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002857 (PLBG)
.iTwit 4 4 Qgbll& P.O. BOX 1504 No. 002857 Building 78-105 CALLE ESTADO Address 5.1--5132 AM&liar LA QUINTA, CALIFORNIA 92253 r Mailing, Address!'t� j City Zip Tel. Quinta 32253... ' Contractor Address p"' Tela- ' 92238 1 328.1747 State Lic. I City & Classif. 2551$4 Lic. # 194 Arch., Engr.,• Designer Address Tel. City Zip State Lic. # - LICENSED CONTRACTOR'S DECLARATION . I hereby affinp that'I am licensed under provisions of Chapter 9 (commencing with Sectio. j 7000) of Division 3 of the -Business and Professions Code` and my license is in full-4drrce and effect. SIGNATURE �" �"'• .r••i"' Z -DATE j OWNER -BUILDER DECLARATION I 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 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 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 theapplicantto a civil penalty of not more than five 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 will have the burden 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- 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.) i ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 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. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (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 NOTICE TO APPLICANT. If, alter 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 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,r mentioned property for inspection purposes. �/,✓ Signature of applicant A`r' /-?"`+e "� + . �.. Date � 7'r�:-' Mailing Address f Y" - ✓ t City, State, Zip BUILDING: TYPE CONST. • OCC: GRP. A.P. Number Legal, Description Project Description Sq. Ft. No. No. Dw. Size Stories Units New R Add ❑ Alter ❑ Repair ❑ Demolition ❑ Zta� I rew seepage pit • a Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk.. Bal. Const. Mech. Electrical Plumbing zb4uu S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: 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 1-26�37 Permit Validated by: Validation: A7173 1 26 25,GG Ch HARD COPYI T CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE RO H PLUMB. BONDING YARD SPKLR SYSTEM, .• 2ND FL. SO. FT. FORMS _ ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. ® GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN SQ. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ -$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING 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 LATHING SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER 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 E AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE RO H PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS EW R PTIC ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. 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. FRAMING FINAL 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 SIGNATURES/INITIALS, GARDEN WALL FINAL .f nI Z O F- U W rn i Z O H U W U) .Cf) Y Q' 2' W M N Z O_ F- U W U) 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 $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.) /-P J Mailing Address j �.5 X ,14 /fit r // �h"SC-� ) 1 .r► (//, City ri T State P-,/- Zip Code S.a�3s" Telephone -T.8 / 7-!/7 Job Property Address City o Oommunity— 'Legal Description of..Propeerty/(Lott,, PM; TR) (� 20, ` *Assessor's Parcel No. .• fr .f,• waterjAgency nrrwelP. - 1f ! S pati• `« tai! C d � tp�i ACOAvG.F"6 `V vii i u - Use of Perm /1�a ' �dTM's lGo , A anning Case H f Lot Size �% (� OV ( G"'�/ �r V • iJli' ) ` ry KJ r MH Site Preparation Etc. t x 10,4 f'sF Sign ure of Applidant Date' *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 ®No� WQCB Clearance required. ❑ Yes 2o 1 ❑ % Jr Soils feasibility report required. Yes moo' Detailed boring report required. ❑ Yes ❑ NOX Detailed contour plot plans required. ❑Yes ❑ N f f Staff Specialist approval required. ❑ Yes El No Lot Inspection Date Soils/boring report by1 �) Project # Date jJ / Soils Map Page �°X Soil Type (WL by�IAA✓!�__ Date Type of System: v No. of Bedrooms S . 3 SiXiM (1) Septic Tank F... SGoil Rate Required ��f/ 9Replacementkr ❑ Existing ❑ New Additional ❑ (yt�0nM ) ,-,X . .S�GaIs. (2) Leach line sq. ft. h Sidewall allowance ft. Sq. Ft. Install Line(s) Ft. Long, t. wii!Fcfe-with min. inches Leach bed Sq. Ft. of bottom (Botto�n.t.enc� are '`tea rock/ ` per running ft. ®<N/A rock below drain lines- area Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI1 Seepage Pit total depth C Applicable N/A ��Overburden factor ? t © /� Max. allowable depth [.rf moi+ f/f ,G%?�" /.moi r ..•..bt-/� .•.l�ar�.. �.-Q--�a /.<�- .,t/:t..��P�1 f,3 r;.e� r7 . i/dr��._ a - % • s� 4 / /Jf .A,/ Al %t , 0fllr .. , 7f , oec., �iLtl `� /�--*�f�._. t?..t ,cl 7't► �"/"'� .�� ,�..-r � .�.« ,�v_..t..�_,r�i l' , . �%G.R�CJC'..1�./Y _ ' This application cis pa prove ;d'e'nied 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 any wells including expansion area / Q 3 Signature of Health Official v - ' Date - RECEIPT NO. 1, 3 4 `7 Issued by 54— Date ~ .2- � — District: ❑ Riverside Vi'n'dio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH -SAN -122 (Rev. 6/86) .1ti - . ..!t. wa V 71 �o .-• . uTHIS APPROVAL GRANTED BY THE DEPARTMENT OF PUBLIC IiEALTH IS VALID FOR ONE (1) YEAr, FROM DATE OF APPROVAL. 'Approval of these plans ny the I)epartment o2 •Yutlu• Health of Riverside County does not relieve the Engin- eer or Architect of the responsibility for the EnYlnsar- the or Ar,-: ''ectural .de ` S HENDRICKSON COBS T RUCTION1, Ii'Ca ......- tt •�'nfnF�ri. n Centra.re:-•=Underground Specialisl • Divi.M641 OF EIdV(c;OiSPorahOTAL f�EALI'H -- F6et) Cst;.bllshment Sewage Disposal TmIler Parc IEK r % Gal. Septic Tank (art G; ^Rotel, Apt., Hotel Sq.F . of Leach Line Dwelling e:"Sr. 3a"'2 '(43..L.,) l�D:� /- F� x Seepage Pit( Commercial Building '""/ Connection to Sewer Swimming Pccl �;'�p".4 _ Na on-site regancrating %va,er soften;n3 nvicas may be discharged into the individual sewage system here,,-.-idarpr d wit. o�;t clew._,. from 'ch -2 V%In er Quality Control Boar 7Water supply s'r�pi i = al":,!on r.. ce i :� an s;: :-vad source. ecX�STL'u.L�� All sewage diep Inf�`•si5: riq;;i,e^-;ants of current Uniform Plumbing — Any cutting, gr l fig,;S/k:f fo;:r (4) f -ac v!i!I nullify sewage disposal approval. �G Approval has cn obtained from the R ional \;!atar Quality Control Board for installation of age disposal s,�s em. fhis is to certify that he.Riverside County Department of Public Health approves for may, con r installation the item ) checked above. I� T Nct`c,,- -A.Qu.►•aT�.I CA - p,©, 139 89 SAdTe- C Q 2 m-* L't r - (%41 tWIL osal sew - I7 pTrc-- to ao ° I p; -r 1 "'bAt-T1(HTiTMFFic Wr ,tegNour PO I Fyrs-Tr.-� to d /t„/ p�"- (ro AgM14w) Vily. CA :. L. �>'t `- (L1 x:11 J.�-��I-,!`•'/