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359675 (SFD) + 11437 (RR)54790 Avenida Alvarado BUILDING PERMIT PERMIT NO. 359675 DEP RTMENT,OF MOLDING & SAFETY fire -+COUNTY- OFRIVERSIDE FIELD 9FACE DST \\ CONSTRUCTION ESTIMATE 1 NO. ELECTRICAL FEES NO. PLUMBING FEES 11 1\I IST‘F1. 1260 SQ. FT. @ 18.40 Valuation § 2 84• 22 UNITS off. F.C.C. • Mk} Permit Fee E 2N\DFL SQ FT @ § Y 93 Use of ermit 7 E7}f'o. ``J" 774-29 Use/tc e No. C 1 • •Mech. Fee YARD SPKLR SYSTEM $ 22 50 ` PO ' '232 SQ" FT de $ 928.0 ^ P1jj MOBILEHOME SVC. '• LS Lot Size A.7 g & Att.- CW?4 C Legal Description F S BAR SINK :'Construction Fee 2 913. gt . POWER OUTLET Dbl $ 2'' h ROOF DRAINS // Z2NRestrictiorr 5 ty - G11,3 5 fyr ' ' GAR. 449 S SQ FT @ 6.50 $ 1 89 1plumbing Fee Dbl $ - _ i DRAINAGE PIPING o71 Unit Pions No. '' -Plan 47o. 7 / Q Checker i?%' 2...,,/,4E_, \' CAR P SQ FT @ 4‘`3ALL SQ FT @ $ ! +v iDerrlpl. Fee .• _ $ Const. Lender Branch DRINKING FOUNTAIN ,'Regislr, Fee $ SQ FT © Mileage Fee ' $ Address City Zip /// ,-1 i ti. Witness, Fee URINAL E ESTIMATED CONSTRUCTION VALUATION 6 931 Owner/Agent r / W- & . BI d Tel. Zip iJ ' WATER PIPING2 Fees `" •00 —NOPE? isr67tebe used as prkik.perty kik.vdluafiaii V i A V s'- SWIM POOL, ka 3Z a }l q it" *'L71♦ 6 ZipTotal r K_ NM.O.O N.C.❑ Cash •Chec 1 FLOOR DRAIN 2 n 00 MECHANICAL FEES ji L reqem I' s\ eage SWIM POOL, COMM Systuirs ' , WATER SOFTENER City Zip VENT SYSTEM FAN EVAP. COOL , 1 OOD SIGN WASHER (AUTO)(DISH) 1L APPLIANCE DRYER 5 GARBAGE DISPCZA, 2 00 FURNACE UNIT WALL FLOOR SUSPENDED 31 00 LAUNDRY TRAY 200 -AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC V'vATER CLOSET Z COMPRESSOR L HP POLE,TEMP/PERM 1 2 LAVATORY4 HEATING SYSTEMS FORCED GRAVITY4 1VM AMPERES SERV ENT SHOWER BOILER B.T.U. 00 SQ. FT. @, c 5 00 i2 a BATH TUB .... . .. . _ SQ.. FT., @y, ,.c 1 WATER HEATER 2 SQ. FT. RESID @ l V. c 1260 SEWAGE DISPOSAL 2 00 S0. FT. GAR @E '/. c 440 15 75 1 • HOUSE SEWER 10 00 3 37 GAS PIPING PERMIT FEE PERMIT FEE 1 PERMIT FEE 2 00 DBL\.'' -+- ' ' TOTAL FEES 206.51 MOB.HM.FEE ' MICRO FEE ' M33 FIQQ 22.50 ' PL. CK. FEE l CONST. FEE a ' I UR_ tx( -`•E3C100 27 _ • 0 J. SMI FEE 1 R4 FEE PL344100E `PERMIT Job Address Space 54-710 Zip Owner NO. 1 3 5 9 6 7 5 Community Avenida Aiveracb La 9U fta _ Valuation § 2 ( / 22 W {3 (Ij' (;Lld n3 ( off. F.C.C. • Mk} Permit Fee E `Micrp Film Fee r Cop § 93 Use of ermit 7 E7}f'o. ``J" 774-29 Use/tc e No. C 1 • •Mech. Fee Dbl $ 22 50 •Pl. Ck. Fee • $ P1jj e LS Lot Size A.7 g & Att.- CW?4 C Legal Description F S S R :'Construction Fee Dbl 5 118 r'Electrical Fee , Dbl $ 2'' h Lot 23 Wokc 25 // Z2NRestrictiorr 5 ty - G11,3 5 fyr ' ' 100 SMI Fee $ 1 89 1plumbing Fee Dbl $ - _ i Bond Amt. E o71 Unit Pions No. '' -Plan 47o. 7 / Q Checker i?%' 2...,,/,4E_, "FinorDate 1no P) Inspector / nit , ' /,- / i.SP:)nsp. Fee $ ! +v iDerrlpl. Fee .