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003409 (SFD)Address 54"125 Juarez `Owner l, Coadhell, Mailing Tel.' , Address A7, City Zi Contractor State Lic. City Starr C Address & Classif.. 387934 44 P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 No. 043409 BUILDING: TYPE CONST: OCC: GRP.• sA sz v A9 A.P. Number 974 103-021 Tel 92262 322==1020 Legal Description Project Description Sinale Family Dwellina ruction Plan k-1 CERTIFICATE OF EXEMPTION FROM WORKERS' COM P ENSATION 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 the 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 ' '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. ' 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. Lcertify 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant --Date- .Mailing ateMailing Address City, State, Zip HARD COPY I REMARKS ZON E: 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 929%8%Permit Validated by: Validation: . City Zip Tel.' , State Lic. City & Classif.. 387934 Lic. # 895 Sq. Ft. 1410 No. No. Dw. Size - - - - Stories Units - 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 7000).of Division 3 of the Business and Professions Code, and my license is in full force and - -a ' effect. f - SIGNATURE` P t " �!"" DATE OWNER -BUILDER DECLARATION Estimated Valuation hhereby affirm that I am exempt from the Contractor's License Law for the following Any AA • reason: (Sec. 7031.5,Business and Professions Code: city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance also a 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 - � ri ' 'Division 3 of the Business and Professions Code; or that: he is exempt therefrom, and the basis for the alleged exemption. Any violation Section 7031.5 by 'any for Plan Chk. Dep. ' of applicant a permit subjects the applicant to a civil penalty of not more than live'hundred dollars (5500).- Plan Chk. Bal. - - - ' ❑ I, as owner of the property, or my employees with wages as their sole compensation, will •, _ A 1 A do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const: • Professions Code: The Contractor's License Law does not apply to an owner of property. who 9AR_ n^ builds or improves thereon and who does such work himself or through his own employees, McCh. - y - provided that such improvements are not intended or offered for, sale. If, however, the building 1 or improvement is sold within one year of completion, the owner -builder will have the burdenElectrical w *1 of proving that he did not build or improve for the purpose of sale.) Ai 117 ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing ^ 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 improvesthereon, and who contracts for S.M.1. ,,� - such projects with a contractors) licensed pursuant to the Contractor's License Law.) 5. ,,,_ - O I am exempt under Sec. B: & P.C. for this reason Grading , �A 09 Driveway Enc. ,yo on Date Owner Infrastructure a•t WORKERS' COMPENSATION DECLARATION I hereby affirm thatA 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. 0 Certified copy is hereby furnished. TOTAL -74? W CERTIFICATE OF EXEMPTION FROM WORKERS' COM P ENSATION 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 the 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 ' '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. ' 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. Lcertify 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant --Date- .Mailing ateMailing Address City, State, Zip HARD COPY I REMARKS ZON E: 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 929%8%Permit Validated by: Validation: . CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES. 1 1ST FL. SQ. FT. ® $ 2ND FL. SO. FT. ® POR. SQ. FT. ® GAR. SQ. 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 ROUGH PLUMB. 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 GAS (ROUGH) 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. SO. FT. ®c BATH TUB BOND BEAM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1Va c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® 3/ac HOUSE SEWER FRAMING 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 / GSETBACK 11-12, ROUND PLUMBIN -�—,? UNDERGROUND A.C. UNIT OLL. AREA SLAB GRADE / J2 F ROUGH PLUMB. BONDING HEATING (ROUGH) TORAGE TANK FROCK FORMS SEWER OR SEPTI ROUGH WIRING DUCT WORK STORAGE ` /FOUND. REINF. / _ '7 _ a 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. rge FRAMING FINAL INSP. ROOFING I �7O v REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING O I MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL I NSYtk; I VK'b JIUNAI UMtb1iN1I IALS• GARDEN WALL FINAL Z O U Lu U) m Z O F— U w C0 U) `1 Q W Ir X Z O U LU U) . t '''/iii... r•r �i-r-,..M�•�.-v':- ..�, "*=}�=�Yv» :': fi1. �..,.�r�`t..���.i..::;,,'�i`�-„+ca-:,'is`'..�"�`...�2�..,a.. ( RECEIPT NO. y TIssued by— District: Ci Date �`� 'a l< 42 '��.1 District: ❑ Riverside ©ndio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept: GOLDENROD—Pending File DOH -SAN -122 (Rev. 6/86) COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISIONr PERMIT APPLICATION FOR A SUBSURFACE SEWAGE -77Y '- �3 -d DISPOSAL SYSTEM / --2- Applicant: 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 # Name (Owner, Agent, Contractor, Etc.) Mailing Address Va ba 60 y 5—(kafz 5:-, w !Je'% 7 A City State) Zip Code Telephone Job Property Address1l tF r City or Community,. Legal Description of Property. (Lot, PM, TR) v /�tJ /i04 LQeZS' 'X Assessor's Parcel No. s�VJater Agencc rxwelk ZD fft. r7 i Use of Permi /•/ �J�J[y 7a,2' styi.nning Case k Lot Size 7,r - / 9 - � 21 ' �` FiJ ► � i SFD. MH Site Preparation / � (�Ll We/ ez?la Etc. Signature of `Ap cant Date 'The above information must be verified from Building Application •� �;;1!,: STAFF USE — DO NOT WRITE BELOW THIS LINE .Initial Date Certification of Existing S.D. System required. ❑ Yes [2 No WQCB Clearance required. ❑ Yes N Soils feasibility report required. El Yes , Detailed boring report required. ❑ Yes Detailed contour ❑ plot plans required. Yes .L'J�,N0 Staff Specialist approval required. - ❑ Yes 0 No Lot Inspection Date Soils/boring report by/ //� . Project # Date Soils Map Page 11, 0 Soil Type�Approved by �`y�-(/�� Date ' Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing ©New E) Additional ❑Replacement ” Gals. (2) Leach line sq. ft. (Bottom,.trench area) Sidewall allowance ft. rock/ Sq. Ft. Instalhe., —Line(s)—Ft. Long, F dewithmin. inches Leach bed Sq. P oPbo, om ®�N A per running ft. rock below drain lines area Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depthV Applicable __1 Overburden factor ©r6W' / Max. allowable depth !% �N/A 'r •- This application is apprbvedf enied for the design of a subsurface disposal system as indicated on the •accompanied plot plan using the requirements forth in Section set B`atiove: A building permit is necessary for the install tion of the above -designed system. •r�.�. (1) Septic tank and sewer lines must b D Y from any wellls pf �, _ r ' t (2 Leach lines must be 100 min. from an wells including ex a slo area 3 Seepage pits must be 180' min. from any wells incl di g expansion area• i Signature of Health Official / {/// {late RECEIPT NO. y TIssued by— District: Ci Date �`� 'a l< 42 '��.1 District: ❑ Riverside ©ndio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept: GOLDENROD—Pending File DOH -SAN -122 (Rev. 6/86)