06746 (PLBG)4
P.O. BOX 1504
Building
} 7&105 CALLE ESTADO
+'
Address 52-'700 E"enhoaer LA QUINTA, CALIFORNIA 92253
No.
46746
I�nfric I.W.C. T BUILDING: TYPE CONST. OCC: GRP.
Address P. 0. Wx 81901 A:P: Number 773-301-012
•
City Zip Tel.
San Diego 92130 . 352-7364_ Legal Description
ContractorD ~ Seepage'it
Project Description p
Henderson Construction Inc.
Address .
6.8-315 K4L* Road
City Zip Tela
Cathedra. Cite 92234 921749... -.-
State Lic. City
& Classif. 256184 Lic. # Sq. Ft. No. No. Dw.
`Size Stories 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 undei)l sions of Chapter 9 (commencing with Section
7000) of Divisidn 3 of Business and Professions Code, and my license is in f 11 force°and
effect/ 1= � .�? Y l�if 7 ���i
�G IATURE • .. . '' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
' reason: (Sec- 7031.5,191usiness 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
repines Me applicant for such permit to file a signed statement that he is licensed pursuant to
Me provisions of the Corbactor's license Law, Chapter 9 (commencing with Section 7000) of
D&Won 3 of Me Ltrsrmss 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 tdvi penally of not more than rive hundred dollars (8500).
❑ I, as owner of the properly, 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, 0uisness and
Professions Code: The Contractors 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 (fiat such inprovenents are not intended or offered for sale. If, however, the burbling
or Improvement is sold within one year of completion, the owner -builder will have the burden
of proving Mat he did not Mad or improve for Me purpose of sale.)
❑ 1, 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 bolds or improves thereon, and who contracts for
such projects with a conWictorrs) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under SecB. & 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
Workers 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 conpteted ff the permit is for one hundred dollars ($100) valuation
or less.)
1 certify that in the performance of the work for which this permit is issued, I shall not
employ any person in arty manner so as to become subject to the Workers' Compensation
Laws of Califomia
Date Owner
NOTICE TO APP0CAN7": tl, after mak V this Certificate of Exemption you should become
subject to the Hibikers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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.)
Lenders Name
Lenders Address
This is abuilding permrly it when propefilled oul,'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 Addmss
City, . State, Zip
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
$45.00
S.M.I.
.1A
Driveway Enc.
Infrastructure
s
TOTAL /
REMARKS , ,. n.:c •s ,._ a n_or, ' { 4{�
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
12/14/89
Issued by: Date Permit -
Validated bv:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT. 0
FORMS
SEWERpflC TAN
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK '
POR ®
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 SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SO FT ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE Not to be used as Property tax valuation
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
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
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.
SO. FT. ® c
BATH TUB
MESH
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR ® V4c
HOUSE SEWER
I
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
SEWERpflC TAN
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.
FRAMING
FINAL INSP.
ROOFING
/J-
// /.r 6��� iiL
///'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
I
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Z
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U)
M
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W
W.
Al
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(1)
COUNTY OF RIVERSIDE ENVIRONMENTAL A89669M Parcel NM
177S-
HEALTH SERVICES DIVISION 3 o / —,:5
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 speculations as indicated on the attached check list
A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of
Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval.
J/
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # r i/'(G CXUGra
"t, Contractor, Contact Person--
VSn
Phone
"
Address & Firm
k'h�o w 4, , < v� � a,s / �
3a9-, 7,
P . GZ�t-7),l
Owner
Phone
Mailing Address
h t,i 'k V/"C. 1 W C�i
..S
City
State
Zip
Job Property Address
Legal Description Prop. (PM, Tract, Lot)
-5;,/ Y /. uo
fZ
<i-�n!7 �� " i
. � /� A X Y11 C.' .Q nr'
Lot Size
_ I 9@ c�/M
Use of Permit P/P, CU, etc.,'. Q--46 py
Other
t /
�y X /00
kkrlr•
J(I�T
-'aw.;/r• C,orr� ��Ti.
i%J
Owellin a Prep, etc.
Signature of Applicant
Date of
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
CY SUBSURFACE DISPOSAL 1238 $ 57.00
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00
a. 1 at 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year)
b. Each parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
❑ She Evaluation in Conjunction with
❑ HOLDING TANK 7351 $ 47.00
Critical Area 7346 $111.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
❑ She Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
IN TIAL DATE
Holding Tank Agreements Completed ❑ Yes 9 NN 1.41 Ile L? ' ! 3 -
O
Certification of Existing S.D. System Required C1 Yes fJ' N00
WQCB Clearance required. (Attach Form ❑ Yes 1WN"' o
DOH SAN 007, Santa Ana Region Only)
Sills Percolation Report Required. ❑ Yes '20Z
Special Feasibility Boring Report Required. ❑ Yes
Detailed Contour Plot Plans Required (i to 5 R interval) ❑ Yes Nom
r
Otter ❑ Yes
Staff Specialist Lot Inspection Required ❑Yes No
Lot Inspection Date
Sills boring report by it Date
/PProject
' I I �`� �"�
Soils Map Page Sal Type Approved by l� Det,
No. of Systems
T 0 System(.)
