003537 (AR)i'_
TW�t 4 4 a"
Building
Address 78-104 Buona Ventura
Owner
F. G. Nicholson
Mailing
Address 78-104 Ano—.-na ` 4P_rttn_r^
City I Zip ITel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Contractor
endrickso.n Constructions Inc .
Address i
City lZip
State Lic. City
& Classif. 256184 Lic. # ( +
Arch., Engr:, -
Designer
Address Tel.
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.
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, alter, 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
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
of proving that he did not build or improve for the purpose of sale.)
❑ 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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.)
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 lhg 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
1 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 Name
Lender's 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.
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 enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
No. aa337
JILDING: TYPE CONST. • OCC. GRP.
P. Number 769-091-006
,Legal Description
Project Description
r!t?i lrta�tsxln[?�t�
Sq. Ft.
Size-
No. No. Dw.
Stories Units.
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$11 000
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Ain. A(I
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES r,
IST FL. SQ. FT. a $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
OTHER APPJEQUIP.
DRAINAGE PIPING
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN
SQ. 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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3/ac
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
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 APPJEQUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL
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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 $40 is required when the application is submitted. Check must be made payable to the County of Riverside.
Building Department Application Log #
Name (Owner. Agent. Contractor. Etc.)
Mailing Address
. c Z
Rt L g —T r
City v jj
State
Zip Code
Telephone
'Job PArof5erty Address
fly
'City or. Community
'Legal Description of Property (Lot. PM. TR) d t[/
'Assessors Parcel No
Water Agency or Well
\ . w , �
use of Permit Planning Case #
SFD. MH Site Preparation Etc.
of Size
L4fi$ture o Appltcanl / 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 No ��
WOCB Clearance required. ❑ Yes No
Soils feasibility report required. ❑ Yes No
Special feasibility boring report required. ❑ Yes No
Detailed contour plot plans required. ❑ Yes No
Staff Specialist approval required. ❑ Yes No Lot Insipeecction Date i
Soils/boring report by Project # Date
' •a
Soils Map Page Soil Type �r� Approved by <•�70 Date
Type of System:
❑ Existing ElNew ❑ Additional IJ Replacement
No. o Bedrooms
✓
be /, ,, M.t�
(1) Septic Tank Vii _
Ste" Gals.
Soil Rate Required
1 y r
(2) Leach line sq. ft.
Sidewall allowance
Install Line(s)—Ft. Long.
Leach bed Sq.
(Bottom trench)
ft. rock/ Sq. Ft.
per running ft. ❑ N/A
Ft. wide with min. inches
rock below drain lines
Ft. ofabottom
area
Leach lines/bed-special design for slope:
Applicable //
N/A Overbdrden factor
(3) Pit DiameterNo.
El 5' l�6'
Pits
rvC
Pit BI
! Q
Seepage Pit total depth NOS
Max. allowable depth y Z
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.
1,} 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
Signature of Health Official Date
RECEIPT NO. A' F,874' $1 Q Issued by lrr
Date / 2 - ' 3
District: ❑ Riverside O-lhdio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH SAN 122 (Rev 8187)
Building
Owner
Address CJ /d V
City lZip ITel.
_%_77 Z.5 /S/e-
State Lic. ' City
& Classif—Lic. #
Arch., Engr.,
Designer
Address Tel.
P.O. BOX 1504 APPLICATION ONLY
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City IZip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereb affirm that I am licensed nder provislo f Chapter 9 (commencing with Section
7000) of Ivis' 3 o t B si and P It si ode, and my license is in full for and
elle Q1
SIGNA D E
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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).
O 1, 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, Bulsness 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 knprovements 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
of proving that he did not build or knprove for the purpose of sale.)
❑ I, 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
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
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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 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: 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.
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 '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 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 enter the above-
mentioned property for inspection purposes.
Signature of
Mailing Addi
City, State,
FINANCE
LDING: TYPE CONST. OCC. GRP.
P. Number 76 r'—' ®,5P—1 — 00 6
Legal Description IWAP
Project Description Gv L.
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
p p p
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
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 Permit
Validated by:
Validation:
• Hendrickson
SEWERS GREASE TRAPS AND SEPTIC TANKS CRANE AND DOZER RENTALS
construction, Inc. a= • &-00e-kA-( /�--S4peo'j
POST OFFICE BOX U PJC) -S je %Slay ,gVe
CATHEDRAL CITY, CALIF. 92234
Telephone (619) 328-1747
IJes10-,eTI:i lu- b i IPa.:T
UL ?
DIVISION Or
Food Establishment `, 2L Se-„cge Dis,..>...
railer , C-1. Sz14`ic Tcnl:,
1otel,(Apt , Hotel EX15 .TLI%LEA _ 54. -t. Lcaci
:riling' 3 f39A,.i, 4AX) EY, -Ser?oc Pit
0
crr.rincrcial Building C ..n ,_.n to S wer
v..i Minn Pcol
crati ..r s_f_tc;:ing c:c.,ccs m.a.y b. disc'.:a ed into dividu I sewage dispc_.
'a?Rr_ .. ^:heat clecrcf,_ rr<< = ii
Si n -'L15' La fror., an 2C ^V SQU"G_.(C ✓aG� .
