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No Permit Number (SFD)Building 52-625 RUblo Address Coaaholl Va+le Mailing Address',247 F3o TahgUitZ 'R. - CityZip , Tel. Contractor Address City - Zip Tel. State Lia & Classif. 387934 CitS Lic, Arch., Engr., Designer Address Tel. P.O. BOX 1504 78-105 CALLE ESTADO LA„QUI-NTA, CALIFORNIA 92253 It WILDING: TYPE CONST. OCC. GRP.—' k.P..Number 773-2.32"'0 0/9 -egal Description )roject Description &3.' y . . ,. Sq. Ft.. 1410 No. No. Dw. Size' Stories Units City (Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION 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. r; d L���/µ.rt.�.mr,"e•: a $L(3NgTURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Seca 7031.5,Susiness 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 file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Lew, 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 five hundred dollars (8500). p 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.) ❑ 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.) ❑ 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 •„ -Cj .4--' p'Copy Is filed with the city. ❑ Certified copy is hereby furnished. New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 4301 Garage 170 61 fence ani R C�ii �s� t y - ni°t�1:;.nt ;•° �,L)''�.1itj'tD�'^c�F4"S".1 h.�3 or less.) I certify that in the performance of the work for which this permit is issued, I shall 'not 10 Cel.14 :;S TOW j+ 23139 51 h of . Cah ornia r Estimated Valuation$75 pO T - PERMIT AMOUNT Plan Chk. Dep. $250.00 MinimumSettiack�Distances: - Plan Chk. Bal. 'x 1V 39.14 Const. 364.00 Mech. 33.00 Electrical 74 „ ] Plumbing a I015 00 { S.M.I..i FINAL DATE INSPECTOR Grading0 Driveway Enc. 20,00 Infrastructure i • I'agree to comply witli.all city and -county ordinances andstate laws relating to building o � construction, •and hereby; authorize representatives of.,. this city to enter the above- bovementioned i mentionedproperty for inspection purposes. 1 :Signature of applicant Date TOTAL 53 Validation: CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation ani R C�ii �s� t y - ni°t�1:;.nt ;•° �,L)''�.1itj'tD�'^c�F4"S".1 h.�3 or less.) I certify that in the performance of the work for which this permit is issued, I shall 'not 10 Cel.14 :;S TOW j+ 23139 51 employ any person in any manner so as to become subject to the Workers' Compensation of . Cah ornia s'J Date�Laws r T - NOTICE TO APPLICANT: NT If, :alter makingthis Certificate of Exemption you should become -ZONE: BY: - ` subject to 'the Woikers'',Compensation provisions, 'of `the, Libor -Code, you must forthwith - comply wtth. such prowsions.or this permit shall be deemed revoked ;. MinimumSettiack�Distances: - _ Front Setback from Center Line Rear Setback, from Rear Prop. Line ,coNsrRucTloN LENDING AGENCY Side Street Setback from Center Line - 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.). $Iris Setback from Property Line Lender's., Name z a Lender's Address `" FINAL DATE INSPECTOR 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.: Issued by:. Date Permit • I'agree to comply witli.all city and -county ordinances andstate laws relating to building construction, •and hereby; authorize representatives of.,. this city to enter the above- bovementioned mentionedproperty for inspection purposes. Validated by' :Signature of applicant Date Mailing. Address Validation: city, State, Zip .+,. is -..: • .� .. .. •, ' .. .: - .. — ,r.;;;y' WHITE PINK APPLICANT,,GREEN BUILDING, GOLDENROD .ASSESSORS OFFICE HARD COPY - FILE .FINANCE ,A_.,.tsr..7.'z. ..7. �:.. <....t�'...s,....�.....^.. ,..l .r.._.. ....,.�t::c- __. ,.#,.•...,. , .._ 3't n .. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO F1 y $ UNITS � SLAB GRADE ROUGH PLUMB(/ t� V BONDING YARD SPKLR SYSTEM 2ND FL SO FT. a FORMS SEWER OR SEPTIC TANK �( ROUGH WIRIN O MOBILEHOME SVC. BAR SINK POR SO FT at GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR 50. FT. f{t EMP. POLE «< GROUT DRAINAGE PIPING CARP. SO FT. 6 FINAL INSP. BOND BEAM WATER SYSTEM DRINKING FOUNTAIN WALL SO. FT. Q _ $ LUMBER GR. FINAL INSP. URINAL SO. FT. (a &�RROOFINGREMARKS: ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES VENTILATION WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISHI APPLIANCE DRYER FIREPLACE 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, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ®c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT. B.T.U. SO. FT. RESID g 1'A c SEWAGE DISPOSAL SO.FT.GAR r ti:c HOUSE SEWER CERT. OCC. 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 8 AIR COND. SOLAR SETBACK [[ S CJ ROUND PLUMBIgN�G 7,!;Lk UNDERGROUND A.C. UNIT COLL. AREA � SLAB GRADE ROUGH PLUMB(/ t� V BONDING HEATING (ROUG STORAGE TANK FORMS SEWER OR SEPTIC TANK �( ROUGH WIRIN O DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) - OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) EMP. POLE «< GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _ $ LUMBER GR. FINAL INSP. FRAMING / V g T FINAL INSP. &�RROOFINGREMARKS: Gly - 'ro VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR' GAR. FIREWALL LATHING ()� tC —� C MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL ' INSPECTOR'S SIONATURESIINITIALS GARDEN WALL FINAL 4 P.O. BOX 1504 APPLICATION ONLY Building78-105 CALLE ESTADO Address Jia — 4- Z ,5" 1e41,810 LA QUINTA, CALIFORNIA 92253 Owner 00AeAE4L,9 1A1-LEV UdP BUILDING: TYPE CONST. OCC. GRP. Mailing Address 2 V7 E %f/1,ct / r, Z W�q V -""�Z A.P. Number 7 7& — 23 Z er7;?' t9,�9 City" Zip Tel. f'fTf�it7 $.fI -149 , S /�Z2 4. Z Legal Description mor- �C,t� /(�S'- Gd.vi r- /> Contractor Project Project Description /t.