08575 (RPL)Building
Address 511 -.!; .., vanida
Owner'`",
R. M' t'r+rR1I.
Mailing
Address
>ti _ t!— MCity r =1p ..
Aa Quints 97253
Contractor
Address
rr
P.O. BOX 1504 N 0 . 08 57
78-105 CALLE ESTADO (�
LA QUINTA, CALIFORNIA 92253
BUILDING: •TYPE•CONST. .- OCC: GRP.
A.P. Number ?Qli�-i9$S-1
Tel. -- '•
Legal Description 1lnt A� .C!!ns_ C, J#-ay ],m !4
Project Description
Tel.:
State Lic.
• & Classif.
City
Lic. # Q
Sq. Ft.
Size
x
No. No. Dw.
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolitiori ❑
Address
Tel.
'
City -
Zip .
State
•
Lic. #
LICENSED CONTRACTOR'S DECLARATION
+
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divisio,n,r3i,df the Business.and_P
effect. ofes/s,ions Code, and my license is in full force and
V
SIGNATUfiE `✓' �a GATE
-
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,'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 live 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 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
Estimated Valuation
-
19.5w.00
PERMIT
AMOUNT - '
Plan Chk. Dep.
,
Plan Chk. ,Bal•
Const.
1202
- Mech.
140
Electrical
-
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.)
Plumbing
i
❑ 1, 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
S. M. 1.
-�, 's1`
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.)
O 1 am exempt under Sec. B. & P.C. for this reason
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
. O Copy is filed with -the city. O Certified copy is hereby furnished.
- -
TOTAL
438.95
REMARKS
-
"i'6Y''-i3xR�9 �. •sii--.•”' r �t.4
'
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
or is section need not be completed it 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.
ZONE: BY:
Minimum Setback Distances: - -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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.)
Side Street Setback.from Center Line
Side Setback from Property Line
Lender's Name
FINAL DACE
Issued by:
Validated by:
- -
INSPECTOR
DatePermit
-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 Date
r
_ Mailing Address -
• • Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2N0 FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
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.
SO. 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
ROCKSTORAGE
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.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
i
N
0
RECEIPT NO. �Issued B ' _ �14 i Date / '( V
DISTRICT: ❑ Riverside, ❑ Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
.vak
COUNTY OF RIVERSIDE ENVIRONMENTAL Aas«twrs ftraW Na
HEALTH SERVICES DIVISION Oy (61— 7
'PERM�TFAPAPLIkCA -ION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Apprloak. S°ubmiF is 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=�'6fundable filing fee(see below) is required when the application is submitted. Check must be made payable to the County of
oWiRiverside. Approval of this application shall remain valid.for a'period not to exceed one year from date of approval.
o�
M03H3
VERIFY ITEMS IN SECTION A FROM BUILDING &_SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
Z
Q
Agent4—
ov,Qs Intact Pe
tom
m� 11 It
� A0
Address &Firm C/�
Owner,
PhoneJ/
Mailing AddressUJ
City
1 NT
site
(
Zip
7-2
Job Property Address
5 l - 380 Avis . Io310
Legal Description Prop. (PM, Tract ) A
i�..l+ 18 x311(4
Lot Size
Water Agency/Well
Use of Permit P/P, CU, etc.
Other
'TI
Dwelling
ng, MH Site Prep, etc.
S
Signature of Applicant
Date
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
SUBSURFACE DISPOSAL 1238 $ 57.00
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
Co
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
Z
LAND DIVISION
13SEWER/SEPTIC VERIFICATION 7348 $ 17.00
O
a 1 at 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year)
5b.
Each Parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
LU
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
ins
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $ 47.00
Critical Area 7346 $111.00
❑ ALTERNATIVEIEXPERIMENTAL 7345 $222.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
(TIAL DATE
Holding Tank Agreements Completed ❑ Yes No t
Certification of Existing S.D. System Required ❑ Yes No
WOCB Clearance required. (Attach Form ❑ Yes No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required.❑ Yes No
Special Feasibillty Boring Report Required. ❑ Yes No
A.
Detailed Contour Plot Plans Required (1 to 5 R interval) i ❑ Yes No
Other # ❑ Yes No
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection Date
�l'�'
Soils boring report by Pry # Date
T.
(�
Soils Map Page Sol Type Approved by pate
Z
No. of Systems
Type of Systems)
❑ Folding Tank ❑ Existing
7
No. Dwelling Unita
Bedrooms, Fixture Units
(1) Septi: Tank
Soli Rate
��
Grease/Sand
Grease Intcp
1)O
New Replaoertwnt
dtn ? V`
I 2V
r
! avLU
!
'
tl!J/1
IS
Gal
(2) Leech Line Sq. FL
Bottom trench area
,, �r� 11 allowance
a•�°� ft rodV R
Install Line(s) fL long k wide with
Leach Bed p_%Ar
urea
per running ft.
min. inches rock below drainlines or
-
�'°
0 NA
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage
page PRTonal Depth
Other:
Applicable
Inlet (BI)
11
Max. AllowaIA Depth
ZJ
N/A _2 Overburden factor
❑ 5 A 8
{
r
`
7
No. 2 System
REMARKS:
11%0t<P
AJA!/ f uc "/ 1vvv� citele Orav rt -4
This application is PPROVED ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompan plot using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Z
above -designed system. No construction is permitted in the required reserved ,100% expansion area.
O
(1) Septic tank and sewer lines must be 50' minimum from any wells
5
Leach lines must be 100' minimum from any wells, including expansion area
LU
D3) Seepage pits must be 150' minimum from avy wells cluding expansion area f �i
0
Signature of Health Official �iU?�/ - r%i7r� Date 5///(
RECEIPT NO. �Issued B ' _ �14 i Date / '( V
DISTRICT: ❑ Riverside, ❑ Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
.vak