Loading...
05615 (SFD)P.O. BOX 1504 Building 78-105 53175 RUB10 LA QUINTAC Address CALIFORNIA 92253 C€T,achella Malley Land Mailing Address 247 E. Tieliquitz say 12 City Zip Tel. Palm Springs 92262 Contractor Starr Construction ress sawn State Lic. City & Classif. 387934 Lic. # 895 Arch., Engr., Designer Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 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,Busimess and Processions 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 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 or 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 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 sale. If, however, the building orimprovement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or inpnove for the purpose of sale.) ❑ 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 does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) ficensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec B. ii 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 Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company 0 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.' ft, after making this Certificate of Exemption you should become subject to the Workers' Conpensatmn provisions of the Labor Code, you must forthwith comply with such provisions or this permit shalt 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 car ity 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 BUILDING: TYPE CONST. A.P. Number - , 774--Ci42-022 No. OCC: GRP. 05515 Legal Description Lot 10 Blk 177 Unit 16 Project Description S" Sq. Ft. 1409 Size No. 1 No. Dw. Stories Units New IN Add ❑ Alter ❑ Repair ❑ Demolition ❑ 430 square feet garage 170 feet 6 -foot wood fence Estimated Valuation $76.360,;00 PERMIT AMOUNT Plan Chk. Dep. 250.00 Plan Chk. Bai. 212.59 Const. 536.00 Mech. 53.54 Electrical 116.41 Plumbing 57.517 S.M.I. 5.:39 Grading 20.00 Driveway Enc. 20.00 Infrastructure 1,679.85 TOTAL ; REMARKS r T tSt 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 4/6/89 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. $ UNITS ' �G•ROUND 1 RI1CJFi PLUMB.' t BONDING YARD SPKLR SYSTEM 2ND FL SQ. FT. FORMS SEWER OR SE1t WIRING % MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SO. FT. ® TEMP. POLE GROUT DRAINAGE PIPING CAR P. SQ. FT. ® FINAL INSP. WALL SQ. FT. WATER SYSTEM DRINKING FOUNTAIN. GRADING cu.yd. $ plus x$ =$ URINAL SQ FT ® FINAL INSP. �Ogl FRAMING 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(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM 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. SO. FT. RESID ® 1+/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ic HOUSE SEWER FINAL INSPECTION 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 GOND. SOLAR SETBACK PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE �G•ROUND 1 RI1CJFi PLUMB.' t BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SE1t 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 x$ =$ LUMBER GR. FINAL INSP. �Ogl FRAMING FINAL INSP. ROOFING 6— I s 4 v REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH I SULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Building Address -5-31715- Owner 414 Mailing Address a-'17 P.O. BOX 1504 APPLICATION ONLY 78-105 CALLE ESTADO ,PLL/O LA QUINTA, CALIFORNIA 92253 �J city C Zip T,Q L /t/ pie 10 G S 9 2 2 4 2 .Contractor ­ .5 57Tig iZ Address State Lic. - - & Classif. Arch_, Engr., Designer Address 38743 Tel. City BUILDING: TYPE CONST.. A. P. Number . 7 70 Legal Description .40 7- Project Description _ _ — O -e17- ZTel. /U OCC. GRP. 77 LL di -r- /8 Vv.4 Z, Tel. Lic. # _ ' LICENSED CID NTRACTOR'S•DECLARATION Tel.. I her affirm that I am licensed under provisions of Chapter 9 (commencing with Section City--- - - Lic. # g 9 S— Sq. Ft. Size /yp3P No. Stories No. Dw. Units effect��.. New DSL Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Tel. City Zip State Lic. # _ ' LICENSED CID NTRACTOR'S•DECLARATION - I her affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bu�ri d Professions ode, and my license is in full force and effect��.. SIGNATURE .DAT OWNEWBUILDERDECLARATION — I hereby affirm that 1 am exempt from the Contractor's License Law for the following Estimated Valuation - �-1 reasorx (Sac. 7031-5,&a*tess and Professions Code: Any city or county which requires a Permit to construct, after. JrWrove,-demolish, or repair any structure, prior to -its issuance also ' that he is licensed- to - PERMIT _- - .- AMOUNT requires the applicant for such permit to the a signed statement pursuant the provisions of the C inbac" License Law, Chapter 9 (commencing with Section 7000) of - -- - - - Division 3 of the fps and Professions Code, or that. he is exempt therefrom, and the basis --7031.5' 'any for Plan Chk. Dep. 2-- 5-0, C7 O ,for the alleged exemption. Any violation of Section by applicant a permit sutijeds the applicant to a civipenalry of not more than rive hundred dollars ($500). Plan Chk. Bal. ai / Z VF ❑ 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, tBuisness and Const. Professions Cade: The Contractors License Law does not apply to an owner of property who buTds.or rrproves thereon and who does such workhimself or through his own employees, Mech. - — - - - S �- a,✓ Provided that Suri improvements are not intended or offered for sale. If, however, the building ,. or irprovement is sold within one year of completion, the owner -builder will have the burden Electrical - 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, Plumbing (' - 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 contraQbrfel licensed pursuant to the Contractor's License Law.) ' -- - Grading as 01am exempt under Sec !