00012233 (SFD)APPLICANT NAME(L F MI) ". _. ,9 .•_. _. '..
ADDRESS
%..4QF'J tF9tl's .• ' - - .Ail x `.:"
CITY/COMMUNITY/STATE/ZIP
LA -Ct149 53666W
pJOB SITEADDRESS/SPACE
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•CITU/COMMUNITY/STATE/ZIP '.
I.A ',QUIN'-A !dA 922530000
PA9
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FORM 284-208 (2/81)
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
It
33
Ventilation System
2
Ftgs 8 Frms
—qr2 011C
34
Plenums 8 Ducts
2A
Slab Grade
I
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
t
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
G,.age Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T.O.
OF
O.
ADDITIONAL INFOR TION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath '
12 Interpol Loth
12A Drywall 3 -
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
D �+
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBiN APP OVALS
AS-
15 Ground Plumb Yz E�
16 Water Piping
17 Rough Plumb iAA
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
2S Final
Tank Pit L. Line
REAR OF PROPERTY LINE
F
ELECTRICAL APPROVALS
P/L
P/
l
4
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
W-Y
241-
r
STREET NAME
APPLICANT NAME -(L F M1),'. - -
y SCITY/COMMUNITY/STATE/ZIP.
6 JOB SITE ADDRESS/SPACE,
ViA
i
3;3 ttCITT�Y/COM*M*UU�NITY/�SQT.ATE/ZIP
It
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7 TRACT NAME
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i_
I CONTRACTOR -FIRM NAME --
,ADDRESS.
CITY/COMMUNITY/STATE/ZIP.
'PHONE N
LICNC N
.ARC/ENG FIRM NAME.
ADDRESS
CITY/COMMUNITY/STATE/zl
•-
PHONE p
i �_
,
LICNC.p
b
USE OF,PERMIT. _ -
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AyOF'
FORM 284-208 (2/91)
:i. "+.i
7 s
d. a. ten?,.!.:•. +T'..:*_�.r ! w.:., .S ,.. Y'_ti-:..
.. .?l. +;F?�:in"'�T ,.'_a:7 rFrl..,�
�. .int c.�.i'� -: x..� I
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System -
2
Ftgs 8 Frms
34
Plenums & Ducts
2A
Slob Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42 Commercial Hood
10
Fireplace P. L.
43 Final
10A
Fireplace T. 0.
°o
--------------------------------
ADDITIONAL INFORMATION
-------- _-- _-
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
---- - ----PLUMBING-APPROVALS---------------
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank Pit L. Line
P/L
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/
26 Power Pole
27 Conduit -
28 Service Entrance '
29 Wiring
29A -Grounding Wire
'298 Bonding'
30+- Fixtures ,.
31 , Service
32� Final
STREET NAME
County
of Rttrerside
Department of
Bulldmp.and Safety
4080.Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. State Street
Riverside. CA 92501 'Banning; CA.92220 - Hemel. CA 92343
- 22r`.Norih "D" Street 46209 Oasis SL Rm. 310 180 N: Broadway .r
Perris: CA 92370, Indio, CA 92201 Blythe, CA 92725 1
a -0h: 787.8148 Ph:• .8437312 • ' , I' Ph: , 658.4464
•E:, `,� . Pli:•(' 657-3898 Ph: 342-8271 Ph: 922-2670
•
This permit becomes void if work not -commenced Within 180 days Irom date of issuance. OR if work has been suspe ded.or abandoned for a period of 180 days.
Y. . .s )., - apr-p1.R�.•pys.. -ti.
•"
.. .. f4a. , A.:r.>;..Af.. '
,LICENSED CONTRACTORS DECLARATION:I hereby affirm that I am licensed under provisions of Chapter 9 (commencing CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the i
�. with Section 7000) ;ol, Division 3 61 the Business and Professions Code, and my license is in lull force and effect.
