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003499 (AR)Building Address Owner Mr. Barbdza Mailing Address 2•» I �� City Zip Lia. QL%inta Contractor Address 68-315 X; elev R City Zip State Lic. & Classif.4 Arch., E'ngr., ' ' Designer Tel. P.O. BOX 1504 NQ. UUi_54NU 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 769-085-003 Legal Description Project Description City Lic. # [Neww q. Ft. ize ❑ No. Stories No. Dw. Units Demolition ❑ Add O$ Alter ❑ Repair ❑ Address Tel. Add seepage pit to exi City Zip State system Lic. #, LICENSED CONTRACTOR'S.DECLAFIATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and$}PrGfessions Code, and my license is in full force'and effect .lM. ±/ "DATE OWNER -BUILDER DECLARATION Estimated V. 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 $1,1800.0 ting septic 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 PERMIT- AMOUNT the provisions of the Contractor's License Law, Chapter. 9 (commencing with Section 7000) of .+ ' Division3 of the Business and Professions- Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any Section 7031:•5 by'any Plan Chk. De ' violation of -applicant'for a permit subjects'the applicant to a civil penalty of not more than rive hundred dollars ($500).' p. ❑ I, as owner of the property,,or my employees with wages as their sole compensation, will Plan. Chk. Bal.. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COr1St 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, Mach. provided let such improvements are not intended or offered for sale. If, however, the building or Improvement is soldwithinone year of completion, the owner -builder will have the burden Electrical ' 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- Plumbing struet 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 S•M.1. such projects with a contractor(s) licensed pursuant to the, Contractor's License Law.) Grading O I am exempt under -Sec. B. 8 P.C. for this reason Driveway Enc. Date owner Infrastructure WORKERS' COMPENSATION DECLARATION I 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 O.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 if the permit Is for one hundred dollars ($100) valuation - • or less.) - - - - I certify that in the performance of the work for which this permit is issued, I shall not • employ any person in any manner so as to become subject to the Workers' Compensation ,1nte•;,,�+� c 71 •rq'q-2 E { _.; {3._t17 t rj Laws of California. IV i;pSk7 I f s t f$t 1 4V %tv Date Owner NOTICE TO APPLICANT. It, after making this Certificate of Exemption you should become ZONE: BY: ' subject to the Workers' Compensation provisions or 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 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 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 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. PLUMBINP FEES 1ST FL.SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. @ GAR. SQ, FT, ® .CAR P. .SO. 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 ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES. HEATING (ROUGH) WATER SOFTENER VENTSYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROCK STORAGE GARBAGE DISPOSAL FURNACE UNIT _ WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM OTHER APPJEQUIP. 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 WATER SYSTEM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ec HOUSE SEWER FINAL INSP. GAS PIPING PERMIT FEE PERMIT FEE H# 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 APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE f GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus _ x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING ,,y� REMARKS: •VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR i GAR. FIREWALL LATHING ' MESH INSULATION/SOUND 'FINISH GRADING FINAL INSPECTION CERT... OCC. FENCE FINAL. . INSPECTOR'S SIGNATURESIINITIALS„ , GARDEN WALL FINAL . ,�� t r.X ..r .e� .�. f% ,-f..�.H�:rl��r...I r'+4'�.`�N", �.'i �+_y��'S Y.;�� T�C����_`'7 .• .y .. r �- .. rn .�. .'ti.- . riy �..- 0 z O 1— U W CO z O F_ U W W U) Y Q W cr N z O F_ U W U) COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION 176 PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM �Q 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 N� is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name Jowner, Agent, Contractor, Etc.) Mailing Address City � � kf..a�.f '.A State �( Zip Code uj Telephone ,i , 1 dr< n5 'Job Property Address 'Cit1 r.Gommcmity,..,.. Legal Description of Property. (Lot, PM, TR) / 'Assessor's Parcel No. f/7 " Water Agenc or -Well o • r Use of Perm , � •f Planning Case N Lot Size SNI/ � z // 4� — /� , yr b SFO, MH Site Preparation Etc. ,�[[�—'�a�a✓ - �AL��d // C" -�g " 7 $1 navuc df ppDate 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE initial Date Certification of Existing S.D. System required. ❑ Yes 2�1 No�= - WOCB Clearance required. ❑ Yes — Soils feasibility report required. ❑ Yes 22N .,//o /'� r Detailed boring report required. ❑ Yes Detailed contour plot plans required. ❑ Yes ❑>o Staff Specialist approval required. ❑ Yes ❑ No Lot Inspection Date i Soils/boring report by n Project # Date Soils Map Page SoilTyp D S Approved by���.1 DateJ—/- /Y' k . /1 .?cPAP [(3AN11x% Type of System: v No. of Bedrooms (1) Septic Tank Soil Rate Required El Existing ❑ New ®R onal ❑Replacement 1318— . Gals. (2) Leach line sq. ft. (Bo trete nch area) Sidewall allowance ft. rock/ Sq. Ft. Insta�17,4�_ Lines) Ft. Long, Leac bed Sq. ft. ©- —Ft wia-e,it.� min. inches Ft. of bo�''ttom per running A rock below drain lines area Leach lines/bed-special design for slope: Applicabje/ (3) Pit Diameter No. Pits Pit:JSI Q Seepage Pit total depth *0 `JVD N/A �� Overburden factor '= " .nr,�F Max. allowable depth 7 This application isrya .eve /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. (1) Septic tank and sewer lines must be 50' from any wells 2) Leach lines must be 100' min. from any wells including expansion area (3 Seepage pits must be 150' min. from y wells including expansion areal/ ©�• �. mr,- +�y,{v,ayc/,�.��,� y , • Ir 9 t/ � ter,. -. �- i/- /J-,5.7 !/)�i(i/i4 G.? ��? rr Signature of Health Official RECEIPT NO. Issued by ��� Date District: ❑ Riverside 2 Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH -SAN -122 (Rev. 6/86) 'r &.