\7:.', r�'C :r?rn_nt5 Cir CUI'r:'nt Ltf:fJrGl Umhing Code.
c.`r.f four (4) `_-et v.:ii r.0::ify S'v..':;;s dl-^'sil]s ::L
i:egicnal \Vater Quality Control Boz::: fbr ir._° .'.F;.icn Cf the sc)
age di<_pcs=ils;_.2m.
.I s is to certify til'ctri: c .:%crsic'.e CCL:nty Depzrtment of Public Health appr._ f;
Y ;r instal€ation the ivn:(s) ehec"`cd cb^ve. l
\: /1%�y�t tS'ac7 �:-} r'1.f-P,J7?"}"j k'4Y?�_ _�l •� �� _(JJ g•.._ �"'� l.%�i__rr•��''�� ! .l%
SeAT,LrAr K
C A amu' c <,,f-
ell,
0_0 o T(Z(PLEX
��ssrr_a�
C C P,
;mac:
trio 2E'►At,J�
f r:-, ;'.''._j+.�•Ji :Jllt''v
mit,,.. i i' LL rO
B UR2h % uN IT)
const. uctic•>
C. O'.cse .l0 0;: t]Se 1. epa:t:atent ot,
sa:Oth ol- Riaera r;: ., _ n,;c r.liere the En.;in-
e- cr Arc',i ,' f)r the &_amP—
t7.!z OZ
1
t
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No on-site
system her;,
Water 'su ."•'
All seer g=
Any cu;if;g
Appro; l „
DIVISION Or
Food Establishment `, 2L Se-„cge Dis,..>...
railer , C-1. Sz14`ic Tcnl:,
1otel,(Apt , Hotel EX15 .TLI%LEA _ 54. -t. Lcaci
:riling' 3 f39A,.i, 4AX) EY, -Ser?oc Pit
0
crr.rincrcial Building C ..n ,_.n to S wer
v..i Minn Pcol
crati ..r s_f_tc;:ing c:c.,ccs m.a.y b. disc'.:a ed into dividu I sewage dispc_.
'a?Rr_ .. ^:heat clecrcf,_ rr<< = ii
Si n -'L15' La fror., an 2C ^V SQU"G_.(C ✓aG� .
\7:.', r�'C :r?rn_nt5 Cir CUI'r:'nt Ltf:fJrGl Umhing Code.
c.`r.f four (4) `_-et v.:ii r.0::ify S'v..':;;s dl-^'sil]s ::L
i:egicnal \Vater Quality Control Boz::: fbr ir._° .'.F;.icn Cf the sc)
age di<_pcs=ils;_.2m.
.I s is to certify til'ctri: c .:%crsic'.e CCL:nty Depzrtment of Public Health appr._ f;
Y ;r instal€ation the ivn:(s) ehec"`cd cb^ve. l
\: /1%�y�t tS'ac7 �:-} r'1.f-P,J7?"}"j k'4Y?�_ _�l •� �� _(JJ g•.._ �"'� l.%�i__rr•��''�� ! .l%
SeAT,LrAr K
C A amu' c <,,f-
ell,
0_0 o T(Z(PLEX
��ssrr_a�
C C P,
;mac:
trio 2E'►At,J�
f r:-, ;'.''._j+.�•Ji :Jllt''v
mit,,.. i i' LL rO
B UR2h % uN IT)
const. uctic•>
C. O'.cse .l0 0;: t]Se 1. epa:t:atent ot,
sa:Oth ol- Riaera r;: ., _ n,;c r.liere the En.;in-
e- cr Arc',i ,' f)r the &_amP—
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COUNTY OF ,RIVERSIDE, DEPARTMENT OF HEALTH
PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM
Applicant: Submit this form with three copies of a scaled plot plan drawn to county 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 payable to County of Riverside.
Name
Mailing Address
Q AJ
City
State
Zip Code
Phone
`Property Address
"City. y@emfnu4a4y._
'Legal Description of Property (Lot, Parcel Map, Tract)
63 0 4e P/ Ap7 e GO
I
s. ' Gf e&,4
LIT o P/ ? _[
'Assessors Parcel No.
Water Serving Property From
Lot size
h/
"Signature of Applicant Date
'The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
Initial Date
WQCB Clearance required Yes ❑ No�-
Soils feasibility report required Yes ❑ No
Detailed boring report required Yes ❑ No
Detailed contour plot required Yes ❑ No
Comments:
Soils or boring report by Date
Approved by n ��QQ ��D''ate
�4`��`�14
- 'P'
Soils Map Page Soil Type Tract File No' t-Metra--j�
Number of Bedroom js
.f' --�
�X�: //�LE'K
Sep i an Size (gallons)
Rate Required
Type of System
New Addition Replacement
oo �r �► t
�Qs'
p2.0 ,v
/ /
Leach line sq. ft. of bottom are trench
Leach be (sq. ft. o bottom area bed)
Seepage Pit Diameter
Number of Pits !
Seepage Pit Depth B.I.
Total Depth of Pit
/.l'T/�l
Location
olCfSystem.11
Additionnq Req 'rement 41p.,,1�
"A permit is a' ed%i --& i.ed-for the design of a subsurface disposal system as indicon the accomparried plot plan
!2ed
using the requirements set forth in Section B above. A building permit is necessary for the installation of the above
designed system.
Signature of Health Official 7 baafe
Receipt No. (�O �[O��l Issued By
District: Riverside ❑ Indio 0--- Hemet ❑ Date
DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File