,, -
2-;V-'
-permit is for one hundred ($100) or less. I certify that in the performance of the work for which this permit is issued. I
shalt not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California; '
Lmerkse,Class 12 [ : Lic Number -
- •
` i• -
• Date Applicant 7
�z// m• .r a
Dater I• �- „� Fes✓• Contractor ? <•y -
-
-�
•r .� ,s - _. .7;y...,:4'•:4ra,a✓v..••Y•,:�^„y.
F "
NOTICE TO APPLICANT: II,'atter 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 i
,OWNER-BUILDER,DECLARATION: I hereby. affirm that I am exempt Irom the Contractor's License Law for the lollowibg
deemed revoked.,, '
reason (Sec. 7031 !'Business and Professions Code: Any. city or county which requires a permit to construct. alter,
-
improveNr9cillsh or;.repair any structure; prior to its issuance, also requires the applicant lor.such permit to file a
DIVISION OF INDUSTRIAL SAFETY, PERMIT CERTIFICATION:
signed stat&enGthaj•heJi licensed pursuant to the provisions: of the Contractor's License Law (Chapter 9 (commencing
I hereby certify that no excavation live (5) or more feet in depth into which a person is required to descend, will be ;
:.with Section 7060),of'Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for
made in connectionwith work authorized by this permit, and that no building structure, scaffolding, falsework, or.
the alleged exemption!„Any violatidn of Section 7031.5 by. any applicant for a permit subjects the applicant to a civil
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8. 9
.;penalty of not more t6n live hundred; ollars (5500),1:.
C.A.CJ
-
I, owner e or myemployees(Sec. with wages as their sole compensation, will do Ihe'work, and the
Q As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial 4
,a'eN• as noted above, unless such person has a permit to do such work from that division
structure is not intended orollereolor•sale (Sec. 1044, Business and Professions Code: The Contractor's License Law
re t n or offer
° does not apply to'an.owner'of'•propertyl who builds or improves thereon, and who does such work himself or through
;
Division of Industrial Safety Permit No. 1
,his own employees, provided,that.such improvements are not intended or offered for sale. If. however, the building or
Date Applicant
improvement is sold within one year of, completion, the owner -builder will'have the burden of provingthathe did not
:build
CONSTRUCTION LENDING AGENCY: I herebyraffirm that there is a construction lending agency for the performance of r
or improve for tlie'purpose of sale.).
-
the work for which this permit is issued (Sec. 3097. Civ. C.).
I, as owner of the.property, am exclusively contracting with licensed contractors to construct the project (Sec7044,
Lender's Name•
and Professions Code: -The Contractor's License Law does not apply to an owner of properly who builds or
'
.Business
:improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
Lender's Address
License Law.).. - •
I certify that I have read this application and state that the above information is correct. I agree to comply with all'.
' 0 I am exempt under Sec. . B. 8 P.C. (Attach Certificate).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives of
}. a
D=te '• Owner •
this county toenter upon the above-mentioned property for inspection purposes. {
_. �. `y ;r.” r
WORKERS' COMPENSATION DECLARATION: •I herebyaffirm that Ihave a certificate of consent to self -insure, era
certificate of Workers' Compensation Insurance,. or certified copy thereof (Sec. 3800. Lab. Q.
Sre 'A I b Agent •T�tC. F
- ��P�e
CERT ATE 9PCO- pUTHl1H ZATI ENTRY: I certify I have read this application and state that the e
int ation g(VgppAAett." agree to comply with all state laws and county ordinances relating to building con.
