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003287 (PLBG)4 P.O. BOX 1504 Building 77»435 $ COLI LA QUINOTACCALIFORNIA92253 Address _ AGM: ROUE YBSSIA17 Mailing Address P.O. BOX A City Zip Tel. LA QU7.rITA • - 92253 j Contractor DAIRLMD G02iMt=10H I Address No. 008287 BUILDING:TYPE CONST. OCC. GRP. A.P. Number 774.114-001 3 Legal Description Project Description SMTC TAMC SEVAM PIT i 50- 05 HIG MAY III j City _ COAt.'Ti X.LA Zip 92236 Tel. 398.5544 State Lic. & Classif. f � } , { r ,+ City Lic. # 31 Sq. Ft. Size No. No. Dw. Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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 ` f 7 - SIGNATURE DATE OWNER -BUILDER DECLARATION.: g I hereby affirm that I am exempt from the Contractor's License Law for the followin - 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 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 (8500): O 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• Or proving that he did not build or Improve for the purpose of sale.) 0 1, as owner of the property, am exclusively contracting with licensed contractors to con- strucl 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 contractors) licensed pursuant to the Contractor's License Law.) - ❑ I am exempt under Sec. B. 8 P.C. for this reason Estimated Valuation ' PERMIT - AMOUNT plan Chk. Dep. Plan Chk. Bal. Const. xti_txti Mech. EI@CtrlCdl Plumbing S.M.I. Grading Driveway Enc. Date 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.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL 20.00 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit Is for one hundred dollars (8100) valuation or less.) - • - I certify that in the performance of the 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 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip HARD COPY REMARKS s n • n-• s s• •+ + t �7 -� � 211 ' CAS0 Y. `f1919 . 1 213, VU 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 7/21/87 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE H PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS V"IAER TANK WIRING MOBILEHOME SVC. BAR SINK p0q, SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. ® GROUT WATER HEATER WALL SQ. FT. ® FINAL INSP. DRINKING FOUNTAIN SO. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ _$ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL INSULATION/SOUND SQ.FT.GAR ® 3/ac HOUSE SEWER FINISH GRADING GAS PIPING PERMIT FEE FINAL INSPECTION 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 H PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS V"IAER TANK WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. 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 FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS. GARDEN WALL FINAL Dom NTED BY 1 HL BLIC HEALTH E (i) YEAR ROVAL. 'Approval of these plans by the Lepurt£nent o1 t'nou. Flaalt-h of P.i:erside County does not relieve the Engin. au or Arehitect of the recponuibility for _the Engineer. ;ice — Arehiteetural design." Coo ,x •�`;aTa S �rstfa� tib ��� �s • - D nj � yg IvE ACO) sir t000 60 <CJv.-.GTrr k ('re «EItA1� i 108 ly_!� _? --3/ DIVISION OF ENVIRONMENTAL HEALTH — rood Establishment X Sewage Disposal Trailer Park Gal. Septic Tank /CCCCA") Motel, Apt., Hotel _ Sq. F . of Leach Linc + Dwelling Py -,5 i 330/L ,, 1*( X% AM %— Ej x Seepage Pitler=`"'�� Commercia! Building` Connection to Sewer ; Swimming FSI X__ 'Jo on-site regenerating water s_f;cning ecvices may be discharged into the individual sewage disposal system here%ith appr:vtd wit^out cleari^ce from the Wat_r Q-.lality Control Board. - ',:'ater supply servi�}e 1h' s'insoliation must be from an apNro•. ;source. ��' /ST- ((Iumbing ✓. ut-'jA!I sewage dispeS3iY� fa-laibn muwt confe:m with rcouir=m_nts of current Uniform Code. Any cutting, gradir%g, or fFtin.1 in extess of four (4) feet will nullify sevage disposal approval. Approval has been o.;a,;: '.--:-n the Regional Water Quality Control Board for installation of the se age disposal system. a is to certify that the Riverside County Department of Public Hea!th approves for -tea ,, ,constructic : ns:a'faticn the item(s) checked above. 1 �� � �.� �.���• �- �'. /`L�- �' �j/. , may" - `� i ✓ `2 Z%�-1 NC �L'"P� q `� y.. LLQ f�XUf ?✓<<.�"1?<2�1��U� �r�cs�/ z 0 41 !h 4 n1 Z O H U W C0 .7, Z O 1— U w U) N Z O 1= U LU C0 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 City state Zip Code Telephone J/ Job Property Address City C6mrtlynitya Legal Description of Property. (Lot, PM, TR) 'Assessor's Parcel No. Water Agency or Well �. ^�= �� Lot Size Use of Permie ' Planning Case # SFO, MH Site Preparation Etc. 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 ❑ Nome%:'� WOCB Clearance required. ❑ YesNO ,Soils report required. E-1 Yes ,El b "feasibility ,,__,,,� betaifed boring reportrequired. ❑ Yes L J�N'o--�— Detailed contour plot plans required. ❑ Yes❑ d Staff Specialist approval required. E-)Yes1"J 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 ❑ New 11 -Additional ❑ Replacement GPIs."�'� (2) Leach line sq. ft. Sidewall allowance Install Line(s) Ft. Long, Leach bed Sq. (�bt�om trench area) ft. rock/ Sq. Ft. Ft. wide wiffrmin. inches Ft. of bottom per running ft. 0 N/A rock below drain lines area— Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI ;; Seepage Pit total depth pplicable Applicable— -)' �'� Q�(f Max. allowable depth N/A Overburden factor N/A �:�� 41 This application i� 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' -z - RECEIPT NO. District: ❑ Riverside ❑ Indio Distribution: WHITE—Office file DOH -SAN -122 (Rev. 6/86) Issued by Date--- 0 ate ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File