No. Dweiling Units(l)
(1) Septic Tank
Soil Rate
,,Grease/Sand
0L Holding Tank ❑ Existing
0 Now ❑ Rf ter,t
Bedrooms, rekleite
EKiZ. (3Q�7AM, X
r"X/i i w
�re9se-1 p
llDD
%
10 00 Gel
Gal
�F�Leach Line Sq. FL Sidewall allowance
f
Ir>s�� Lines) f . bng ft wide with
Leach Bed sq. k
8oltttcrt french en�a _ (t rock/_ sq. fl
`a
min. tea rock bebw drainlinees or=bottom
a►ee
per running ft. 1
—
roes/bed special design for slope:
Applica,blef �
Applicable
(3) Pit DiameterNo.
Pits
PR Below
Inlet (BI)
(TD) Seepage �T / Depth th ~
Max. Allo�wa 1p Depth
N/A tO Overburden facto
No. 2 System
REMARKS: �JfiG�% 0 4s`a•�
Gr rz r tit •� ,.� 4V
ilop
This application i APPROVED/ __ WD for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied p of pan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
above -designed system. No construction is permitted in the required reserved 100% expansion area.
(1) Septic tank and sewer lines must be 50' minimum from any wells
(2, Leach lines must be 100' minimum from any wells, including expansion area /
3 Seepage pits must be 150' minimum from wells,, including expansionarea ` "r /
//any
��✓� Gu:. +�' lirTr f� "�
Signature of Health official CN, /l Date
RECEIPT NO. / �ZZ/
//O Issued By f:�/ 6.— Date
DISTRICT: ❑ Riverside, L9*" Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
-�a
HENDRICKSON CONSTRUCTION, INC.
General Engineering Contractor • Underground Specialists
rco o t,
-4o tot',
jV
p i T� (7o AEMAJ
(091 VPA (DP. IB.:01
3�sa.Q 1�.� ��-
i f
ag I
v
MVWMg COUNM f e.:50MIT GSF- M.eMe -7, WITH
DrASM OF Mit i;NC-11Mi MUL NsFALTH
Food Estshllshi nt _G._ Sngr Diaps+eal
Trifler Park/COC V,4LJ
AMID, Ari., � Ual) ,y-- 30. SPL, X11 Lank Ling
131Y9:l g, E 9IS'T. �3 !30•x. fix/ Appl =1¢ _ (. t� Hasps^✓ E'rc
Q alar sl MiWing
suimmi,.a Pool
Na on -aft winga r oea
system ihbl"EYil h Epp%h-3'i %"3 �:: le'� C�' :...... .. ''.�. _ • . � " iii' 'i I a3ayd.
Water sup, y .^,a i it." ��. j v:i :u•'.e C. f] o. :. .. .:;�, '•.e.'�.. :! :.;L'.
All sem 3iscil`'(„:��� c : 'u:,:3 : a; r i; ��:L, i?2rm Prrt�irr3 Godo.
Ail Citat.l,F .il .'i: il,N%? , i': +:a:;sj ui ivur VI-) � .i'si: li�� ✓ e;F;:,:;5 :sy�sl
h.:s bm ci k � from 0.9 c_ywal VAS 'ar', Q!:,2N,j 6:rjvi Stiard tar bsiaUatW of the sewaga
,
-h:..s is .t: i.•, nr,-? th.m the Mvers's CS j"j13d r wrai:.ot lPubk Hath 3p{emes for aeoupwiq wratruttion 3r
�r
o -.. �.o : V-�:.t.. —•:• y nnry 11 '���� �� / `�
%ate. I(Y FMM ANY OWS MM -W Wb' TM MNK -7-0
(.�ttrr,;•,�,�i�.CC.r, .,, v mss.
[FR
c=.i1?T�.v1Vt p.
v "J. up Fv s a�7 �y�� �aa.EL vf Riverside County does no, relieve tiro ILo�is-
OM DAME QF MARIO Nt or Architect of the raapona4for tha► inswewf
-�j Itsf o: At+ebiteetat'si dr.�aYasp .. ,