Loading...
002562 (PLBG)Building' Address Owner Mailing Address City _2; ic. Zip I Tel. Contractor Address :}aI �• .+Cif fT City Zip State Lie. & Classif. cj 1 Arch., Engr., Designer [� gW b4K4fW W P.O. BOX1504 No. 0032562 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 ..." ra T— Tel. 14 City Lie. # 1 0 LJ BUILDING: TYPE C/O�NSST. OCC. GRP. A.P. Number lCl� Legal Description Project Description Sq. Ft. No. No. Dw. Size Stories Units New �t Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lie. # LICENSED CONTRACTOR'S DECLARATION I herebyy alilrm that 1 am Ilcensed under pro4Wons of Chapter 9 [commencing with Section d effect. C�' r; 7000j of Dlvisipn 3 of Aire Business and Professions Code, and my license Is�.fuII fpr*-7E SIGNATURE_ _ � 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 requtres a I permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also II raoires rho applicant for such permit to file a signed statement that he is licensed pursuant to rho provisions of the Contractor's Licansa Law, Chapter 9 (commencing with Section 7000) of Dvisfon 3 of the Buslness and Professlons 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 Estimated Valuation y PERMIT AMOUNT Plan Chk. Dep, 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 Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bussness and Professions Code: The Contractor's License Law does not apply to an owner of property who COnst. 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 Mech. Electrical 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.) Plumbing ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- 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 S.M.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec. B. & P.C. for this reason Grading Driveway Enc. Dale Owner WORKERS' COMPENSATION DECLARATION 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. 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 thV 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: if, after making this Certificate of Euernpilbn you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shaii 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.) Lender's Nam Lender's Addrass 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. 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 enler the above - mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip Infrastructure TOTAL REMARKS 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 `x Per Validated by: Validation: A6Z97 9 8 25,00 CIS HARD COPY] CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL, SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. ® FORMS SEWER OR SEPTIC TANK POR. SO. FT. ® MOBILEHOMESVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. OTHER APPJEOUIP. DRAINAGE PIPING WALL S0. FT. TEMP. POLE DRINKING FOUNTAIN SO. FT. ® GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP, WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM 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 LAUNDRY TRAY AIR HANDLING UNIT CFM 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 SPARK ARRESTOR SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/a c SEWAGE DISPOSAL LATHING SO.FT.GAR ® 3/ac HOUSE SEWER MESH GAS PIPING PERMIT FEE INSULATION/SOUND 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 SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING 6KINA:L INSPECTION ry CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS, GARDEN WALL FINAL THIS APPROVAL GRANTED BY THE DEPARTMENT OF PUBLIC HEALTH IS VALID FOR ONE (1) YEAR FROM DATE OF APPROVAL. t. • "Approval of these plana by the Department o7 i+nWjv Health of Riverside County does riot relieve the lRngin. c, Der or A.achitect of the responsibility for the EneweeN MZ ar Art$iteetural desivn." M -so C,rT:rs o 73 13c., -,e to U.Q i,7u v:,', •in+ tlnr erg,otll.:,, c::r., sis 7C S -Q N 0lSz=, I �^41.4, rl''il �u5 c tTV.rl - e"'A AS -T l0r TaACi c. WI -tv ,40tecoVVa 7-D r"J. a *Ape tTo &EmA t ") Aws ExIf7 r' � 1 00 KI VCKJIN[ t.1JUIV i I LJs=,KH 1 mC1j 1 Ur r ��. r ! DIVISION OF ENVIRONMEIATAL @I L-THj I��� (ooY �Io DEEP (T, D,) Food Establishment f X Sewage Disposal ��`P���`I Trailer Park !- / \ � c >- S Gal. Septic Tank _ Motel, Apt., Hotelt I S? Sq.:F�t.of Leach Line Dwelling i, Z r✓'P:�it^ . • v✓�% �g� �- + % C� `x _,c Llsee a e Pit 7� ) _ X , Commercial Building ( r Connection o Sewer" f %� S= vI G°�'= iS %`• %,/T. Swimming Pool I \ No on-site regenerating water softening devices may be disc arged into the Individual sewage dispos: system herewith approved without clearance from the Water ualil r ontrol Board. Water supply seryijlg� thisnst�llation must be frorc, an approv d s3�cire. L' X 1ST CC i rcb� All sew5ge disposa��ins4'iYla>7n must conform with requiremen s o`Q�c rrent Uniform PlumbirfC.� X Any, euIli" prapg, OrKT1 L ,in excess of four (4) feet will r�ulli$6 swage disposal approva''.\\ Approval s nob/tainec�j from the Regional Water Quality Con--f�r'ol Board for iristallation of the seg• age disposal system. This is to certify that the Riverside County Department, of Public Health approves for oearpaney,. co stru'ctio- or installation the item(s) checked above. 7 -1/ /- %<' �` /may �� �.�-'C =LTJ,/��c. c.:=>!�;:-•..-./ �. on Z O_ H U UJ U) Cf) Y Q W cr N Z O I— C) W cn 41 COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION W ' 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 checklist. A non-refundable filing fee of�0 required when the application is submitted. Check must be made payable to the County of Riverside. IF3 7 C+ ��! r %"„ Ssc c,.46 %.A S Building Department Application Log # /�' Name (Owner, Agent, Contractor, Etc.) Mailing Address ,a City ,//r- a , . 7.4 State . Ic, , + Zip Code Telephone Property Address e6ityxd Comm nity'"' Legal Description of Property. (Lot, PM, TR) �Joyb 1 �� /5t+-P,I> ur—/gas-/y .[ 04� /�C� -? t. �-- !.L— 'Assessor's Parcel No. Water Agency i �� 1 � � � E Use of Perm�� r J +� Planning Case q— Lot Siz • ' W ,L j> SFD, MH Site Preparation Etc. � /�P�rGi�t©sem✓ �d�#/�r � �,b Signature of Applicant Date -The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE /�� Initial ►� Date Certification of Existing S.D. System required. ❑ Yes L�J�, o WOCB Clearance required. ❑ Yes CJ jald Soils feasibility report required. ❑ Yes ;,�,i�o Detailed boring report required. ❑ Yes U . o Detailed contour plot plans required. ❑ Yes KJ NO >' Staff Specialist approval required. ❑ Yes Fr No Lot Inspection Date— Soils/boring report by Project # Date Soils Map Page Soil Type_ _Approved by _Date_ Type of System:F f�ISgf B%oorrps 1/vL_1 (1) Septic Tank Soil Rate Required ❑ Existing ❑ New eoAdditional ❑ Replacement Z 6,0/L -V q,�qy ��.tl l Gals.! . 6 (2) LLeeaach line sq. ft. h Sidewall allowance ft. Ft. Install Line(s) Ft. Long, Ft'Wid, inches Leach bed Sq. Ft. (Boat -tcry area) rock/_ _Sq. with min. oi'bgtom per running ft. �/A rock below drain lines area Leach lines/bed-special design for slope: ApplicableN (3) Pit Diameter No. Pits PitrAl Seepage Pit total depth 4 / burden 6' Max. allowable depth A factors' This applicatio<,epprove 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. (1) Septic tank and sewer lines must be 50' from any wells Leach lines must be 100' min. from any wells including expansion area Iv �, t— (3 Seep ge pitsmust�be 15/0 min frofm any wellsincluding expa sion are�j q Signature of Health Official Date RECEIPT NO. Uy Issued by— /aG41 c- Date 4/1_ �a District: ❑ Riverside Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW -Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH SAN 122 (Rev. 2186) f + i A