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001592 (SFD)4 Af P.O. BOX 1504 No. 001592 Building��� 7&105 CALLE ESTADO Address 53'�ZHO Avmida ftmimm LA QUINTA, CALIFORNIA 92253 Owner Aftb= Anderson BUILDING: TYPE -CONST. VN- OCC: GRP. - R 3 Mailing Address 4Sr-700 w*o Palmepas City I Zip ITO. Contractor Aaaress . I aboW City lZip ITel. State Lic. 1city & Classif. Lic. # Arch:, Engr., 7-7 Designer Address Tel. City Zip State Lic: # ' LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 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. %1 . . _SIGNATURE ` - '• -"7 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 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 ofnot'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 Contractor's License Law does not apply to - an owner of property who "builds or improvesthereon 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 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- • structsthe 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) licensed pursuant to the Contractor's License Law.) O.I am. exempt under. Sec. B. & P.C. for this reason Date Owner C ' 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 i O. 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 thg work for which this permit is issued, 1 shall not employ any person in any -manner so as to become subject to the Workers' Compensation Laws of California. Date Owner A.P. Number 774-122-007 Lot' 12 Legal Description Project Description Sq. Ft. VM 1552 No. No. Dw. Size MID A10 Stories Units New ©C Add ❑ Alter ❑ Repair ❑ stimated valuation (. .$81#447.60'. PERMIT Plan Chk. Dep. . Plan Chk. Bal. . Const,, 'Mech. -Demolition ❑ AMOUNT fr.50. 33 t9W.cJFs Electrical 70.12 Plumbing 89.0 S.M.I. .71 Grading Front Setback from Center Line Driveway Enc. 20.00 Infrastructure 1#221.71 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 I VIML ( i.yiJJ.VV I if QS7J�Vi7 REMARKS NOTICE TO APPLICANT:. If, after making this - Certificate of Exemption you should become ZONE: BY: ' subject to the Workers" Compensation provisions - of the Labor Code, you must forthwith 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 Lender's 'Name Lender's 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 180 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 - ateMailing Mail ing'Address• _ Validation: . City, State, Zip ..A1772. b .28 1.8-85,1,6' CK HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMPING FEE 1ST FL. SQ. FT. @ $ UNITS COLL. AREA 2ND FL. SQ. FT. ® YARD SPKLR SYSTEM POR. SO. FT. @ MOBILEHOME SVC. BAR SINK GAR. SQ. FT. @ POWER OUTLET ROOF DRAINS CAR P. SQ. FT. @ DUCT WORK DRAINAGE PIPING WALL SQ. FT. @ DRINKING FOUNTAIN SQ. FT. @ HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ GAS (FINAL) TEMP. POLE WATER PIPING NOTE: Not to be used as property tax valuation WATER HEATER SERVICE FINAL INSP. 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 FINAL INSP. LAUNDRYTRAY AIR HANDLING UNIT CFM i KITCHEN SINK ABSORPTION SYSTEM. B.T.U. MP USE PERMIT SVC WATER CLOSET COMPRESSOR HP OLE,TEMIPERM [AMPERES LAVATORY HEATING SYSTEM FORCED GRAVITY 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 @ 11/4 c SEWAGE DISPOSAL SQ.FT.GAR @ 3/ac HOUSE SEWER LATHING 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 I UNDERGROUND .C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. oll BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TA0K ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. 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 FINAL INSP. ROOFING /� % VENTILATION i REMARKS: FIRE ZONE ROOFING - FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND'' FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL ' INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Z 0 h U W fA I to Z O F- U W U Z O_ U W N COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SvSTEM 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. r Name -e Mailing. Address City _ State Zip Code L' PI -one "Property Address F 'City orp C6mn nunity 'Legal Description off Property (Lot,,Pna cel Map, Tract) I !? �ntfl.6i .t 'Assessors Parcel No. Water Servin _ Property From Ldt size y 7�1Z7.n..�1 CT f✓ ..�'L. L', a.� l.- i, ��" f,, jh /,4 .Y ..�R /-A G ../ � r Signature of Applicant Date yam= '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 LJ k J Detailed boring report required Yes ❑ No Detailed contour plot required Yes ❑ Nob Comments: Soils or boring report by Date Approved by -Ar Date ^� Soils Map Page Soil Type Tract File Other Number of Bedrooms Septic Tank Size (gallons) Rate Required ,f Type of System New Addition Replacement Leach line sq. ft. of bottom area trench y" Leach bed (sq. ft. of bottom area bed) Seepage Pit Diameter ISTp Number of Pits Seepage Pit Depth B.I. Total Depth of Pit 6' Of`9 j Location of System Additional Re uirements Cl �� A permit is�approve ;e ied for.the 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 We installation of the above designed system.. Signature of Health Official "- Date Receipt No. / (� 62 s s u e d By ' ,v District: Riverside ❑ Indio ❑� Hemet ❑ Date DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File DOH SAN 122 (Rev 10/84) a„