002554 (SFD)��. .. .. :°ws: _ � r ..rpt. }T+•o• f
IOU
P.O. BOX 1504 ' ��• ' ...002554
Building 51-850 AMLift Mca s. LA QUINTA78-105 CCALIFORNIA92253
• Address -
.. ,. Owner - ..-... •. n .. .. .. .... .. , .. - ,
..
BUILDING: •TYPE CONST. OCC: GRP.-
Mailing
Address ' 5.2,x340 A`j3ta_' .�.a cammm A.P. Number _ 773-152—M-6 "
City IZIPY
Tel.4Ss n•y- BK'92253 - 564-20434 Legal Description i3 . 8 .:.a�, 7 �s
:Contractor . Project Description'r3
Address _ 'a.
17.
City - Zip Tel: _
State Lic. City DM
1440
& Classif., Lic. # Sq. Ft. No. No.'DW.
Size Stories Units
Arch., Engr., _.. ��
Designer New ❑ - Add O' Alter ❑ Repair El., Demolition ❑•.-
Address Tel.
City Zip State
_ ... Lic. #
LICENSED CONTRACTOR'S DECLARATION u
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 Estimated Valuation �p
I hereby affirm that I am exempt from the. Contractor's -License Law for the following' l ;CA3g et}�
reason:(Sec. 7031.5,Business and Professions Code: Any city or county which requires a ! a
perhift. io construct, after, improve, demolish, or repair any structure; prior to its issuance alsorequires the applicant for such permit to fife asigned statement that heis-licensed pursuant to' - .•PERMIT " - _ AMOUNT
the provisions or 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" - - - • ' - + 0Q -
:
..for
the alleged exemption. Any violation of .Section, 7031.5 by 'any applicant for a permit. Plan Chk.-Dep.. �'oi .r�G�
' subjects the applicant to a civil penalty of not more than five hundred dollars'(8500).' .Plan . Chk. Bal.' . r09
ff�
❑ 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 of offered for sale. (Sec: 7044, Buisness and COr1St' }! ee try nn
Professions Code: The contractor's License Law does not'apply to an owner of property who. 29�IiAzx
. builds or improves thereon and who does such work:himself, or through • his own employees, Mach. `
r„ 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 Electrical -' -
of. proving that he did not build or improve for the purpose of sale.). _ - '• �,•. -'
_w 0 I, as owner of the properly, am exclusively contracting with licensed contractors -,t6 con-.. Plumbing
struct the project. (Sec. •7044, Business and Professions Code: The Contractor's Lice4se Law -
does not apply to an owner of property who builds or improves thereon, and .who contracts (or S.M.I.
• such -projects with a contractor(s) licensed pursuant to the Contractor's -License Law.)
Grading2fi;_fbtD
O 1 am exempt under Sec. . B. R P.C. for this'reason
Driveway Enc.
Date' Owner a�7 ""l Infrastructure 1„x,03 70,,
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
0 Copy is filed,with the city.,. ❑ Certified copy is hereby furnished.
TOTAL~ .I$.�?Q1 1.772.0152.
CERTIFICATE OF EXEMPTION FROM REMARKS 1
_ WORKERS' COMPENSATION INSURANCE 3
(This section need not be completed if the permit is' for one hundred dollars -(S 100) valuation
.. or less:) _..« _- . .. .. _ . , ,,•.
certify that in the performance of thg work for which this permit is issued,.l shall not
• • employ any person in any manner sous 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 • ZONE: BY:, '
subject to -the Workers' Compensation provisions -of. the Labor Code, you must forthwith Minimum Setback Distances: .. '
comply with such provisions or this permit shall be deemed revoked. -
Front. Setbac, k.froML Center Line
Rear Setback from Rear. Prop. Line
CONSTRUCTION LENDING AGENCY Side Street'Setback from Center 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 Llne
Lender's Name
Lender's Address FINAL DATE INSPECTOR
This is a building permit'when properly filled out; signed and validated, and is subject to FI.NAL
expiration it work thereunder is suspended for 180 days. —�" Lifi
86
I certify that I have read this application and state that the above information is correct. ,•ISSUed by: Date 9Permit
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. Validated by:
Signature.of applicant rf j - J� / Date
Mailing Address Validation:rim
City, State, Zip
A6Z74 9 ."2 77ZG4.f'1K
_ HARD COPY T _
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
1-1
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
FOR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SO. 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
,jOUGH PLUMB. 3 "1
/
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
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
OFING
/ L
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
A !i
SETBACK
GRO DPL MBING �3
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE
,jOUGH PLUMB. 3 "1
/
BONDING
HEATING (ROUGH)
STORAGE TANK
ORMS t 11
EWER OR SEP
�eOUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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.
