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PLBG (002628)414 Q44r - P.O. BOX 1504 002628 Building 78-105 CALLE ESTADO ' Address '52-640 AAS Nava= : LA QUINTA, CALIFORNIA 92253 Owner , bard HardY Mailing. G BUILDING: TYPE,CONST. OCC: GRP. Address A.P. Number •�•• City Zip Tel. - - • 2253 Legal Description Contractor _ City r ipn P1 _ Project Description 12� Address,.,.' . P.O. B= 125 City .. _. Zip . Tela Val 92260 327-4860 State Lic. City & Class.if.. 33,{2. Lic. # Arch.,, Engr., Designer. Address Tel. City Zip State Lic- # ..... n Sq. Ft. Size _.... .. .750 a9I..:. No. -• ••Stories Irk No. Dw. Units - New [it,. Add ❑ -Alter ❑, Repair ❑, :•: 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 isAwfull force and + effect t n s . Driveway Enc. Date owner Infrastructure WORKERS' COMPENSATION DECLARATION ' 'I hereby affirm that '1'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 q Copy is filed with the, city.. _0 Certified copy is hereby furnished. T :Demolition ❑ SIGNATURE > - !`•. DATE OWNER -BUILDER DECLARATION 'v; ? 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 REMARKS Estimated Valuation - - :.,� •. • 2�ap i ' ••_ PERMIT 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 - -- -... .� -Plari Chk.. Dep.- ep.'subjects 'subjectsthe applicant to'a civil penalty of not more than gve hundred dollars ($500).- • ❑,l, 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 -who Plan.Chk. Bal.. COnSt. Mach. builds of improves thereon and does such work.himself or through his own employees, provided that such improvements are not intended or. offered for sale. If, 'however, the :building Electrical ,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.) Plumbing 01, 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 , S:M.I. - 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 Grading Driveway Enc. Date owner Infrastructure WORKERS' COMPENSATION DECLARATION ' 'I hereby affirm that '1'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 q Copy is filed with the, city.. _0 Certified copy is hereby furnished. T :Demolition ❑ CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100)' valuation .orless.). .. .. .. .... _ .. . I certify that in the performance of lha 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 - ZONE: - • BY: subject',to `the 'Workers' 'Compensation provisions of- the Labor' Code, 'you must iorthwitn comply with such provisions or this permit shall be deemed revoked. - - Minimum Setback Distances: • •' "" ' Front Setback from.Center.Line ;,. .•Rear Setback from Reac.P.,rop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback froRl, Pfoperty Line Lender's Name Lender's Address ' This is a building'permit when'properly filled out, signed and validated and is'subject to FINAL' DATE INSPECTOR 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.ISSUed by: Date • 100 4-86 Permit 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 Date Mailing Address Validation: City, State, Zip A6451 10 8 -40:0.0 U HARD COPY - CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. ® POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. Q. FT. WALL SO. 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 SLAB GRADE FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENTSYSTEM ' FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROUGH WIRING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED DUCT WORK LAUNDRY TRAY AIR HANDLING UNIT CFM GAS (ROUGH) 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 WATER HEATER SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL BOND BEAM SQ.FT.GAR ® 3/ac HOUSE SEWER $ GRADING cu. yd. plus x$ 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 SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. 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 DEC- 17 19 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPtGI UX'S WUNA 1 UMLWINI IIALS. GARDEN WALL FINAL -••••y. r � +nj�-:�•�. _ � ..�. -- , -, �i-y. .: +.,M1 '�" - "' of •� - - ,,, •.. . - - •l�`.' .es•-•�.. wc.. .t E0 Z O H U W W Z O 1— U Ud W U) V Q 2 W Cr COUNTY .OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION s -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.) MailingAddress r',2G"76) A)AV,4ie'/2p City State Zip:Code Telephone Job Property Address �f C1 141,4 'City or Community G Legal Description of Property. (Lot, PM, TR) rPew r r! R/ / r -o i/ ,r �.� ; , , f !y r/ . ! r . y r-� t . 'Assessor's Parcel No. - ` Water Agency or Well Lot Size c E.. C/ Use of Permit Planning Case # - Sf DMH Site Preparation Etc. S gnature of Applicant �/ %' — 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 WOCB Clearance required. ❑ Yes No Soils feasibility report required. ❑ Yes No Detailed boring report required. ❑ Yes No Detailed contour plot plans required. ❑ Yes No Staff Specialist approval required. ❑ Yes No Lot Inspection Date Soils/boring report by Project # Date Soils Map Page Soil Type 41 c1q Approved by �._� Date J Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required �/ LT Existing E) New E) Additional C!�Replacement /"a)" —Gals. :2 -� (2) Leach line sq. ft. Sidewall allowance f, Install Line(s)—Ft. Long, Leach bed Sq. (Bottom trench area) ft. rock//'Sq. Ft. s` Ft. wide with '' inches Ft. of bottom. per running ft j'❑ N/A rock below draDlines area Leach lines/bed-special design,for slope: ApplicableEl5' (3) Pit Diameter, No. Pits Pit BI ! Seepage Pit total depth N /A OO;erburden factor N/A—:: - Ip Max. allowable depth' ° This application is approved/denied 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 ttie installation of the above -designed system. Septic tank and sewer lines must be 50' from any wells (2) Leach lines must be 100' min. from any wells including expansion area Q)> Seepage pits must be 150' min. from any wells including expansion area Signature of Health Official Date RECEIPT NO. ! Issued by— District: y District: ❑ Riverside ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. DOH -SAN -122 (Rev. 6/86) Date ❑ Blythe GOLDENROD—Pending File je- 1-0 I , h 4-- M� h d �^ RIVERSIDE COUNTY HEAL TF1 DEPARTMENID vil — _____FOOD ESTABLISHAriENT/ ----SEWAGE DISPOSAL -lk '''+iR PA,�t----- ITr, 17C'`o GAL. SEPTIC TANK -''• -EL, APT, HOTEL �---- �r — FT.; � ee _ Se. i . OF LEA, Fi L71NE /^�\•?i LL1ivG — 2✓er/hy Io�� PIT SWLDING -�--1 G e M 4�V SEWER V, I_IPec LAYOUT ---WATER 1 L.PYOUT POOL i ,;s �-� „ ;g -ia D:U3!trsenl knr r �. roses for the item(s; -Necked Above. Date By f���Octi��vb.o� RhiS/ice C'crsdpaa� `i r.