• _ $ Const. Lender Branch Supplimental Permit Numbers f . :•J)t-` u, ,'Regislr, Fee $ Mileage Fee ' $ Address City Zip /// ,-1 i ti. Witness, Fee E Reinsp. Fee $ Owner/Agent r / W- & . BI d Tel. Zip iJ ' Fees `" E' Y206 s'- r8 - ......... Address ' ' n Ay 117x540 rets 3Z a }l q it" *'L71♦ 6 ZipTotal r K_ NM.O.O N.C.❑ Cash •Chec Ifji; ceived•by,o} Contractor • `Dex V 0 y f@F. S + Ifo; i ' j,& • 92240 ji L reqem I' s\ eage AMY Gf+1rp. Systuirs ' , s ij IIIIIIIIIIIIIIIIIIIIIIIII 39 —Sara" 1 IE City Zip Form 284-208 Rev.8/78, THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK FOR 120 DAYS SHALL ALS • CAUSE PERMIT TO BECOME VOID. I HEREBY AGREE TH , verified by: AtikfTON WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY /IND THE STATE OF CALIFORNIA. 1 HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE'SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. :r BUILDING PERMIT MIT NO. 9675 DEP RTMENT OF BUILDING & SAFETY {•. COUNTY OF R)VERSIDE FIELD DST CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES tt IST FL. SQ FT @ $ 53 ii 6 H 3aii'Ldereff. UNITS F.C.C. MH. Permit Fee S Micro Film Fee 1260 t irrW 2ND FL + a ..i SQ FT @ n' I E M cr40o. ;;3..79 Usefe No. Z CO ► Mech. Fee Dbl YARD SPKLR SYSTEM PI. Ck. Fee POR. 23 SQ FT @ ' ','• ?.i., • s Lot SizeBS MOBILEHOME SVC. S S R BAR SINK Construction Fee Dbl GAR. SQ FT @ POWER OUTLET Electrical Fee Dbl S i 72 v ROOF DRAINS Z,a Restrictio GO t[1Vyp4 iV _449 CARP .• SQ FT @ + 9 Plumbing Plumbing Fee Dbl S DRAINAGE PIPING Q karrrntttFl 9 V t em %( ( Q Alcfict$ g J ., a WALL SQ. FT. @ Sp. Insp. Fee S Demo!. Fee S DRINKING FOUNTAIN Const. Lender `! f i Branch G Supplim t Permit Numbers / Registr. Fee SQ FT @ $ Mileage Fee S Address City Zip URINAL $ ESTIMATED CONSTRUCTION VALUATION $ S Owner/Agent " i ^/` tilider* Tel. Zip WATER PIPING j NOTE...Not to.be used as property tax voluation • 24t 3*+00 • • . SWIM POOL, PVT • • lit T 3Z e771 Zip r 1 FLOOR DRAIN 2 00 MECHANICAL FEES / "Z r- 1 SWIM POOL, COMM Sewage System As 11 wr.m. Ci City Zip WATER SOFTENER VENT SYSTEM FAN EVAP. COOL HOOD SIGN WASHER (AUTO)(DISH) APPLIANCE DRYER 1t00 5 1 GARBAGE DISPCi6A1rs 2 400 FURNACE UNIT WALL FLOC; SUSPENDED 3 00 1 LAUNDRY TRAY 2 00 AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC 1 WATER CLOSET 2 (10 COMPRESSOR HP POLE,TEMP/PERM 2 LAVATORY 4 00 HEATING SYSTEAA344 T FORCED GRAVITY 7 50 AMPERES SERV ENT 2 SHOWER 4 OQ BOILER B.T.U. SQ. FT. @ < 5 00 1 BATH TUB 2 00 SQ. FT. @ c IL WATER HEATER 2 00 SQ. FT. RESID @I 1/2 c , 1 SEWAGE DISPOSAL 2 00 1260 SQ. FT. GAR @ V. c LJ 73 t HOUSE SEWER 10 00 449 3 37 GAS PIPING PERMIT FEE PERMIT FEE• 1 PERMIT FEE 2 CO DBL. TOTAL FEES yh , SiIt 206. 