003157 (SFD)144
! P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address 53-553 Villa LA QUINTA, CALIFORNIA 92253
James E.Sie.r Trzst
Mailing
Address F. 0. Box 6835
City Zip Tel.
- Santa Rosa - - - .. I . 9.5405.. 707-564-3841
Contractor
53-475 Ber=d as
City Zip . Tel:. .
T_" tlaxi'�A'sx Q�3C�is/4..Ptf3h�'
State Lic. City
& Classif.- Lic. #
X31 ]
Arch.; Engr:,
Designer
Address Tel.
003157
BUILDING;• TYPE.CONST. 'OCC'. GRP..
A.P. Number 774.433-015
Legal Description
Project Description Stt I . PRIM -4 I-V T)%;TA1_1 i"a
Sq. Ft. No. No. Dw.
Size 145 Stores Units
New.Ck Add ❑ Alter ❑ Repair ❑
City Zip State 200' 'Pence g.
Lic. #
..LICENSED CONTRACTOR'S DECLARATION T
I hereby affirm that l am licensed under provisions of Chapter 9 (commencing with Section. M
7000) of Division 3,of the Business and'Professions Code, "and my license is in full force'and
effect........4
-
SIGNATUREDATE
"✓ :{ti�x
OWNER -BUILDER -DECLARATION "
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation
reason: (Sec. 7031.5,Business 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- - PERMIT. .
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3of the Business and Professions Code, of that. he is -exempt theiefron, and the basis. ..
It 5►'
for the alleged exemption. Any violation o/ Section 7031.5 -by 'any applicant, for a permit
• subjects the applicant to'a civil penalty of not more'thanYive hundred dollars ($500):
- ❑ I, as owner of the property, or my employees with wages as their sole compensation, will -
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of. property who
builds- or improves thereon and who does such work himself or through his own employees,
. provided that such improvements are not intended or. offered for sale. If, however, the building
or improvement is sold within one year of completion, the. owner -builder willhave the burden
. of proving that he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
- struct the project: (Sec. 7044, Business and Professions. Code: The Contractor's License Law
does not apply to an owner of property•who builds or improves thereon, and who contracts for
such projects wither contractor(s) licensed pursuant to the Contractor's License Law.) -
O I am exempt under Sec. B. 8 P.C. for this reason
Plan Chk. Dep. -
Plan Chk. Bal. ,
Const.
M@Cil.
Electrical ' -
Plumbing
S•M•l. -
Grading
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' I hereby affirm that l have'a certificate of consent to selfinsure, or a certificate of '
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800,.Labor CoVe.)
Policy'No. Company--` '. % ti
...O; opy,lefiled with the city.. O Certified'oopy is hereby furnished.
TOTAL
Demolition ❑
AMOUNT
33 M
75.'p
105.00
g.5qv.,50
20.00
1,148.71
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE _�
(This section need not be completed i/ the permit is for one hundred dollars ($ f 00) valuation -x ,� R�,.t-srre;; �•� � J ">;f P s '�
or less.) - .. _ .. _ .. _
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 o/ Exemption you should become' ZONE: BY:
-subject to the Workers' Compensation provisions o/ the Labor Code: you must forthwith 'Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. - --
Front Setback from Center Line
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
Work for which this permifis,issued. (Sec. 3097, Civil Code.)
Lender's Name A ' _
Lender's Address i N 9 t -, A 0
This is a building permit when property filled out,.signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 certify 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 -of this city to enter- the above-.
mentioned property for inspection purposes.
,Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line -
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: nate Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
Sp 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.COOL 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, TEM/PERM
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING �%
/
NAL INSP
GAS PIPING
PERMIT FEE
L 7 �
0
)�
O 4
0 ' A~
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 �?- -j it
GROUND PLUMBINC�aC
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
�(fEWER OR SEPTICgkHF-T?
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPIEQUIP.
REINF. STEEL 9- �D
GAS (FINAL)
EMP. POLE
GROUT
WATER HEATER
SERVICE
Aft NAL INSP. �pf
/6
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -plus-x$_=
$
LUMBER GR.
AL INSP.
/G - _
FRAMING �%
/
NAL INSP
ROOFING
�� �� �{
ak
L 7 �
0
)�
O 4
0 ' A~
QL��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
,! LATHING -7
MESH
���
NSULATION/SOUND '� -3 �
FINISH GRADING
&INAL INSPECTION /y
v
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS_
GARDEN WALL FINAL
NO
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COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION
�E�/_ j 33 _ 19/fPERMIT
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 $37 is required when the application is submitted. Check must ae made payable to the County of Riverside.
Building Department Application Log #
—N^a-m�e (Owner, Agent, Contractor, Etc..)) /
Mailing Address
city
Sttitee
Zip Code
Telephone
Job Property Address��
td City or Community
Legal Descrbtion of Property. (Lot, PM; TR) A: f�\/►}� � b
'Assessor's Parcel No.
Water Agency or-�Well> /
/V!
P
Use of ermit Planning Case #Jr.
Lot
��
T
SFD, MH Site Preparation Etc.
' L
Signature of Applicant Date
'The above information must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
Initial Date
❑ D 4I X
Certification of Existing S.D. System required. Yes No-
WQCB Clearance required. ❑ Yes No- l !
0 -'NO {
❑
Soils feasibility report required. Yes
i
Detailed boring report required. ❑ Yes ❑N o 7
Detailed contour plot plans required. ❑ Yes ❑D No
Staff Specialist approval required. ❑ Yes ® No Lot Inspection Date
Soils/boring reportby1 i Project Date-
ate Soils Map Page/1t tY/(9 Soil Type L_ u Approved by r ! `" Date j� e
Soils
A
Type of System: v
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
❑ Existing ❑ ew ❑ Additional ❑ Replacement
, f,n toxo
I Gals.
(2) Leach line sq. ft.
Sidewall allowance
FL
Install `* Line(s)—Ft. Long,
Ft�wlde'=with
P
Leach bed Sq.
bottom„.
(Bottorxl trench area)
ft. rocW . Sq.
min. inches
Ft. of
per running ft. /A
rock below drain lines
area
Leach lines/bed-special design for slope:
(3) Pit Diameter
No. Pits
Pit BI
Seepage Pit total depth
Applicab�le/
®6'
Max. allowable depth
N/A Overburden factor❑
This application isPaprove %denied for the design of a subsurface disposal system as indicated on the acccmpanied plot plan using the requirements
set forth in Section B3 above. A building permit is necessary for the installation of the abovfe-designed systE n
(1) Septic tank and sewer lines must bf0' from any wells/ /U `�"+c� S� �'' a/�x...F�a7
(2 Leach lines must be 100' min. from any wells including expap's" ion,a'"rea
W3 Seepage pits must be 150' min. from any well ctudln expansion area-/
Signature of Health Official. f Date
RECEIPT NO. ?�� Issued by `t�//2 Date S �� 0
District: ❑ Riverside [Indio ❑ 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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PA,