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003358 (PLBG)Building Address 52-375 Bermudas i Owner ! Itiarr1 Mailing Address City La 'Quinta Contractor Zip 52253 P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 No. 003358 BUILDING: TYPE CONST. OCC: GRP.; A.P. Number 773-275-01.5 Legal Description Project Description Si6ptic Tank Date Owner i I WORKERS' COMPENSATION DECLARATION I 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 ❑ Copy is filed with the city. . ❑ Certified copy is hereby furnished. l CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE i (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. Date ' '"'Owner - NOTICE TO APPLICANT: It, 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. 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.) Lenders 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 certify that 1 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 HARD COPY n ras ruc u e TOTAL uu • his REMARKS City Cathredral City Zip 42235 Tel. . . _3241728 State Lic. City Minimum Setback Distances: & Classif. 2� Lic. # 144 Sq. Ft. No. Size Stories ' No. Dw. Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. INSPECTOR Issued by: Date 9/9/87 Permit Validated by: 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 Division 3 of the Business and Professions Code, and my license is in full force and effect. ✓ 4,14��` 4. ` 7 JY 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,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 rile 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 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 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 or improvement is sold within one year of completion, the owner -builder will have the burden i of proving that he did not build or improve for the purpose of sale.) Estimated Valuation ' PERMIT AMOUNT - Plan Chk.. Dep. Plan Chk. Bal. COr1St.Gii• '�7yt3 t�ayyi� VV Mech. - Electrical Plumbing ! ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- i 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 i 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 I I S.M.I. - Grading Driveway Enc. I f t t r Date Owner i I WORKERS' COMPENSATION DECLARATION I 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 ❑ Copy is filed with the city. . ❑ Certified copy is hereby furnished. l CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE i (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. Date ' '"'Owner - NOTICE TO APPLICANT: It, 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. 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.) Lenders 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 certify that 1 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 HARD COPY n ras ruc u e TOTAL uu • his REMARKS E—17w,14 1 I1 t L f,I 20.o.1— k 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 9/9/87 Permit Validated by: Validation: _ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS d-WER OR SE POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APP.IEOUIP. DRAINAGE PIPING CAR P. SO. FT. ® TEMP. POLE WALL SQ. FT. GROUT DRINKING FOUNTAIN SO. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM 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 R GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. I 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 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 INSULATIONISOUND 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 d-WER OR SE 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. BONO BEAM WATER SYSTEM GRADING cu. yd. $ -plus-x$-=$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING /s t -?,Ake R 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 Hondrickson SEWERS GREASE TRAPS AND SEPTIC TANKS Construction, Inc. POST OFFICE BOX U CATHEDRAL CITY, CALIF. 92234 Telephone (619) 328-1747 • CRANE AND DOZER RENTALS yy�� y GJ,�-�/P•- �2 17-5— A0 -e , cj,, f Jt CU:UN Food Estahiis :rt+cst -- -- Trailer Park Motel, Apt„ Hotel brreliin _ Cf�r'n rferG l2t E`u:lGirS� �—� lwirr,mina P�v: , e A No on -Stat rencrAfe;i , ^`'renirr. o --� n-.av i:_ c ,.