11717 (PLBG)Building
Address 58-500 Jefferson
Owner
Ranch of the 7 -tip Range
Mailing
Address sax
City
La Quinto,
Contractor
Address .
Sartre
Zip Tel.
X2253 777 -
5
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 1171.7
ILDING: TYPE CONST: - OCC: GRP..
P. Number
7 Legal Description
Project Description Insta?l 'grease interceptor -
1500 gallon.
City
Zip
Tel.:
State Lic.
& Classif.
City
Lic. #
Sq. Ft. No.
Size Stories
No. Dw.
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
7000) of Division 3 of the Business and Professions Code, and my license Is In full force and
effect.
�SIGNATl1RE DATE
OWNER -BUILDER DECLARATION .
I hereby affirm that I am exempt from the Contractor's License Law for the following
.. reason: (Sec. 7031.5,Buslness 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 Lew, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he Is exempt therefrom, and the basis
for the alleged exemption. Any violation of_Sectlon 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 1, 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.saie. (Sec. 7044, Bulsness and
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-bullder will. have the burden
_ of proving that he did not build or Improve for the purpose of sale.)
t3 I, as owner -of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. -7044, Business and Professions Coder 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.)
❑.I am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
4 0 @
$ 00
PERMIT ":
AMOUNT
Plan. Chk. Dep.
Plan Chk. Bal.
Const.
Mach.
- -
Electrical
Plumbing
.6V • U
S.M.I.
_
Grading
Driveway Enc.
Date 2 %' '"� ON owner �= ' � �— y - - . .-
Infrastructure
ORKER 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
❑ Copy Is filed with the city. ❑ Certified copy Is hereby furnished.
w
TOTAL
=-u ^ V
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit Is for onelhundred dollars ($100)' valuation
or less.)
I certify that in the performance of thq work for which this permit is Issued, I shall not
employ any pperson In any manner so as to become subject to the Workers'. Compensation
Laws of Callfornle.
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
Ihereby 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.
I car Illy that•I have read this application and state that she 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 chis city to enter the above-.
mentioned property for Inspection purposes.
Signature of applicant Date
Melling Address
City, State, Zip
REMARKS
,iia' �: i•f.i f`i _#, t �! r NL. ,t �.,:.. \J+s .
ZONE: BY:
Minimurn.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 Permit
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. ®
CARP. SO. 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 APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
i
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
REMARKS:
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
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 APPJEOUIP.
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.
FRAMINGFINAL
INSP.
ROOFING
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
RIVERSIDE COUNTY
RTMENT OF PUBLIC H
DIVISION O ENVIRONMENTAL HEALTH �� ,
aJ
yFood EstablishmentSewage Disposal /� C'-t�v-� S" u/c594 57164-
Trailer Park Gal. Septic Tank i^r✓gf�a S
Motel, ., Hotel
Dwelling '2X,Sq. Ft. of Leach Li9 r eag e- .
Commercial Building x Seepage Nit 5,610
Swimming Pwf Connection to Sewer t /-
Cf No on-site regenerating water softening devices may bs discharged into the individual sewage d sposal ka-c� �S
system herewith apA�'oe%ed vr€i1ouE cfaarance from the �d�ier Qualify Control Board. ��ay
/ 1G_ Water supPly se"j" t"ia illsta9latia1 :.-just be from an a
All sewage .iiµ.n �,s; pp• oved rA ce Aer 9 eez_s e X�7 w s
l .°o`a` inst'••.ati�n Must conform oath requirements of current Uniform Plumbing Code.
Any cup fin�rW b, ka;il& cr f:?: ,,,, in oxcess G. four (4) feat will nullify sewage disposal approval. � � • l y1 �w
Apnrav:a 'in, b6 -ii, obtairie from the Regional Wa►er Quality �/t
disptsa; sysE n, Quaff CGntrol Board for installation of the sewage f
•T• t
this is to certify that the Riverside County Department of Public Health approves for occupancy, G��'N
nstallation the itern(s checked above. Pp panty, construction x /
A .#,e
/l / !✓O X 5 �9t l �..� 2 �!�(, . PJB L cc QcC n
CSS i'IPP P M`AtINT& � tea;3�: q M Z F 6�iNY 1NE:�.
Afli4V. 10' .GC- OR WATER MAIN.
SsPfic tank ani &,saw final f!3'Iust be s0 ft.
zparvam cress.
Lit ihm f : a ff. fp m and � e �� �'� 6aT ,moo
swPaP$� reif., 1 1 ft. IrWr,,; lu. from r p`,iVpuc HatW weft.E. .
�1 TE OF APDROVAL
5 ?IV a k-\- 'q'X r'3
U
I sal11,7
ilm e l-leu,l
cS
by acs 0,7 �►