7L MOB.HM.FEE MICRO FEE ( acHolo 99_ %A PL. CK FEE CONST. FEE 2'!tn hh • acout 0 i 1A t SMI FEE s 'Rfn FEE P9MIDOE 7 YV 1.. V7 7.00 }j1.3 -(v Form 284.208 (Rev.8/78) • THIS PERMIT SHALL BECOME VOID'IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by: . FOR 120 DAYS SHALL ALSO CAUSE PERMITIT!TO BECOME VOID. I HEREBY AGREE TH.p.:01 ®bIa& ION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVERSI' •UNTY• D THE STATE OF CALIFORNIA. I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. Job Address Space Zip Owner PERMIT NO. 359675 -sec Avenaela Alvarado rtra { Valuation 92 S 53 ii 6 H 3aii'Ldereff. F.C.C. MH. Permit Fee S Micro Film Fee Cop S ,}{ ,/ afTglAllern 26,93 M cr40o. ;;3..79 Usefe No. Z CO ► Mech. Fee Dbl S2 PI. Ck. Fee S 774' 934102, Lot SizeBS F S S R Construction Fee Dbl S 118 Y A P raAn, 6411050ego escn io *fir Electrical Fee Dbl S i 72 v Z,a Restrictio GO t[1Vyp4 iV ) /'kf► i . JrW SMI Fee S •l 9 Plumbing Plumbing Fee Dbl S yp r14 Do^a Amt.3 a e $ Q karrrntttFl 9 V t em %( ( Q Alcfict$ g J ., a y,,, «n Date ( / + 6O Inspector i/y/_ J//J •--X17.- % r Goh/ Sp. Insp. Fee S Demo!. Fee S Const. Lender `! f i Branch G Supplim t Permit Numbers / Registr. Fee $ Mileage Fee S Address City Zip Witness Fee $ Reinsp. Fee S Owner/Agent " i ^/` tilider* Tel. Zip Total Fees $ t•JG i VV i adre ss 11 lit T 3Z e771 Zip r M.O.❑ N.C.❑ Cosh 0 Chec Received by ' . ...Hiram* trc P ra Dr.tax $13 Carp. Hat i Springs, CA / "Z r- 1 Trees require Sewage System As 11 wr.m. Ci City Zip d' }j1.3 -(v Form 284.208 (Rev.8/78) • THIS PERMIT SHALL BECOME VOID'IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by: . FOR 120 DAYS SHALL ALSO CAUSE PERMITIT!TO BECOME VOID. I HEREBY AGREE TH.p.:01 ®bIa& ION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVERSI' •UNTY• D THE STATE OF CALIFORNIA. I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. NO. OPERATION DATE ZPECT? OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back Si - A 7? ,----C15 33 Ventilation System 2 Ftgs & Frms rJ' .2-'19 &A{/+ 34 Plenums & Ducts L./9.-- 7% 2A Slob Grade Cj- Z 79 t%4iry. 35 Furnace Comport. ,----ri 3 Steel 36 Inlets & Outlets 4 Grout Blocks 37 Combustion Air 5 Bond Beams 38 Compressor P 3 -S-S-0 ,., 6 Roof Deck 7.-H- 77 39 Appl. Clearance 7 Framing fr-- /9 7 7' i e r 40 41 Fire Damper Smoke Detection DeviceS' -r0 I, 8 Vents 9 Garage Fire Wall 9 3 -s-F-V Li,/ ' 42 43 Commercial Hood Final 6--3 a joa.,--(4 10 Fireplace P.L. M 10A Fireplace T.O. MI No y ADDITIONAL INFORMATION %mt },otj REGo/L-t gea. 1- oxi F;/e. 426-'%9. (i % SV{ LA-IHQ. S CO L hQ kA.A4% S-2.-77 SEWAGE SYSTEM SIZE & LOCATION • 11 Exterior by!♦.i./4; /I-/x 4 /q ! -fig /r N+ /, 12 Internal Lath 13A Drywall J'` 79 13 Finish„,. Finish Grade 3 -Se' _S/a INSULATION Thick R Value 7A Walls (Botts) y Z , ) j //-/9— 7% -- 12B Ceiling (Batts) ,72-1 / /1 o `r, // i/ ' - / 12C Ceiling (Blown) 14 Final a --Po )> Q / 1 _ O Y1 0 PLUMBING APPROVALS 15 Ground Plumb it” 6- 7'7 r` Q 16 Water Piping 17 Rough Plumb 1-1,1;-- 7,' . 18 Vents 19 SewageeDisposal /4-g-' -77 20 20 Sewer .--------IS: 21 Water Heater %ice-r0 22 Water Softener —J 23 Water Service 1 -J ---ro 0 24 Gas Test 25 Final Tank Pit L.Line REAR OF PROPERTY LINE ELECTRICAL APPROVALS P/ 26 Power Pole 27 Conduit 28 Service Entrance 29 r Wiring / /-/7 / % /4----a)' 29A Grounding Wire //,/9- -7' ;P/L 29B Bonding 30 Fixtures 3 -S-'Jv Qi 31 - - 32 Final 3,C.:15"0 'll,!