003413 (SFD)7
Address
Building
Address
54r,-165 Jmr
Owner
Tel. -
Coachella V
' Mailing
Address
247 E. TAIW-
City
State Lic.
Zip
Palm
Contractor
Lic. # 893
. `4 4 a
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P.O. BOX 1504 No- 003413
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Co. BUILDING: TYPE CONST. OCC: GRP.
?w 2 A.P. Number 7741-193-020
Tel.
322-1020 Legal Description
Project Description iiilCte .ly n
HARD COPY
Address
.rii?m
City
Zip
Tel. -
State Lic.
City
& Classif. 387934
Lic. # 893
Sq. Ft. 1529
No. No. Dw.
Size
-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
N
7000) of Division 3 of the Business and Professions Code, and my license is'in full force and
effect.. r ~� I. . ).l ; -. • �; `"
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
7031; Code: Any
SMA, nr
SMA 505
reason: (Sec. 5,Business and Professions city or county which requires -,I
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance
uance also.
� ,
-
requires the applicant, for' such permit to. file a signed statement that he is licensed pursuant to
PERMIT
AMOUNT• -
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 therefiom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
Plan.Chk. Dep. -
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subjects the applicant a'civil penalty of not more than five hundred dollars ($500).
❑ Ithe
Plan Chk. Bal
�-
S 46. 2
as owner of property, or my employees with wages as their sole compensation, will,
doihe work, and the structure is not intended or offered Jor sale. (Sec: 7044, Buisness and
COr1St.
tr n ,
Professions Code: The Contractor's License Law does not apply Yo, an owner of property who
376.. 00
builds or improves thereon and, who does such work himself or through his own employees,
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- '
• _ provided that such improvements are not intended or offered for sale. If, however,, the building
,n- on
. • or improvement is sold within one year or completion, • the owner -builder will have the burden
Electrical
. of proving that he did. not build or improve for the purpose of sale.)
0 I, as owner of the property, am exclusively contracting with licensed contractors to con.
Plumbings��
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
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such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
❑ I am exempt under Sec. B. R P.C. for this reason
Grading
211 tin
Driveway Eno.
2,n.n0
Date Owner
- Infrastructure
1.182.0
WORKERS' COMPENSATION DECLARATION
1 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
1, -
CERTIFICATE OF EXEMPTION FROM
REMARKS
r v
WORKERS' COMPENSATION INSURANCE
'
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
'
or less.) •-
certify that in the performance of the work for which this permit is issued, I shall not
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• employ any person in any manner so as to, become subject to the Workers' Compensation—
Laws of California.
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' Date ' Owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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, Civilcode.)
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 if 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:
Date Cs -AA IQ -Y 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. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
FOR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. 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
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
/fj/
Y�
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. Fr. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING / 4J
FINAL INSP.
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
ROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE (�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER SE TIC T "I_
---ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF. / L
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/fj/
Y�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
EMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
-cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. 3
FRAMING / 4J
FINAL INSP.
ROOFING12
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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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RECEIPT NO. .-�g) S y(---) Issued by �K �r Date��
District: ❑ Riverside E *Inds ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 6/86)
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COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION t�- p
PERMIT APPLICATION —
7 7
FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM ( (-3
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�W'ls required when the application is submitted. Check must be made payable to the County of Riverside.
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Building Department Application Log #
Name (Owner, Agent, Contractor, Etc.)
Mailing Address
City
State
Zip Code
Telephone
Ata
Job Property Address A/, c-- - //OR
5 1495 lv o Q e
°"'Cit ,oj�6emsnwnity—
l,tl'�
Legal Description of Property. (Lot, PM, TR) /,1� . J `
�a! t .,GttiG�. 677 �t ,(
Assessor's Parcel No.
Wate6 -A enc eUr-
1.w 9
/1� $ / /
Lot Size
�fy/
7 r I —/�� — D
� ►��I+ �7
v/� �Ic
Use of PermitIl �•+••r c>' Planing Case N
SFD, MH Site Preparation
Etc.
Signature of A hcant Date
'The above information must be ver/lied from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
/� Inittiall/f Date
Certification of Existing S.D. System required. ❑ Yes ® o"
---_�
WQCB Clearance required. El Yes 1CJ�f
Soils feasibility report required. ❑ Yes .o
Detailed boring report required. ❑ Yes ;E ] N'
Detailed contour plot plans required. ❑ Yes ,2NNo,-'
Staff Specialist ❑
approval required. Yes No Lot Inspection Date
Soils/boring report by/ F Project # Date
Soils Map Page 0, r Soil Type' . Approved by��-�✓�-^ Date -, -
Type of System:
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
❑ Existing 19New ❑ Additional ❑ Replacement
Gals.
(2)\6Leach line sq. ft.
Sidewall allowance
v
Install Lines) Ft. Long,
Leach,�bed Sq.
(Botto. trench area)
ft. rock/—Sq.
Sq. Ft.
per running ft. l]`N/A
Ft. wide ft in. inches
below drain lines
Ft. oaf b"oi'tom.`�
rock
area
Leach lines/bed-special design for slope:
(3) Pit Diameter
No. Pits
Pit BI
Seepage Pit total depth ^�12 fl
Applicable -
Overburden factor
5'
�%
l
Max. allowable depth O r
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3• t � %
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This application ig a proved/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.
Septic tank and sewer lines must 4be`50' from any wells'Y/��,t"Lc~-,
(2 Leach lines must be 100' min. from any wells including exp nslon,��area
3 Seepage pits must be 150' min. from any�rwells including expansion area,„/
!P ” k -Z 2 -Ig. i
Signature of Health Official
RECEIPT NO. .-�g) S y(---) Issued by �K �r Date��
District: ❑ Riverside E *Inds ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 6/86)
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