�C( F AMING �3 C �i
O /
FINAL INSP.
OFING
/ L
o
0
DEC 17 19$7
111
IC�
REMARKS:
ENTILATION
t=
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
Ov /-
GAR. FIREWALL
LATHING j -J i
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
G
CERT. OCC.
FENCE FINAL
tl:I VA"J wumAI Vmra Ir I I IALb.
GARDEN WALL FINAL
f7
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
ounty specifications,required on the attached check list. A non-refundable filing fee of
. is required when the application is submitted. Check must be made payable to the
ounty of Riverside
Building Department Application Log N
a
z
O
H
H
U
W
Name (Owner, Agent, Contractor, Etc.)
No. of Bedrooms) (1) Septic Tank
Mailing Address
Existing New ddition
/ /
! Gals.
City v /'�`
State
Zip Code
Telephone,
(2) Leach line sq. ft.
Sidewall allowance
Install Line(s)
Leach bed
*Job Prope. ty Addreys)s
ft. rock/ Sq. Ft.
C yyor;;�C,ommun�tyy
*Legal Description of Prpty. Lot, PM, TR)
. %�/�.
run inft.
.= v.
.141-
L YS 35 s > '%: .0 '_ i ... -�- P .
*Assessor's Parcel No.
N/A [ ]
Water Agency
Use of Permit T
.1,f%0 �/�,�
�r Lot Size
design
(3) Pit Diameter
y0r?Well
SFD, MH Site `Pr"ep
Etc.
/
6' [�,]'`��
Pits al
Planning Case #
N/A Overburde'^factor
I In
Max. allowable depth
Signature of Applicant Date , ' -i
*The above information must be verified from Building Application
STAFF USE - DO NOT WRITE BELOW THIS LINE
)Init(iial Date
Certification of Existing S.D. System reqd. Yes[ ] No[A/ I,/,�,tvJ({ . 6
v
WQCB Clearance reqd. Yes[ ] No VI
Soils feasibility report reqd. Yes[ ] No Cf] {
Detailed boring report. reqd. Yes[ ] No. (�/J q/
zDetailed contour plot plans reqd. Yes[ ] No[.�J
o
Staff Specialist approval reqd. Yes[ ] No[/] Lot Inspection Date
Soils/boring re ort qby Proj. N Date ,r
Soils Map Page,. 1 Soil Type�Approved by Date
Type of System:
No. of Bedrooms) (1) Septic Tank
Soil Rate Required
Existing New ddition
Replacement
! Gals.
(2) Leach line sq. ft.
Sidewall allowance
Install Line(s)
Leach bed
(Bottom _trerich area)
ft. rock/ Sq. Ft.
Ft. Longt,+ _ Ft. wide
Sq. Ft. of'
run inft.
with Mina inches rock
bottom
N/A [ ]
below drain lines
area
Leach lNines/bed-special
design
(3) Pit Diameter
No. Pit
Seepage Pit total
depth VI) l
for slope "Apraicable
6' [�,]'`��
Pits al
N/A Overburde'^factor
I In
Max. allowable depth
-r
This application is' approved/deem--Q for the design of a subsurface disposal s -.-stem as
indicated on the accompanied plot plan using the requirements set forth in Section B above.
U A building permit is necessary for the installation of the above -designed system.
F�(,�)lSeptic tank and sewer lines must be 50' from any wells -4/6H -U, '�% .y 7� w -.,IA
�,�,) Leach lines must be 100' min. from any wells including expansion area
Ew (3). Seepage pits must. be 150' min. from any wells including expansion area//a f
Signature of Health Official Date
RECEIPT NO. 0,339 Issued by I('/L- Date
District: Riverside C ] Indio 1401 Hemet [ ] Perris[ ] Rancho Calif. [ ] BlytheC ]
Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File
DOH SAN 122 (Rev. 2/86)