},a:e_� ".e .._ivi::ual se..•aoc c. - tystCm hPrcwish appy='i wi:%.u: tL' -:.r.ce�s;cV. Y.' ;,+ �.,=:, .,.:r;C br.zra. •� Water supply serv' �i�•. n muw: b f -cm, a; nrrn rce. G ca wh All sewage disac zT`lt,s: • -:: is isi con`crm :i?h reou:: rents of curve.^.1 Uniform Piumbirg Ce Any cutting, grzu'inc, e: ` `vna m excel of four (4) f:ci will nullify sewage d,sposal approvai.I � � C Aparoval has been cbiaina� from the Reoionai �';'ater Q.:a:ity Control Board for instaliatio� Tte age disposal system. his is to certify that the Riverside County Dep rtrne� Public ,Health approves for �occupancy, const or instillation the item(s) checked above. 6V _ v . :� t r.! - r�:,Frr; Hi\Y l't+tLL ri;- n GC_ fi mit, _ii:� Jf f y': us : i .may. E i i , C m, �71N 0 9 ! � I c,4P�Y r' J1% (' J./ �• u p G • A o c s y � dao UEPARTMtEN O� PU6LIC: 111 6Te<i ::fir%j; : e. — t (2- IS91-1 "`— .!0l4 v. IJw�� SE CZDispo_sal` �Ock7 Cwt. S r :c—tank 3 hew c y 5q- r• ,--,i L=_a:h Linc 9 L � U; \ �o x i soovnE pl1 Scwer y P G Q C Cc.<na tion to 4 F c No on -Stat rencrAfe;i , ^`'renirr. o --� n-.av i:_ c ,.},a:e_� ".e .._ivi::ual se..•aoc c. - tystCm hPrcwish appy='i wi:%.u: tL' -:.r.ce�s;cV. Y.' ;,+ �.,=:, .,.:r;C br.zra. •� Water supply serv' �i�•. n muw: b f -cm, a; nrrn rce. G ca wh All sewage disac zT`lt,s: • -:: is isi con`crm :i?h reou:: rents of curve.^.1 Uniform Piumbirg Ce Any cutting, grzu'inc, e: ` `vna m excel of four (4) f:ci will nullify sewage d,sposal approvai.I � � C Aparoval has been cbiaina� from the Reoionai �';'ater Q.:a:ity Control Board for instaliatio� Tte age disposal system. his is to certify that the Riverside County Dep rtrne� Public ,Health approves for �occupancy, const or instillation the item(s) checked above. 6V _ v . :� t r.! - r�:,Frr; Hi\Y l't+tLL ri;- n GC_ fi mit, _ii:� Jf .el 2 Z O H U W cn tr Z O H U LL1 U) U) Y Cr Q W Cr_ X COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION 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 specifications required on the attached check list. A non-refundable filing fee of $37 is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name (Owner, Agent, Contractor, Etc.) Mailing /Address �f ,/.i� .�9Ajf i /rw Ga �/ < City state Zip Code Telephone 1 Job Property Address 'City or Community Legal Description of Property. (Lot, PM, TR) 'Assessor's Parcel No. Water Agency or Well - Lot Size Use of Permit Planning Case b SFD, MH Site Preparation Etc. / ,r5 Stgnature'irb ticant Date The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE InitialDate Certification of Existing S.D. System required. ❑ Yes No WQCB Clearance required. ❑ Yes ❑ No f Soils feasibility report required. ❑ Yes ❑ No C rtirin�L u f Detbboringg rep report required. ❑Yes No Detailed contour plot plans required. ❑ Yes C!1 No Staff Specialist approval required. ❑ Yes ❑ No Lot Inspection Date Soils/boring report by ` , Project # Date Soils Map Page Soil Type Approved by Date Type of System: No. of�Bed�o�orrts (1) Septic Tank Soil Rate Required E) Existing El New El Additional ❑ Replacement 1 `t M -u No X _') Gals. (2) Leach line sq. ft. r Sidewall allowance Install Line(s) Ft. Long, Leach bed Sq. (Bottom trent area) ft. rock/ Sq. Ft. Ft. wide with min inches Ft. of bottom per running ft. ❑ N/A rock below drain lines area Leach lines/bed-special design slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth Applicable El 5' 5' '6' l( Max. allowable depth N/A Overburden factor N�.ys , % �6''• t V,U / ? C X P. -J(, 'S"t<­k. %K'e.4�, l 'L S r, NS 1 0 •. 1. This application is approved/denied 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 the installation of the above -designed system. Septic tank and sewer lines must be 50' from any wells (2) Leach lines must be 100' min. from any wells including expansion area ((3) ,'Seepage pits must be 150' min. from any wells including expansion area C. � . �ke • tt �, .. t c , '� c_r Signature of Health Official Date RECEIPT NO. , k Issued by Date V District: ❑ Riverside ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH -SAN -1122 (Rev. 6/86)