003308 (SFD)t'i t ri L
Building
Address
Mailing
Address
City
Contractor
Address
P.O. BOX 1504
78-105 CALLE ESTADO
78-645 Bottj,gbrush LA QUINTA, CALIFORNIA 92253
No. 003308
BUILDING: TYPE CONST. OCC. GRP.
2ahQuitz Way A.P. Number 617--382-014
Zip Tel.
92262 . 322-1Q20 Legal Description
Project Description Salnctle Fztmi.ly Dwelling
["�3nlFtx°fltlfifc.�f^at�, �"`.AT•19C3�.ffi�: _ - -
City -
Zip
Tela
State Lic.
City
8. Classif. A-3857934
Lic. # 8$94,
Sq. Ft. 152.9
No. No. Dw.
Size
Stories Units
Arch., Engr.; - - ,' --
'Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
•__ LICENSED CONTRACTOR'S DECLARATION
thereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and''
'
r
effect. J. _e
SIGNATURES - -f DATE
' '.1 OWNER -BUILDER DECLARATION
Estimated Valuation
-Thereby affirm that I am exempt from the Contractor's License Law for the following
��fi ��
reason: (Sec. 7031.5,Business and Professions Code: 'Any city or county which requires a
'
s�$Q s
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
PERMIT
' ' AMOUNT '
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 Any Section 7031.5 by 'any for
Plan Chk..Dep.
rysA, Air,
alleged exemption. violation of applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
.
Plan ChkBal
-
❑ I, as owner of the property, or my employees with wages a s their sole compensation, will
. •
'A 77- A M
do the work, and the structure Is not Intended or offered for sale. (Sec. 7044, Bulsness and
Const.
Professions Code: The Contractor's License Law does not apply to an owner of property who ...
7 g _ nn
builds or improves thereon and who does such work himself or through his own employees,
-Mech.
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year or completion, the owner -builder -will have the burden
Electrical
�ry
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
fit+ t1
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
_.
-
does not apply to an owner or property who builds or improves thereon, and who contracts for
S•M.I.
,T AA
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)•
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
A
Driveway Enc.
i
Date t Owner
Infrastructure
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.)
i Policy No. Company
9}Copy is filed with the city.. ❑ Certified copy is hereby furnished.
TOTAL
A11 _ 717 A4
CERTIFICATE OF EXEMPTION FROM
_ REMARKS
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
t.fval t 1 i iY 1 NL. 1 i :
Laws of California.
ily 1 U • uo
Date Owner
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 it work thereunder is suspended for 180 days.
I that I have
certify read this application and state that the above information is correct.
Issued by:
Date/ j�f IPermit -
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 Address - .
Validation:
City, State, Zip
' HARD COPY
?
T
'
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
B GRADE
YARD SPKLR SYSTEM
2ND FL. S0. FT.
HEATING (ROUGH)
STORAGE TANK
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
%
OUND. REINF. v
DRAINAGE PIPING
CAR P. S0. FT. ®
HEATING (FINAL)
OTHER APP.IEGUIP.
WALL S0. FT. p
REINF. STEEL
DRINKING FOUNTAIN
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as properly tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
BOND BEAM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP. ( /
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFIfIr r� / / J
C�/_/.. /
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
SO. FT. ® c
BATH TUB
S0. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
MESH
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
e
BACK
GROU D PLUMBING %,UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
'/ EWER OR SEPTI ROUGH WIRING
DUCT WORK
ROCK STORAGE
%
OUND. REINF. v
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APP.IEGUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu.Y d.
$ -plus_x$
.g
LUMBER GR.
FINAL INSP. ( /
FRAMING
FINAL INSP.
ROOFIfIr r� / / J
C�/_/.. /
p/n
v ///
l/ `/
SUS/
1
REMARKS:
1P9
VENTILATION
FIRE ZONE ROOFING
_
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
I t ULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL
Z
O
U
W
U)
M
Z
O
H
U
W
U)
rn
Y
Q
W
X
Z
O
U
Lu
V)
COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION
6 %
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.
, �J44 Q e,00,JWuuilding Department Application Log #
Name (Owner, Agent, Contractor, Etc.)
Mailing Address
,o, v 2 WA
City
State
Zip Code
Telephone
1*1 Qgldef5
Gla-
�ia�.lvz
_41-Z7_-14J-Zc0
Job Property Address
_791—A�
City 6 nAL x
Legal Descriptio f Pro art . ol, P T
_� Sµ
1
l4 lir i� 1I2 C�
Assessor's Parcel No.
Water Age
Use of Permit,Planning Case M
Lot Size
t
�A
'CL.A "Z/gr
r
SID Site Preparation Etc.
X /DO
Si re o Applicant ^Date 100,
'The above information must be vert/led from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
Initial Date
p
Certification of Existing S.D. System required. ❑Yes L�"N "O
WQCB Clearance required. ❑ Yes
Soils feasibility repo.�rt required. ❑ Yes
9=4boring Irepoilt required. El Yes
Detailed contour plot plans required. ❑ Yes
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 Bedrooms
(1) Septic Tank
Soil Rate Required
❑ Existing 5 `New ❑ Additional ❑ Replacemen
I 41 wa�)(,
�lLGals.
% /Q 1-(4j
(2) each line sq. ft.
otto ch area)
Sidewall allowance
ft. rock/Sq. Ft.
Instal�Line(s) Ft. Long,
Ft. wl min. inches
L bed Sq.
o
Ft.�ch
running ft. Lb"NIA
rock below drain lines
area
per
Leach lines/bed—special design for slope:
Applicabl
Overburden factor
(3) Pit Diameter
,
No
Pit S1
Seepage Pit total depth
Max. allowable depth SAO
N/A
/elo
This application i pproved etor the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
set forth in Section ove. A building permit i;Vecessary for the installation of the above -designed system.
1) Septic tank and sewer lines must bAe'5J01 from any wel/p0
Leach lines must be 100 min. from an wells includingex nslo area .✓
(3 Seepage pits must be 150' min. from any wells including expansion area_00
Signature of Health Official �i��,(� �a� �^
RECEIPT NO. Issued by �� U Date ,C- a -
District: ElRiverside Indio ❑ Hemet ❑ Perris E)Rancho Calif. ❑ Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 6/86)