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003512 (MISC)Building Address Owner Mailing' Address City La Contractor P.O. BOX 1504 NO., 00351? 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 7. BUILDING:' -TYPE CONST. OCC: GRP.: Sam A.P.,NUmber 631%-064 -011.6 Zip Tel. 1i rota,. 92253' . 6" 915.38.7 Legal Description Project Description Additi6n -see-paged pit for septic tanr�, Address 6€ 0315 Rieley € oad ZONE: BY: City -z f°* . he'Ar-11 �4.t..1r 922- 'TeI:... _ 328-1'747 -Front, Setbackfrom Center Line State Lic. — & Classif.-. 25618.4 City Lic. # - Sq. Ft.' Size - • No. No. Dw. Stories Units Arch.; Engr., . - , Designer New O' Add ❑ Alter ❑ Repair ❑• Demolition ❑ Address Tel. work for which this permit is issued. (Sec. 3097; Civil code.) - Side Setback from Property Line Lender's Name City _ Zip State Lic. # . FINAL DATE INSPECTOR' LICENSED CONTRACTOR'S DECLIARATION, :. 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. - SIGNATURE DATE ' OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following . reason: (Sec. 7031.5,8usiness 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 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'of the Business and Professions Code, or that: he is -exempt therefrom, and the basis for. the alleged exemption. Any violation 'of Section 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 sale. (Sec> 7044,' Buisness and •- 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, provided that such improvements are not intended or offered' for sale. It, however, the building orimprovement -is sold within one year o/ completion,- the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.). ' b.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.•& P.C. for this reason Estimated Valuation 000 - - PERMIT. - - ✓;• - - - AMOUNT - Plan Chk. Dep. construction, and hereby authorize representatives :.of this city to enter the above-. Plan. Chk. Bal. Const. ' � � � §� • �� - McCh. ' Signature'of applicant Date - Electrical- - ' Plumbing Validation: - • S.M.I. - _ - —' ... • Grading Driveway Enc. HARD COPY Date owner Infrastructure WORKERS' COMPENSATION DECLARATION I'hereby affirm that I have a certificate of consent to self -insure; or 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. CERTIFICATE OF EXEMPTION FROM 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 thg 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 " TOTAL `Tel S1i I'_IJ lfit: f� n.orl' REMARKS r - NOTICE TO APPLICANT: If, after making this Certificate of .Exemptionyou 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- istances-Front.Setback -Front, Setbackfrom Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY, Side Street Setback from (,enter 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 Lenders Address FINAL DATE INSPECTOR' ' This is a building permit when properly filled out, signed and validated, and'is subject to' expiration if work I ereunder.is suspended for 180 days. rg 12/3/8 I certity 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 lives 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 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. ® POR. SO. FT. ® GAR. S0, FT, ® CAR P. S0. 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 ONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP.IEQUIP. 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 HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB FINAL INSP. SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER VENTILATION 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. ONDING HEATING (ROUGH) STORAGE TANK FORMS EWER OR SEPT E GH WIRING :i DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. 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. FRAMING FINAL INSP. ROOFING 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 WR z o_ U W U) z O U w rn U) Y Q w Li z O U LU U) y COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM° 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 S40 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 City -�} A Slate /� Zip Code Telephone % ' 'Job Property Address F`G y�o .Cpmrmunn,,& 'Legal Description of Property. (Lot. PM. TR) / 'Assessors Parcel_No--� ' ``Water Agencyar•Weff` �.7F�"�. „E Use of Permit 1"1"'D JIfFh4CF ���� Planning Case # Lot size — 0JI... 7 ex is �_rr cz,Gds w U W , SFD. MH Site Preparation Etc.y �ignalure`bl Appficanl ° ' Date 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial, Date - ` �ii�,�f/,% -3-A2 Certification of Existing S.D. System required. ❑ Yes ®'No,, 12 WCC WOCB Clearance required. El Yes RIO", gll� f t1 Soils feasibility report required. ❑Yes [2,< NP i Special feasibility boring report required. E-) Yes ON Detailed contour plot plans required. ❑ Yes i❑ No,, Staff Specialist approval required. E) Yes ©o Lot Inspection Date C Soils/boring report byr r j Proect # l `a 00 3 —Date -",f �� Soils Map Page Soil Typey Approved by Date Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing ❑ New ©A�ional ❑ Replacement EX�rr. Gals. 3• �� /,A' � raon ca, i e (2) Leach line sq. ft. Sidewall allowance Install Line(s)—Ft. Long, Leach bed Sq. (Bottom trench area) ft. rock/ Sq. Ft. Ft. wide with.min. inches Ft. of bottom per running ft. ❑ N/A rock below drain lines area Leach lines/bed-special design for slope: Applicable. (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth N/A !� Overburden factor -le ®li rµ v n!F„c / 7 Max. allowable depth ?7L* ✓ /K4 �B� ..`�iR' /%�i/C-r. rr?f/f V °.'a/v"�E'sri !�'Y`C.l, .? 1� t6 This application is�appiove--d/`dgniedafor the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B a'bove. 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 pC) Seepage pitts( must be 150' min. from any wells including expansion area � i � ��+^ �� d �-- ��G='"'ria � `�` �' `�y01 -�G�; /`1 !N. __ ? .� fd`,w4i� _3 _34? Signature Of Health official A y 'Date � Cis.- ✓� .`may. � �� '-,I RECEIPT NO._ , ; District: ❑ Riverside El Indio Distribution: WHITE—Office file DOH SAN 122 (Rev 8/87) Issued bY y Intp /. `) e_3 J ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File