"Policy No. .Company
st uctiiin�and auth representative of the County of Riverside. Department of Building and Safety to enter upon
~Q Certified copy is hereby tarnished. t
'the property for whave applied for this permit for the purpose of making inspections.
jilding Inspection Department or County - Departmei
Applicant ,.rJ"•';..:f.. ...
rAPPLICANT NAME (L, F, MI) ��^ ~•Tri
to `t
:i � �'r- �
CITY/COMMUNITY/STATE/ZIP '
ppJ��OpBB SITE A.DDRESS/SPACE � 1 _44'' NIi.gy gAmk `
'CITY/COMMUNITY/STATE/ZIP
,600
LA QUINTA - ' CA_ . 922-5-34,6001
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OWNER NAME (L, Fr MI)
AL
CONTRACTOR -FIRM NAME -
ADDRESS,
C IT VCOMM U N ITY/STATE/ZI P
-:PHONE #
ARC/ENG FIRM NAME
'ADDRESS
c i
CITY/COMMUNITY/STATE/ZIP -
PHONE #'
LICNC # -
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USE OF PERMIT ?' '
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LFORM. I... •TM, a <., �t1:.r...
,n% r+
284.209 (2/81) .� '+ :.. cT�i _., i -...� *¢� ...gyp
NO.
._ OFE%ATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System '
2
Ftgs & Frms
34
Plenums 8 Ducts h'a'
2A
Slab Grade
35
Furnace Comport. '
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
,.
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
G-oae Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T.O.
Cj
°o
------------
ADDITIONAL INFORMATION
----- - - -- -------
------15
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internol Loth
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
- PLUMBING APPROVALS ------ ---------
15Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank
Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L
'
-
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
:�i
W
Z
O
,F -
v
W
0
Z
O
V
W
o -
RIVERSIDE COUNTY DEPARTMENT OF HEALTH
APPLICATION FOR PERMIT TO INSTALL A RESIDENTIAL SUBSURFACE DISPOSAL SYSTEM
Applicant: Submit this form with three copies of a scaled plot plan drawn to the 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 payableto
County of Riverside.
Name — -
Mari lirigAddres
�
City
State
Zip Code
Phone
'Property Address cvy9l ��
'City or Community
'Legal Description of Property
.Assessors Parcel No.
Water Serving Property From
10
Signature ot�Appt%nt� Date
'The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
/j Initial Date
Soils feasibility report required Yes ❑ No ❑
Detailed boring report required Yes ❑ No ❑ F
�
Detailed contour plot required Yes ElNo ❑f
Soils or boring report by i Date
ff
l ' `� �� ��, �-
Approved by Date'
�% o 4y F?r,� /��' tics s
Map g Soil Type Tract File No Other
Soils Ma Page
Number of Bedrooms
Septic Tank Size (gallons)
Rate Required (sq. ft./100 gal or gal. sq. ft./day)
f1A All
Leach line sq. ft. of bottom area trench ~
Leach bed (sq. ft. of,6,dttom area bed)
Seepage Pit Diameter
Seepage Pit Vertical Feet 99
�s
Number of Seepage Pits
Maximum/Depth of Pit
Location of System e
t 14s it%•
Additional Requirements
A permit is approved/den-ied for the installyi ation of a subsurface disposal system as indicated on the accompanied
plot plan using the requirements set forth in Section C- above.
Signature of Health Official -, abate
Receipt No. d- 3
District: Riverside ❑ Indio ® Hemet ❑
DISTRIBUTION: WHITE - Office File YELLOW - Applicant
DOH SAN 122 (N:': 10/81) l
Issued By
Date 1�.i �s . 2
PINK - Building Dept. GOLDENROD - Attached to Plans
APPLICANT. NAME..(L.,F'
`As FN
514!1AA4.. is s
CITY/COM MUN I TY/STATE/ZI P
J�OBSITE.vAODRESS/SPACE
C I TYCO MM U N ITY/STATE/Z I P
LA blANVA
BOK ` PAG PRC;,,
4 fit
TRACT '
4 p Q0
WT �.MpE.. tp O
pO�WNER NAME (L, F,.MI)
r At•:h9.
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
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NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T. 0.
°O.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
__ __ -_ -PLUMBING APPROVALS ---------------=-------------
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. tine
PSL
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/
26 Power Pole
27 ` Conduit
.28 Service Entrance
• 29 Wiring
24A Grounding Wire
298 Bonding.
-,30 ,Fixtures
31 Service
32 Final
STREET NAME