001546 (AR)r
P.O. BOX 1504 No, 001546
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Dmg
Mailing �.I BUILDING: TYPE CONST. OCC: GRP. It 3
AddressFOM r A.P. Number 774-154-025 Lat 7
City Zip Tel
TA Ninta 92M 5614-4773 Legal Description
Contractor.
Project Description
Address.
abovia
City Zip - Tela ...
la � 92253 4 ,
State Lic. City
& Classif. Lic. #
Arch.; Engr.;
Designer
Address Tel.
City Zip 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.
SIGNATURE DATE
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, 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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of.
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
fc, 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'(S500).
❑ 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 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,
pn;vided 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. forthis reason
,.
Date Owner Vi %. 11"e%
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 (5100) valuation
or less.)
I certify that in the performance of the 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 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 cit to enter the above-
mentioned property for inspection purposes.
Signature of applicants Date
Mailing Address
City, State, Zip f
1
HARD COPY
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:
A1542. 6- 12
16),20 CK
Sq. Ft. No.
Size • 306 Stories
No. Dw.
Units
New Alter ❑
Repair ❑
Demolition ❑
��❑��y,yjyy,�,���,,�Ad��c'rh�,�X
['lG�ii.Tw3fi]31i $0 � % . � Wim
=M.
Estimated Valuation�$�.
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
55,55
Const.
rs
Mech:
V1 C
Electrical
1.7AS
Plumbingl#.
(IQ
S.M.I.
a fes}
Grading
Driveway Enc.
Infrastructure
TOTAL
167..24
REMARKS
_
See �t 1 IEUi
r `tL'�._t. 29
�yy8,�t
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:
A1542. 6- 12
16),20 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO, FT. ®
CAR P. SO. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS F74�— o l
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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 ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR Q 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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
/ P ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS F74�— o l
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.
t; #FRAMING L
G/
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
I Nbrr%i I UK" 01UN A l UK tb[INI I IALJ
GARDEN WALL FINAL
THIS APPROVAL GRANTED BY THE
DEPARTMENT OF PUBLIC HEALTH
IS VALID FOR ONE (1) YEAR
FROM DATE OF APPROVAL,
RIVERSIDE COUNTY DEPARTMENT OF PUBLIC HEALIK
DIVISION OF ENVIRONMENTAL HEALTH _,..Aa 3 kl-Ak",
Food Establishment
V1 Sewage Disposal"'
7��A
Gal Septic Tank
Trailer Park 20P
:5E1qFt. of Leach Line
Motel, Apt., H y
Seepage Pit
-b--1 Dwelling - &41, o ewer
Connection t S
- Commercial Building r v`le., 41
- Swimming Pool C a
No on-site regenerating water softc iing devices may be discharged into the individual sewage clisposal
systern herewith approved without c earance from the Water Quality Control Board.
7"Water supply serving this installatior must be from an approved source.
All sewage disposal installation must conform with requirements of current Uniform Plumbing Code.
-::7-- Any cutting, grading, or filling in e cess of four (4) feet will nullify sewage disposal approval.
Approval has been obtained from 0 e " nal Water Quality Control Board for installation of the sew-
age disposal system.
'this is to certify that the Riverside CountD�itment of Public Health approves for v=mpo."T, construction
or installation the item(s) checked above.
-3
Oate
CIT
.,3 ellr.,
C
D
/ Nirl; L
7-7'
y
e A -lb C
17"
o��� -
E' i S I hlC�j
T C t vJAI—L.
L:,�: � c �' PP1Ti Win%
�,/ • � R /� yes gg _� e AAAA '
" hy. � p• ye�=� � o �,. .a, �, . 2`i .'sM q ..yti �, `'P � � �...�r (ra � `
ION ALS -R
Ai�iU AL'
DAT F
ti
r -
:X)
X
5
r
'k,
f
LA
Jm �3
C9
;s
C,
C-4
r
trzs,
-------------
:X)
X
5
j f' r' _ •
C F,cc,(fY/
_ •T7.L�C •a t�
�G /�O oc.T1lSS
./
.
�:CrOISTT7✓C� lf-� Ate, AVER HGAMO
`fir crjCTENas to-7c.5iSTI/dG Oc)T �6TS ',
- iin/Q Jyi't'GN WiTA y�AI.E_ ��
'�jY L.t �J sNG �oc9M
/V /
..
�c3UM i^LE(C��TRSCAI_ ACJ L
./
.
�wo Ml l
Z .
@`�►`® F PEP P.Oo�n`'�FWO �K�TbL :' iTH%ZOJ_.
rw • ' t ,r �. 1.�' a at
)' � A s -L Fj'�+7/✓O b J c f� T EIgQ
A S
/ ts�ng/��(g Eg 6
'• > f.n,
w THc Li �IN(o +..^
CE
dd,,
p
rottitDA
W6cR :•:��
.�ij-.Fib:
mw
a
it
6N
%9 1
cl�
>
74,
cl�
1 � J
F
r..
a
QCf-
x
o
1 x
r..
QCf-
o
1 x
r..