159059 (RPL)DEPARTMENT OF BUILDING & SAFETY
ok COUNTY OF RIVERSIDE As
r CONSTRUCTION ESTIMATE
ELECTRICAL FEES
' 1st Ff.
2nd FI.
i Por.
Gar.
Car P.
•
` Wall ..
1pVI�
i��£;•�4rY �v �t L.
Sq. Ft. @
NO.
WATER SOFTENER
Sq. Ft. @
/ GARBAGE DISPOSAL
Sq. Ft. @
KITCHEN SINK
Sq. Ft. @ POLES
LAVATORY
Sq. Ft. @ SIGNS
BATH TUB
TA.AJ/.Sc..AM4/
Sq. Ft. @ OR T. CLK.
S 6.WII�Cd I S P�¢SAt
Sq. Ft. @ MOTOR p,
H. P.
�% MOTOR
H. P.
ESTIMATEb VALUATION Is
MOTOR
H.P.
MECHANICAL FEES
MOTOR
H. P.
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR
H.P.
APPLIANCE
FIXTURES
I
} FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
- J
- Z AIR HANDLING UNIT
0
SUB-PAMEL
LEGAL DESCRIPTION
J GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
P RMIT
Q
U COMPRESSOR OHP
RANGE AND/OR OVEN
cr
W APPLIANCE VENT
WATER HEATER
� ABSORPTION SYSTEM D B.T.U.
SPACE HEATER
O
U INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
r
CONSTRUCTION POLE
SPEC. INSP.1
( HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SERVICE ENTRANCE
I BOILER B.T.V.
RESID. 15 SO. FT.
RESIDENTAL,FEE SQ.FT.�@
GARAGE is SQ. FT.
f, PERMIT FEE
PERMIT FEE
PLAN CHECKER
PERMIT NU
r
B
9059
CASH
PLAN FILE #
REN.
DBL.
TOTAL FEES
HEAT & VENT FEE
PLN. CCK. FEE
//
CONS EE
J LSI
J F M A M J J A
F
S
FIELD OFFICE
PLUMBING FEES
DRAINAGE PIPING
DRINKING FOUNTAIN
d URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) (DISH)
/ GARBAGE DISPOSAL
LAUNDRY TRAY
KITCHEN SINK
WATER CLOSET
LAVATORY
SHOWER
BATH TUB
WATER HEATER
S 6.WII�Cd I S P�¢SAt
HOUSE SEWER
GAS PIPING
b PERMIT FEE
ELEC. FEE
3,
PLUMB. FEE
A1
O N D
10I
SET BACK
LOT
SIZE
USE 11
JOB ADDRESS
i/Z OWNER
,.rC �/11A 4EI r' /�� t • e'1, 1
1�
�)
S sR
_J
PLAN CHECK FEE
,✓sa
ZONE
)?-
USE OF BUILDING
jt'
DATE
I
J
CHECKED BY
COMMUNITY
DISTRICT
F.C.
UNITS
VALUATION
OFFICE
MECHANICAL FEE
j��'
�y
J
I
GROUP
TV PE
LEGAL DESCRIPTION
P RMIT
FEE1
I
01��CONSTRUCTION
SPEC. INSP.1
{++,
SU PP. TO PERMIT 1111
ELECTRICAL FEE
PLAN CHECKER
BOND $
BOND
CASH
PLAN FILE #
DATE
INSPECTOR
PLUMBING FEE
t /
1
I
)FINAL
1
TOTAL FEE
t'�
S
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED
a00c11� e/
WITHIN 60 DAYS. CESSATION OF WORK FOR 120 DAYS SHALL ALSO
CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
CASH I CHECK C IM. o. N.C.
RECEIVED BY
SEWAGE SYSTEM
! a
T
LL
P
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORNIA 90VERING CON -
TRACTORS IS ALSO GUARANTEED. 'r
INFORMATION
OWNER
CO.NTRA`CTOR
/
ADDRESS
ADDRESS 1
TEL. NO.
TEL. NO.
LICENSE NO. '
284-208 11/87
4 4
P.O. BOX 1504 APPLICATION ONLY
Building /� 7&105 CALLE ESTADO
4
Address r `�J , EL �/L��% LA QUINTA, CALIFORNIA 92253
Owner
1400 0/�M 4- 6�i�
Mailing //�� � _ ����// BUILDING-, TYPE CONST. / /' OCC. GRP.
/ )
4Wkrx: - 61jG/J oP,.
jty
& Classif. I LiC. #.