�G t c f'ff«!! ,d►�.17CQ�TlG/�G �fPi-YL.t�L �,O.cJ Sr'l�t.Z c�T/Ya,r� - Address ,,?91 5t, iAH u r7/, WA City Zip Tel.. �igL�LI SPRI�'� S 1 Z z. G Z &2z- Z e, State Lic. City & Classif. J 87 9.3 4-1- Lic. # Sq. Ft. No. / No. Dw. Arch., Engr., Size 9. Stories / Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. /7Q e- City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I herebyy aff� 1ir�n that I am licensed under provisions of Chapter -9; commencing with Section 7000) of Diviston 3 of the Business a d rofes`lioons Code -and -my license is in fu%I force nd effect _ � /f iT SIGNATURE ' —LDATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, atter, 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 PERMIT AMOUNT 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 Plan Chk. Dep. subjects the applicant to 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 Plan Chk. Bal. do the work, and the structure is not Intended or offered for sale. (Sec. 7044, Buisness and Const. 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, Mech. 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.) - - ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 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.) Grading ❑ I am exempt under Sec. B. 8 P.C. for this reason Driveway Enc. Date Owner Infrastructure L /,Liv -7— WORKERS' WORKERS' COMPENSATION DF�CLARATION I hereby affirm that I have a certificatejofyconsent}to self -insure, or a certificate of Worker's Compensation Insurance, br a cert('ed+copy ther, of: (Sec. 3800, Labor Code.) Policy No. CompariL ❑ Copy is filed with the city. ❑ rtif ed-copy-Is.hereby furnished. TOTAL —7_7 CER IFICATE OF EXEMPTION FROM REMARKS 7 WORKERS' COMPENSATION INSURANCE _ r (This section need not be completed if the permit Is for one hundred dollars ($100) valuation or less.)i, X ♦ y ' I certify that in the performance of thg work for which this permit is Issued, I shall not 1 �} I.G#�ki 4 VY TK6TXIY Y Y "'779-00" iLi'779.0t7" 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 forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback'from'Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line 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 expirationit 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_Permit 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 Date .Mailing Address Validation: City, State, Zip BUILDING DIVISION CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. 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 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 WASH ER(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 SO. 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 & 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./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 il C_ , Z O H U W M Z O H U w U) Do Q W li 14 O19 COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION, SYSTEM 1;! 7� 32 — PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL 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 $41D is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log q Name (Owner. Agent. Contractor. Etc.) .57i -A7 d a. fie- v s r v& -7 lo Mailing Address ,,7 y7 t:F rZ v.4 V City ig,(M -s'pg 1 r, S State 0 Zip Code l�Z Z 4- Z Telephone 'Job Property Address 4W'Gt o `or'"5r7ist7nlry 'Legal Description of Property. (Lot, PM. TR) S"o2 Z-5- 12a 8J45 YF! A0 7- 6 6t,� 'Assessor's Parcel No - 01ei A en oo w 1�� / Use 01 Permit /�/ '�Pla fu5g Case M Lot Side ���_ _ Q '% �,� 0 5'D X/�� W �/J y.,;k/d SFD. MH Site Preparation Etc. Signature of ApgyCant - Date " ..// 'The above information must beverNied from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial Date El of Existing S.D. System required. Yes N 7 -11-A / WOCB Clearance required. El Yes 1,1- o I Soils feasibility report required. ❑ Yes Y N�/ I / Y l Special feasibility boring report required. ElesC� 0 Detailed contour plot plans required. Ell Yes U 10 P Staff Specialist approval required. ❑ Yes ' No Lot Inspection Date Soils/boring repo by Project N Date Map Page Soil Type C .Approved byDate 7— 1' Soils Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required El Existing New El Additional El Replacement 3 tv_0T A,Gals. (2) `Lech line sq. ft. Sidewall allowance Install—Line(s) • Ft. Long, Ft~ inches .Leac4/ed Sq. Ft,o�bottom (Bottom`tr itch area) ft. rock/�Sq. Ft. w�id'e`wit min. per running ft. A rock below drain lines area Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth Applicable 6' 2 /� Max. allowable depth 5<d N/A Overburden factor o This application i a roved/; " ied,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 wellO /0� ,1�� ", -area 2) Leach lines must be 100' min. from any ells including expar ion c Fj Seepage pits must be 150/' min. from any wells including expansion area, -7- Z fT r,.� Health Signature of Official /b: rf (moi A4Li�L, RIi RECQPT NO._ �7vy� Q / Issued by S_L�� / Da District: ❑ Riverside .©`Ind oo El Hemet E-1Perris El Rancho Calif. ❑• Blythe Distribution: WHITE—Office file YELLOW —Applicant PINK—Bldg. Dept. GOLDENROD— Pending File DOH SAN 122 (Rev 8187) %, ted7-/iZf cvk I �� R U" LEON SPnUGY 01 f if E OF 7, 0 AGMCQUI`UIZAL -Di-AMISSIONL,I;Z :': LL 1n�1E5` 0 WALLACE 0 �1 .• ,Q. ,AyU � �s5�s��r�ro".naciu�ed '� :WEIGI I1 S:;�c MEASURES, cLE�►E�scBE EaVE!�►sfE 49=613 Ilwy486, Suite D-1.2 Coacl ella C 92236 y :: MA r q i gq� 61`9 34`2=.8L91