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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. 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