� A.P. Number / , /� ,/�
Legal Description 407- lg`4 NUN/�
Project Description,
Arch., Engr., `' 4 / y
Designer L /'j71(�J,�Ae fi'
Address rf,C Tel 40 //ZZ /
7,VD,,U1 Gl/� Zip�22i0 �«t#6- g32j
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
effecI.
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, 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 ($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 safe. It,, 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 inprove 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 propertywhobuilds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. -B. & P.C. tnr this n
14
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that 1 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
0 Copy is filed with the city. O 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 pperson in any manner so as to become subject to the Workers' Compensation
Laws of Calhf0 nia_
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 shalt 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 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
BUILDING DIVISION
Sq. Ft. LJ3`` -V o. % No. Dw. /
Size !O/Q I iAfAztc Stories / Units
NeWX Add ❑ Alter ❑ Repair ❑ Demolition ❑
a O< iC zti�,-C 1AJ Cg C u 1066
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. 27 d a
Plan Chk. Bal. ' 3
Const.47J • ScD
Mech. 7 pQ
Electrical / S
Plumbing 15.- e2
S.M.I. /3 7a
Grading 020. 49p
Driveway Enc.
Infrastructure yo? y
TOTAL
REMARKS
005f R'? 0 _040445 05-02-90 14
10 `H,S H 1 I U I AL i 1:_3V 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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIV FEF,
1ST FL. $Q. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. g
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS'
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT.
FINAL INSP.
WALL $Q. FT.
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
_$
URINAL
SQ. FT.
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
FINAL INSPECTION
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 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
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In
COUNTY OF RIVERSIDE ENVIRONMENTAL A"Mem POMM NM
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 speculations as indicated on the attached check IISL
A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of
Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval.
VERIFY ITEMS IN SECTIONX
A° FROM BUILDING & SAFETY APPLICATION DEPARTMENT APPLICATION LOG/�#I
Contractor. C�:act Pe✓ n AQ
v
�BtUUIILL�DING
�^?lfI
n �c
dress8 $ Firm449 h !% aKA&PC `/ Z''
owner 6 A n 4
Phone
/�,
City
State
Zip
Job Props dress Legal Description Prop. (P Tract lot)
i41;EL �//AITi�
Lot/size f ter Agenc I —, /
Use of Permit P/P, CU, etc.
1
elli P , etc Z _
WOW
Signature of Applicant
Date
CATEGORY: REV CODE FEE,
CATEGORY: REV CODE FEE
0 SUBSURFACE DISPOSAL 1238 57.00
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00
a. 1 at 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year)
b. Each Parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $ 47.00
Critical Area 7348 $111.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
RI DATE
Holding Tank Agreements Completed 11Yes it o� s a ' /C�
y
Certification of ExWing S.D. System Required ❑ Yes ® N
WQCB Clearance required. (Attach Form ❑ Yes No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes
Special Feasibility Boring Report Required. ❑ Yes
Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes
OCter ❑ Yes .E�lw'r��,,°
Staff Specialist Lot Inspection Required ❑ Yes ” ' No
Lot Inspection Date
Solis boring report by Project ft Date
L
E ^ <
Soils Map Page SOA Type Approved by Dams
No. of Systems
T of Systems)
❑ Ing Tank ❑ Existing
No. Dwelling Units I
Bedrooms, fixture UnIts
(1) Septic Tank
Soil Rata
Greaee/Send
Intop
New o Replacer,w,nt
[3-80 31An
Leach Ur Sq. Ft.
Sidewall allowance
Install Lines) fl long it wide with
Leach Bed sq. ft.
trench area
ft rodV sq• ft
min. wishes bsIow, lines or
of+bettom area
per running fL
tJ--PzA
—
Leachlines/bed special design for slope:
Applicable
(3) Pit Diameter
�r
No. Pits
PRAMlaw
lnlet't88
(TD) Seepage PitTotal Depth
4�
Other:
Max. able Depth
4000%r
6
N/A Overburden factor
u
No. 2 Systeme,
REMARKS: ,,, - ry���
.- - �
This application i APPROV68' pNIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompany ' p p n, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
above -designed system. No construction is permitted in the required reserved 100% expansion area.
Septic tank and sewer lines must be 50' minimum from any wells C/ ( 0
Leach lines must be 100' minimum from any wells , includingexpansion
t2'
Seepage pits mustbe1J0 minimum frrom, any wells, including expansion area
Si nature of Health Official /%/� W.LtiJ.l�„ 1���! pate /G%%
RECEIPT NO. -33o Issued By ' �"^� Date
DISTRICT: ❑ Riverside, La! --0P ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
M