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13199 (AR)Building Address 80-800 nista Bonita Owner Dennis a Renee 1:aroyana Mailing Address 80-'659 Cherry Hill City Zip Tel 4 P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 La Quinta, C_J 92253 1771-3606 Contractor = S7hit=yer Construction Address 76-371 SrocA Pea I -ay 91ya.m Daus rt, ,Al 922&0 Te1345-5 03 State Lic.Pity` & Classif. B 417062 'Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in frul�l f—o a and effect. i r 7" — 11� ' V S NATURE �1 ATI J OWNER -BUILDER DECLARATION 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, after, 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 rive 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. 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.) 0 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 or 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 Date Owner WORKERS' 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. 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 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 I 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.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and slate 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 BUILDING: TYPE CONST. OCC. GRP A.P. Number 769-420-007 I Description Project Description Lot 7 Tract 21176 Guest Houea Sq. Ft. ;527 Size No. No. Dw. Stories Units New ❑ —Add -C] Alter ❑ Repair ❑ 1Demolition ❑ Pext3i or st AourA only. I NO JUL 2 3 1993 Estimated Valuation « }q ,.0 I PERMIT ( AMOUNT Plan Chk. Dep. Plan Chk. Bal. 4 G Const. S • 50 Mech. • 50 Electrical 0 .9 5 Plumbing M.30 S.M.I. 1.00 Grading 20. 00 Driveway Enc. . 0 Infrastructure • 00 TOTAL 1 rr=t-3. D 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 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. @ $ UNITS AB GRADE — ~ ^ r BONDING HEATING (ROUGH) 2ND FL. SO. FT. FORMS YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ, FT. @ POWER OUTLET ROOF DRAINS CAR P. SQ. FT. OTHER APPJEQUIP. DRAINAGE PIPING WALL SO. FT. TEMP. POLE DRINKING FOUNTAIN. SO FT @ GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM 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 LAUNDRYTRAY 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. SQ. FT. @ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ 11/4 c SEWAGE DISPOSAL LATHING SQ.FT.GAR @ 3/ac HOUSE SEWER MESH 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 UND PLUMBIN UNDERGROUND A.C. UNIT COLL. AREA AB GRADE — ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. 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 Uff —g� FINAL INSP. ROOFING (�C/ Lj ����..���..�JJJJJJ REMARKS: VENTILATION FIRE FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FI AL'INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Z O U W M T Z U W J r_, " COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY Assessors Parcel No. DEPARTMENT OF ENVIRONMENTAL HEALTH 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 Ind Gated 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. ,n(� +so ;0--93 16:33CO03 LOG # q�c��rc.�� VERIFY ITEMS IN SECTION AFROM ANON -FEE BUILDING 3 SAFETY (golden°,zAPPLICATION $j Agent, or, 'Contact Person Phone Address City lNo Zip ,.C/onnt'ra Offf/V � I.+: ECK $153r 4 CHECK Owner Phone Address City State Zip Y2 ,QZ.t/.t�/S '&/ .GGSc L1 J f� 7T`� '/7� �� l/<�<% �d �:?� %�L � ./i.✓T/5r Job Property Address City State Zip Legal Descriptkat Prop. (PM, Tract, lot) .0- .407' 7 7F,4-,'7 2 // 76 Lot Size ater Agency Useof PermitP/P, C ,etc. Other _ w� Akz4ag-2 P,4,4 114 Dwelling, MH-3He431�c. Cate Signature of Applicant CATEGORY REV CODE FEE CATEGORY REV CODE FEE SUBSURFACE DISPOSAL (per system) 1238 ($15300 ❑ SITE EVALUATION UPON REQUEST 7349 $120.00 ❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION �_ (NO PLOT PLAN) ❑ SEWERJSEPTIC VERIFICATION 7348 $ 58.00 a. 1st 4 Parcels (Each) 1238 $153.00 ❑ PRELIMINARY ELECTIVE EVALUATION b. Each Parcel after 4 7344 $ 55.00 (Attach DOH -SAN -63) 7352 $ 69.00 ❑ REREVIEW (2nd review same parcel 7344 $ 55.00 ❑ HOLDING TANK 7351 $119.00 ❑ SITE EVALUATION in Con)uction with Critical Area 7346 $197,00 ❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00 ❑ GRADING PLAN REVIEW DETAILED 1238 $104.00 ❑ SITE EVALUATION Lot Less than 10,000 Sq. Ft. 7347 $172.00 ❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00 ❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.0 ❑ COPIES (LAND USE) 7786-81 $ .50 INITIAL DATE Holding Tank Agreements Completed ❑Y,e/s' ❑ No Certification of Existing S.OASysterr"Requ� d wYes ❑ No WQCB Clearance Required ❑ Yes ❑ No (Attach Form DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required ❑ Yes ❑ No Special Feasibility Boring Report Required ❑ Yes ❑ No Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes ❑ No Grading Handout Provided ❑ Yes ❑ No Staff Specialist Lot Inspection Required ❑ Yes ❑ No Maintenance Booklet Provided ❑ Yes ❑ No Lot Inspection Date Initials 01421,Soils Percolation Boring Report by AL�g "f Project # Date S �o " 75' el V Soils Map Page Soil Type Approved By Date No. of Systems Type of System(s) No. Dwelling Units 1 (1) Septic Tank Soil Rate Gre sand ` ❑ Folding Tank ❑ Replacement Bedrooms, � r� Grease'RtcpNn�tTrap ( ew ❑ Addition J4M*, A(rPA:( d3atM,M,4X 90 Gal.aZ0 07 Gal. ❑ Existing Sq. Ft. Bottom Area Total Linear Ft. Sidewall Allowance Install / Lin 6 O �- ,l long n. Leach Bed sq. ft. n. rock/ sq. ft. per running n. wide with�. ttom Area / Inlet Tested Depth 6519A' � ..� w ml Inches rock below dreinllnes�or �Un �t �d �— Proposed Bottom Rated Depth a Leachlinestbed special design for slope: ,' (3) Pit Diameter No. Pits Pit Below Seepage Pit }total Depth Other: Applicable ❑ 5 6 (TD) � Max. All eb a Depth N/A I Overburden Factor Well Review Approved: Signature Date Well Drilling Permit # Grading Plan Approved: Signature Date EMARKS: REMARKS:- This This application is OVED ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompanied plot plan, using the requirements set forth in SON&0Naybuilding permit is necessary for lie installation of the above -designed systeconctr�ctron isle nn►rn&a in the rjjju a —ro 1nngfi axpapajpD_grgg j (1 Septic tank must be 46W minimum from any wells Leach lines must be 100' minimum from any wells, including expansion area of / $'t.0 s► G�� h, �a Seepage pits must be 150' minimum from any wells, including expansion area ASignature of Health Official Date�lJ RECEIPT NO. -3-?34 DISTRICT- ❑ Riverside DOH -SAN -122 (Rev 1/92) O CASH & CHECK NO.'7a(, Issued By 4-30 - 93 ❑ Hemet ❑ Perris ❑ Rancho Calif. C! Blythe DISTRIBUTION: WHITE-401fice file YELLOW—Appilcam PINK—Bldg. Dept. GOLDENROD—Plans/Records 338 .00 !0