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003435 (SFD)' +4 P.O. BOX: 1504 No. 003435 Building 78-105 CALLE ESTADO Address 34-105 Juarez LA QUINTA, CALIFORNIA 92253 _ Coachella Vall Address 247 E. Tab City Zip .. - Palm- 5-pri as Contractor - Address. 3."dS^ Co .' BUILDING: TYPE CONST, OCC: GRP: lay #2 '� A.P. Number 774-193-617 Tel. 322,l'020 Legal Description Project Description Plan Ai'— SiI3CIle Family D4• F71 . .IZip Tel:... State Lic. City & Classif. 387934 Lic. # 895 Arch., Engr., Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and, Professionnss:'Code, and my license is in full force and 1 effect. JI(r fi! .O< ....ae t'5r 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,Susiness and .Professions Code: Any city or county which requires a permit to construci, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile 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 oftheBusiness and Professions Code, or that. he is exeinpt there/roto, and the basis for the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a permit • subjects the applicant to a civil penalty of not more than five hundred dollars ($500). • • . ' 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 of 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.) O 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.) - ❑ 1 am exempt under Sec..B. B. & P.C. for this reason Sq. Ft. 1410 No. No. Dw. Size' • Stories Units New ❑ Add ❑ Alter ❑ Repair El Demolition ❑ Estimated Valuation c%7K_AAl PERMIT Plan Chk. Dep. a" Plan Chk. Bal. Const. ` Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Date Owner Infrastructure 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. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed i/'the permit is for one hundred dollars (S 100). valuation or less.) t. r:iX< .f r A` .. I certify that in the performance of the work for which this permit is issued, I shall not i �� 9,A. � 3 "IN77dT j7L4 eta '-'Jemploy any person in any manner so as to become subject to the Workers' Compensation Laws of California. fv:SA43A.j* IF Vli#3t#1t —va- u f .3 0 4.V NOTICE TO APPLICOANT.'rIf, alter making this Certificate of Exemption you should become ZONE: BY" ' subject to the Workers' Compensation provisions of the Labor Code, you must forthwith MIf11rnU(Tt Setback Distances: comply with such provisions or this permit shall be deemed revoked. - ' Front Setback from Center Line AMOUNT 00~ A j rtrt s 364.00 3i .i. f:r0 74.17 103.00 5.36 20.00 20.00 1.321.12 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.) r 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 -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant -Date- Mailing ateMailing Address City, State, Zip HARD COPY Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by:. Date 10/8/-87 Permjt Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. WALL SO. FT. ® SO, 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 BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USEEPERMITVC WATER CLOSET' COMPRESSOR HP POLE, TEM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES T SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL y SO.FT.GAR ® 3/ac HOUSE SEWER VENTILATION GAS PERMIT FEE PERMIT FEE EJPERM�FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR SETBACK GROUND PLU 81 GU UNDERGROUND s A.C. UNIT - COLL. AREA SLAB GRADE (� �� ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS i SEWER OR S EP IC A ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. / /11J'Al GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE Vz-,& FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. GRADING cu. yd. $ plus x$ _$ LUMBER GR. FRAMING //;0/06 FINAL INSP. ROOFING /.Z g pT y / 3ll�g / y REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE/ SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN'WALL FINAL n z O F -- U U-1 W M Z O U LU rn U) Y Cr Q 2 W Ir IN Z O U W U) COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFAdE SEWAGE DISPOSAL SYSTEM M — Of 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 ofj$37�is required when the application is submitted. Check must be made payable to the County of Riverside. /f 10 Building Department Application Log # Name (Owner, Agent, Contractor, Etc.) zlo�,u " .4,U,611 LOW O Mailing Address 2w7 tic::; ! r 7L - O2 City ,OLM :5;T1A1;!5 State Z Zip Code 24!;.2 Telephone 321 /02t.� 'Job Property Address eQ�ity/or'TGernrounityry� /�t! m Legal Description of Property. (Lot, PM, TR) 1194.fd�+. c -c �•}.I ��� ��/ii. 2J�7// �[ Assessor's Parcel No. ter Agency We16 , _ _ 1 � L� % Use of Permi +� «'w�F �2tf 'Planning Case # LSott S'ii4e .., 7Al - 7 n jrC4[it4 (� M SFD, H Site Preparation Etc. / / Sig nat of Applicant Date 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE r Initial Date / Certification of Existing S.D. System required.00 ❑ Yes 2 No-<' ..�2 ��� - r--� 7 WQCB Clearance ❑ eN,© required. Yes , f Soils feasibility report required. 1:1 Yes LfJ Nom Detailed boring report required. ❑ Yes �No Detailed contour plot plans required. ❑ Yes�� ,N�o- Staff Specialist approval required. El Yes LTJ No Lot Inspection Date Soils/boring report by / Project # Date Soils Map Page% 11 Soil Type OW �' Approved by- Date Date�� Type of System: "'; " . No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing R New El Additional El Replacement �� &," .Gals. Q, (2) Leach line sq. ft. (Botto,, trench area) Sidewall allowanceIF ft. rock/ Sq. Ft. Instal Lines) Ft. Long, Leach bed Sq. f ft. ©"N/A Ft. wl +w' h min. inches Ft. of ott®. per running rock below drain line area Leach lines/bed-special design for slope: Applicable -- (3) Pit Diameter / No. Pits Pit BI Seepage Pit total depth N/A�,O✓verburden factor :=P ©. � /[� Max. allowable depth YU r r � � This application i �apenied for the design of a subs urface disposal system as indicated on the accompanied plot plan using the requirements set forth in SectioA building is necessary for the installation permit of the above -designed system. J'" Septic tank and sewer lines must bt50' from any wells `/ U (1 _Y / 2 Leach lines must be 100' min. from any wells including expansion area.(;, (3) Seepage pits must be,150' miS'. from any wells including expansion area./,,)' /0—S =,G 6 r/- / Signature of Health Official Date4446:- RECEIPT NO. C-e/I C. / Issued by ~,/`� District: El Riverside ©i' dio ❑ Hemet ❑ Ferris ❑ Rancho Calif Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. DOH -SAN -122 (Rev. 6/86) Date/( " 74,7 7 bV111 ❑ Blythe GOLDENROD—Pending File