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003382 (SFD)Building Address malting %8*113 Address City .1250. Contractor .Const. Lender's Name 174tna j^ Address Electrical FINAL DATE Plumbing City S.M.I: State Lic. Grading Issued by: & Classif. 349691 Arch., Engr., - Designer T 0 44 4hf " P.O. BOX 1504 No. .003382 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC. GRP. A.P. Number 774-194-004 Legal Description Project Description Sing'i8 Family Dwelling Zip ITel. Zip Tela City Lic. # Sq. Ft. 1453 No. No. Dw. Size Stories Units 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 o the Business and Professions Code, and my license is in full force and effect. SIGNATURE I 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 thathe 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.) . ❑ 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 A 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—L--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. New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ stimated Valuation %8*113 PERMIT I hereby affirm that there is a construction lending agency for the performance of the Plan Chk. Dep. .1250. Plan Chk. Bal. .Const. Lender's Name Mech. Electrical FINAL DATE Plumbing This is a building permit when properly filled out, signed and validated, and is subject to S.M.I: Grading Issued by: Driveway Enc. I agree to comply with all city and county ordinances and state laws relating to building Infrastructure construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Validated by: Signature of applicant Date TOTAL Mailing Address REMARKS AMOUNT S 68.,48 370. no - 33.00 75.0 105.00 5.550 20.00 20.00 1.148..71 ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR 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. Issued by: t �7 Date 917 8 Permit 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. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLOJMMiNC,F.r-.EC,, 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. ® FOR. SQ. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. WALL SQ. FT. ® SQ, FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET ` YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) METER LOOP GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ®c BATH TUB /LUMBER JF- FRAMING - /� / SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL VENTILATION SQ.FT.GAR ® 3/ac HOUSE SEWER FIRE ZONE ROOFING 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 PLUM2G /) ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PL MBING // 17 UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE Ol1GH PLUMB.� Cf BONDING O HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ��ROUGH WIRING_?—) '� DUCT WORK ROCK STORAGE FOUND. REINF.!� Z �z GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) EMP. POLE/O GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM I WATER SYSTEM $ GRADING cu. yd. plus x$ _$ GR. FINAL INSF:'70e0 /LUMBER JF- FRAMING - /� / FINAL INSP. ROOFING ,�// IP1714:0� �v n ), /I , / �r� /�� !/• j REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL r 1 .—r• r Wit.,. .r, _• Z O_ H U LU U) `e] Z O U W U) U) Y Q W Ir X Z O F- C) W 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 # e. ----- -Name (Owner, Agent, Contractor, Etc.) Mailing Address SRS City rr� I �1J� �1 State Zip Code Z Z S Telephone h Job Property Address_ ._,,City -,. > e --�� "Water or Community u Legal Description of Property. (Lot, PM, TR) t o Z\ � ick �-S b ��r► 'Assessor's Parcel No. . Agency br Well, Use of Permit Planning Case #� Lot Size 0 - O SFD, MH Site Preparation Etc. :A Signature dFAppltnt � � - • d. • .+ Date 'The above iiformation must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE V Initial�`j /; Datre Certification of Existing S.D. System required. El Yes No^� I�� WQCB Clearance required. El Ye YNo ' Soils feasibility report required. ❑ Yes No Detailed boring report required. ❑ Yes No Detailed contour plot plans required. , El Yes No 1 Staff Specialist approval required. ❑ Yes ❑ o 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 Rate Re uired ❑ Existing 13xNew ❑Additional ❑Replacement -17-x ( ZGals . �Soil (2) Leach line sq. Sidewall allowance % Install Lines) `Ft. Long, - Leach bed Sq. (Bottom trenarea) / ft. rock/ Sq. Ft. per running ft. NiA Ft. wide with min. inches rock below drain lines `� Ft. of bottom area Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth Applicable N/A Over/rrden factor ❑ 5' 6' IF Max. allowable depth CS, l Uv ! f� A Ct , w t • Z 1 This application isp rove /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. (0) -)Septic tank and sewer lines be 50' from must any wells x, (�) Leach lines must be 100' min. from any wells including expansion area t (3 Seepage it mint- b 150'4min. from any wells.vncluding expansion area <- 1-" `M n r�- e � -S Signature of Health .0 icia Date RECEIPT N0. ( Issued by ��+ DatU—% District: ❑ Riverside Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file ' YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH -SAN -122 (Rev. 6/86) 11W