• B. & P.C. for this reason Driveway Enc. __vC3 Infrastructure - 77 i Date Owner . , WORKERS COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of consentCto setj,�nsu or a certificate of. Workers Compensation Insurance, or a certified co00, Labor Code.) 'Policy No Company ❑ Copy is filed with the city- . ❑ Certified copy is hereby furnished. TOTAL 2• Z 00 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS COMPENSATION INSURANCE ()�1 L :1 .S'-3Y—t3. AV �(llds completed N the permit one hundred dollars 3100 valuation section need not be pe ( ) R n rw nu n R Tr1TA1 s n -7c nT or Iris.) ,... ......, , , . , .. — r ,.. o .... I certify that in the performance of the work for which this permit is issued, I shall not employ any ppeersrsoon in any manner so as to become subject to the Workers' Compensation Laws of Callfomila - - Date Owner NOTICE TO APPLICANT: 0, after making this Certificate ' of Exemption you should become ZONE: BY: subject to the Workers• Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: .comply with such provisions; arthis Permit shall bedeemed revoked. 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, C" Code.) - - Side Setback from Property Line Lenders 'Name ,Lenders Address FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 1110 days. I 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 Add y—M Validation: City, State, Zip BUILDING DIVISION CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO. FT. ® FINAL INSP. BOND BEAM WATER SYSTEM DRINKING FOUNTAIN WALL SO. FT. ® =$ LUMBER GR. FINAL INSP. URINAL SQ FT ® ROOFING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES VENTILATION WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FIREPLACE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1114 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER CERT. OCC. 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 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. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL /'tP1�6/vbq.� F '�9r''iT�"�"�T� t '1+7AyiF' 1" "7-'T+^ {i F it'�%r• '` �, t r� �,�,-•• -�af'� ;� � �L��» 3r,?` "�}d3�+r¢$' u' •r4r;�i�';s ,ate' Q Z O U W Z 0 W V) COUNTY OF RIVERSIDE DEPARTMENT OF HEALTHAssessors Parcel No. ' 7 �� o ENVIRONMENTAL HEALTH SERVICES `'�— z z_ 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 checklist 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 Phone Address & Phone .2 12 DA) S rA? 3Z2--/O'L4 Owner Phone . Mailing Address a 14/17--4/An v,r c C) `✓z City State Zip Job Property Address,IrV Legal Description Prop. (PM, Tract, Lot) PA1_i'45`F7Je/AJ& C/a ZZv S'3/75 2vA3i0 4o p. /77 :a} Lot Size y 'tW ter AAgeenc I of Permit P/�P,,CfU, eettc..�e'._1 ,V;7i Other �r S'a x io0 tXJi9 r,E....,,,,�;,j.- ^Use f0(„U,, G'vF.f.%if• r'aC�'i-� �;<. ' Dweln, H. Site 1 rep, etc. Dafe Signature of Applicant CATEGORY: REV CODE FEE— -\ CATEGORY: REV CODE FEE L€]UBSURFACE DISPOSAL 1238 $45.00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DMSION_ ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 a. 1 at 4 Parcels (Each) r' 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 $13200 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 INITIAL DATE p "" Holding Tank Agreements Completed ❑Yes OfNo ✓C.t _ /)� o Certification of Existing S.D. System Required ❑ Yes Q f c t WO CB Clearance required. (Attach Form ❑Yes laNo DOH SAN 007, Santa Ana Region Only) Sons Percolation Report Required. ❑ Yes m,✓ Special Feasibility Boring Report Required. ❑ Yes,✓ Detailed Contour Plot Plans Required (1 to 5 fL Interval) ❑ Yes ca No- Other ❑ Yes Staff Specialist Lot Inspection, Required ❑ Yes 13 No lot Inspection Date Solis boring report by # Dale �^ rgrro'je/ct Soils Map Page Soft Type , �-- Approved by e Date r _3 4)' f5P No. of System Ty a of Systems) No. Dwelling Units(/) (1) Septic Tank Soil Rate Grease/Sand O.jHolding Tank ❑ Existing ED -98W ❑Aeplacernent BedroomQQs, Fi&tkmW- ft & t'I• lyox• / / ?e� Grease atop 'OwGial /� wGu �2) Leach LIne Sq. Ft. Sidewall allowance Install Lines) it long ft wide wtth /,Leach Bed sq. it. trench area ft rock/ sq. R fl. min. ' , below drainlines or bc0.tornarea per running Leachlines/bed special design for slope: Applicable (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Plt.Total Depth Other. r Max. Allowable Depth N/A Overburden factor j A0 5— / [/ f No. 2 System REMARKS: ¢ i .� Ir Y C.Y <-wvf._ .s /1 �"� f `� > /' UwpJ'<sP�F � 1' Gr �'� �>_ r^ ,/� , r9 �"7../.f .%r ,� ..�.,..v .s;.z-,a�'�. �.��� . .,,•, r, �:c�c.c,.--•Q. ,/,7..s�'G�� o's-�r t J This applicat• is,APPROVEt NfEU for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated op on the accompanre plot pan, 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 permitted in the required reserved 100% expansion area. minimum / 0 (1 Septic tank and sewer lines must be. 50' from any wellse. minimum from any wells, including exp Leach lines must be 100' ansio ares 3) Seepage pits must be'%150' minimum from any wells, including expansion area , Signature of Health Official RECEIPT NO.}° Issued By ! i��'r 4 ~ Date I ltiDISTRICT: ❑ Riverside, O—Indio ❑ Hemet Q Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records r.,