. (PM, Tract, Lot) L64I MA&,�t L -t 3 ?gy/ Lot Size-ga Use of Permit P/P, CU, etc. Other W,b) E' l.J r A't L we , MH Site Prep, etc. � t1AGE Sy Iy M r02 t�1/1j 2 /f99 Signature of Applicant ' Date CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE SUBSURFACE DISPOSAL' 1238 5.-�"� �f ❑ SITE EVALUATION UPON REQUEST 7349. ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 a. 1 st 4 Parcels (Each) 1238 $45.00 (Less than 1 year) b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 ❑ Rereview (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 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 NIT L SATE Holding Tank Agreements Completed ❑ Yes 00, Certification of Existing S.D. System Required ❑ Yes � N I WQCB Clearance required. (Attach Form ❑ Yes No=' ,DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yes ?N;�' Special Feasibility Boring Report Required. ❑ "Yes Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes L�7 Other ❑ Yes Staff Specialist Lot Inspection Required ❑ Yes k'J No Lot Inspection Date Soils boring report by Project # Date Soils Map Page it Type Appro by Date No. of Systems Type of System(s) No. Dwelling Units !) (1) Septic Tank Soil Rate Grease/Sand Xr S F ❑Holding Tank ❑Existing New ❑ Replacement Bedrooms, ulRaiLv X/ S i• �,eyse Intcp❑ l f Cr/ jj 'N E / s% �B M4 '• Gal I P I Ga (2) Leach Line Sq. Ft. Sid_ewall allowance Install Line(s) ft long ft wide with Leach Bed sq. ft. Bo trench area ft rock/sq. ft per running ft. 01 min. inc oc bebw drainlines or r of bottom area A D Leachlines/bed special design for slope: Applicably (3) Pit Diameter No. Pits .� Pit Below • Inlet (Bl - Seepage Pit Total pepth ^0 Oahe Max. A�llswabl Depth !=5• rj 6 rA N/A ` Overburden factor S No. 2 System REMARKS: 00, This Wlication i ' "PROVED -P•for the catego c ecked i&CT10 B above, regar in he design of ;subsurface disposal system as indicated on the accompanie p o plan, using the requirem nts 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 100% expansion area. (1) Septic tank and sewer lines must be 50' minimum from any wells Leach lines must be 100' minimum from any wells, including expansion area 3) Seepage pits must be 150' minimum from y wells, includin a pans ion area C/ �� • g'vuw42 O v Signature of Health Officia .rV Date RECEIPT NO. Issued By Date DISTRICT: ❑ Riverside, qr Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records 14 h— rmWi t coi nhy tF PUM3 IC H -TH +. ' + . Fooc Trail Establishment ir Park' 3w:7�,o Disq=l ws al. Soptic Tank (ra 6*^ -a -w) _. •.r ,„, Dw ling EX ! ST -�2l3 04.t-, 4i* it &aolj Cork arcial Euild'ig nnbctibn to Serra + Swir. iming Pact on-sito reger erating. water so:d €i nz d:A4Da ice" -, be dixazreAc i .o -the individual f turd. awage disposal system herewith approved v.itlizut ctvsr2P tfrom A; :� W -26Y QuIlity antroi Water supply si 6 is !E'u'� Uxtvn mam°� ba 4rcm sn ar,;-roved soya co.Ek/ST• VU/O)` All. seivage Anil cutting tib. M !WI orfillingin 74P zeros of+i��ar�(4) cet will nullify I-;@ di€po-sal app oval. Approval hes b an obtainad from tha Ra&nal Wat3r Quali4y Control Eo rd .for installation of the seeva; dispmsal system: _ This Is to �oertify that he Riverside Cour Depirtment of Public Ran a rum for occupy ., construction 2 }instaRitiohithe Item(s) hecked above. + ��l nate' —� FhP j a o EN P'.M.';e MIN. 1W FFICM ANN TREE 0R %#VN MR OM 7&5 _ � - + r C�tie 2 rl . 'jfa 1, 7 T b� rr I �r °'`a la of ;jkege pidna}'by €iia Davwtmenl of .Pabnr © s �� (� # �• ry BeatLta Ri%resrside Count 7 does not relieveI be ngia- _ _ - 4 "1 L i or 6ir 'iec 'of the ngbility for the Are ifiMStui6I ¢lnea+ Y ` of •4aiEES . OWO t _L � _ - _ " .. a ... .. • --. _ +�_ �+. y .. -�. « — _ _ 4. C I 7�oas:'La, � 1 s Exisr- ""J SEPTic. } r P0, E<XISrt�n►d ..�," 1 'a (fes,✓� ti• _, l _ Lv d, �l18s -rcJ 6 a j- ` r.6 r R T/lQf�l c ceJT C "CKT J I /i L4f� U�a , �v r ' S�Pa6E P I � •, 070 21FM,4 I � v • for 3 7-124cr 3961/