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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 .. 'f �.'v��.. ,.^ �,7:`+"-„-.- � .. . .>>.� .:. • -.'�c- �`-� `•✓'x -f `.'. �� .0 : �,. �i'c c .. .. �, :� ...t,,.,t ,i :,J yti r. , :y .� .. I U Z O b LU U) 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