06401 (SFD)1�
Building
Address
Owner
Mailing
Address
City
. Pei
Contractor
Address
53--777 Ramirez
Coachella Vall.
247 E.'4ahquit
Zip —
^�T�TiI
Starr Construction
Bata@
Tel.
I.
• P.O BOX 1504 No.,
06401
78-105 CALLE ESTADO ' I. - ,
LA QUINTA, CALIFORNIA 92253
BUILDING:'TYPE CONST. OCC: GRP.
A.P. Number 774-161-015
Legal Description
1020
Project Description r S
State Lic. '.
City
& Classif. 38.7934
Lic. # 893 , .
Sq. Ft. 1409
No. No. Dw.
Siz-
e-
'" Stories Units
Arch., Engr.,
' Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
- Address
r
"
Tel-
430 sq. ft.
garage '
City
Zip
State
1701 wt3 d fence
`
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I 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
y. effect.
'
— SIGNATURE DATE
" OWNER -BUILDER DECLARATION
.•.r a hereby affirm that I am exempt from the Contractors License Law for the following
. •reason:'(Sec.••7031.5.8usiness 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 appGcant.for suchpermit to We 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�thealleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than Ihe'hundred dollars ($500).
0 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 whoCn
Estimated Valuation
76 �fr�
PERMIT
-
4. AMOUNT
Plan Chk. Dep.
- -
$250.00 '
Plan Chk.. Bal.
212.59
COrISt.
536.00
Mech.
.3,
3 .50i.V
builds or bnproves 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-buflder will have Ne burden
of proving that he did not build or improve for the purpose of sale.)
Electrical
]�, �.�
+
Plumbing
C
+
l57 fl
-,0A,,as,owner of the property, am exclusively contracting with licensed contractors to con-
Strutt 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.
_
5.39
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec � B. 8 P.C. for this reason
Grading
20.00
Driveway Enc.
20.00 ;
Date owner
Infrastructure
- WORKERS' COMPENSATION DECLARATION
• t
1 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
0 Copy is filed with the city. 0 Certified copy is hereby fumished..
TOTAL
S3.041.24 > r r.771 11. `^
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE.
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
^ or less.)
' I certify that in the performance of thg work for which this permit is issued, I shall not
'employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
REMARKS
l:fif�i$. °,s ;y Lir tigst atP-' „ji� �:� ^' •;,�
d, y ,,g t ti .! t^a 1 rca. _. .,
r
-
_
a
Date Owner
NOTICE TO APPLICANT: ff, 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
i
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 Cede.)
Side Street Setback from Center Line
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 if work thereunder is suspended for 180 days.
FINAL DATE
_ INSPECTOR -
INSS
9/27/89
I certity. that I have read this application and state that the above information is correct. -
I agree 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.
Issuedby:
Validated by:
Date Permit'
'
Signature of applicant Date
Mailing Address
Validation:
City,. State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SD. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. SQ. FT. @
WALL SQ. FT.
DRINKING FOUNTAIN.
SERVICE
FINAL INSP.
URINAL
SQ FT ®
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
cu. yd.
$ -Plus-x$-=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/aC
HOUSE SEWER
INSULATION/SOUND �� 0
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
ROUND PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
R SEPTIC TAN
�%*
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE 0
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FINAL INSP.
FRAMING / /1 /,P4*
[l
FINAL INSP.
ROOFIN
alo
1 1
10
/
0
f
f
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING Q"OWI1/
MESH
INSULATION/SOUND �� 0
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
1
s-v+� .. .: ya.. i '� /k. '- rS yiy,t'��`k� � a n, ay}-t�..,�WpW +a. S y;V y„L;-•
t!}, �� +�fX >•�, �ry Y• L -fit '.
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.
s
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION. -BUILDING DEPARTMENT APPLICATION -LOG #
.t
Agent, Contractor, Contact Person
Phone
Address & Phone s
Z7'Nq �. GB Alsr0-ZtV_T/0AJ
Owner
"
Phone
3Z2 -/020
Mailing Address t-
A 4,t7 .E 7-Al"14Pca.rz V/E4Y 4+Z
City
State
Zip
Job Property Address
Legal Description Prop. (PM, Tract, Lot)
-Pin /vw SPp. ftil Gs
e I
91Zz4-0-15'3
7-7-1 RRAtfec-L
t,ar 3 a3s aw,- Z -Z
Lot Size
Water Agency/Well
Use of Permit P/P, CU, etc.
Other
S61t /bp
d"'V �RT� 2�i
-
Oe C.'r-
Dwelling, H Site Prep, etc.
Signature of Applicant
date'
CATEGORY: REV CODE FEE
y
CATEGORY: 'REV CODE. FEE'
B -,SUBSURFACE DISPOSAL 1238 $45:50
❑ SITE EVALUATION UPON REQUEST. 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME t i7
(NO PLOT PLAN) t
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
g
INITIAL DATE
Holding Tank Agreements Completed ❑ Yes No ^
Certification of Existing S.D. System Required,rr.. ❑ Yes No
WQCB Clearance required. (Attach Form ❑ Yes 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 (T to 5 ft. interval) ❑ Yes No _
Other ❑ Yes No
Staff Specialist Lot Inspection Required ❑ Yes ❑ No
Lot Inspection Date -
Soils boring by 1'! / E
report Project # Date *j`+
Soils Map Page Soil Type Approved by -`Date
No. of Systems
Type of System(s)
'., No �D`elling Units =>:
(1)•Septic Tank
Soil Rate
Grease/Sand
j
0 -Hol ding Tank ❑Existing
Bow ❑Replacement
Bedrooms Fixture Units
�/�
Grease Intcp
LJ a Gyl
S o n.
Gal
(2) Leach Line Sq. Ft.
Sidewall allowance
Install Line(s) ft. long ft -wide with
Leach Bed sq. ft.
Bottom trench a
ft rock/ sq. Rof
per rupnin'g ft.
min. inches rock beloww draihlines or '
bo�m-mea
❑ NA
Leachlines/bed special design for slope:
(3) Pit Diameter
No. -Pits
Pit Below
Seepage Pit Total Depth
Other:
Applicable
Inlet (BI)
N/A Overburden factor
❑ 5 B-6
Oye
/ c�
Depth
Max. Allowable '-
No. 2 System
REMARKS:
This applicatio is APPROVED�RENIED fof-..the category checked in SECTION'S above, regarding the design of a subsurface disposal system as indicated
on the accompanied-plet-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 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 15f01 minimum from any wells,, including expansion area. _
Signature Health Official•`
of Date
RECOPT NO )ssued,By Date
r
'DISTRICT"_ O Riverside, = ❑ slndio O Hemet ❑' Perns - ❑ Rancho Calif '❑ Blythe
DOH SAk 122 (Rev 5/88) DISTRIBUTION WHITE - Office file `YELLOW.- Applicant PINK Bldg: Dept GOLDENROD - Plans/Records
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