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."
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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
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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 $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