/di e C W z 3 0 or O al to PLANNING & ROAD DEPT. O z -z~ za a W J0 a APPLICATION FOR TREE PLANTING Job 925-39 1 (we), the undersigned, hereby certify and acknowledge that 1 (we) have read the application and agree that if trees are required under Ai County Ordinance No. 457, the applicant agrees to install said trees prior to final inspection. It is understood that no final inspection will be given until said requirements have been met or exception has been granted by the County. Now, therefore, it is agreed that the prop- erty owner shall cause the property lines to be surveyed in the event no survey stakes can be found. Further, it is agreed that the County of Riverside shall assume no responsibility should trees have to be removed due to lot line errors. �! W & H BUILDERS Building Permit No 3. `A 75 Owner's Name Mailing Address 12540 Palm Dr. P 0 Bbx 818 DesertcHpt Springs state ['a zip 92240 Job Address 54790 Avenida Alvarado Community T. Qpinta Legal Description Lot 23 Blk/279CUnit 25 Santa Carmelita at Vile Assessor's Map, Book & Page T 7 7 - 2 9 3 - 0 0 D-- Type Structure TWP1 ling Type of Soil sand Is water available yes Rood Dept. Plot Plan No Type of existing trees in road right—of—way /r/•5'/t/rte Trees preferred by applicant (1) Olive (2) Palo Verde . (3) Date 9 Feb. 1979 Planning Commission Case No Owner's Signature W & ff BUILDERS PE•RY C OBERTSON ROAD DEPARTMENT APPROVAL Approved species Jacaranda styraciflua (Jacaranda( Spacing of trees Distance from lot lines: Front 2' in R/W Side Additional requirements Per plot plan on reverse. Number of trees 1 Date Building and Safety notified 5/79 SignatureL,W�..�[�� REQUEST FOR EXCEPTION Reason Request for hearing: YES ❑ Owner's Signature (attach additional page if necessary) (Forward application to Planning Dept. if exception requested) NO REQUEST FOR HEARING Planning Dept. Concur ❑ Non -concur ❑ Explanation Date Signature Road Dept. Concur ❑ Non -Concur ❑ Date Signature REQUEST FOR HEARING AND COMMITTEE DECISION Date hearing established Date hearing notice mailed to owner Approved ❑ Disapproved ❑ Date Owner notified of decision Date Ruildina R Safety notified ._.__ Sianature ' .17\ ' LEGAL DESCRIPTION: LOT: 23 PLOT PLA Owner Job No. 925-39 BLOCK• 279 TRACT- Santa Carmelita at Vale La Quinta Unit #25 54790 Avenida Alvarado CITY/COUNTY: La Quinta/Riverside La Quinta, Ca. House Plan 3120 R Pad Elev • eY9' B (and finish grade elev. at house croners) Finish Floor Elev.: f°°' S Garage Floor Elev •LD Sewage Disposal: Install one 1000 gallon septic tank and: (4 ( nnf 6ft. diameter seepage pit 1 st feet deep lineal ft. of 3 foot wide leach line with 3 feet of rock beneath pipe N0 R T H Scale: 1" = 30' 4 NOTICE: THIS IS NOT A BUILDING' PERMIT APPLICATION TO CONSTRUCT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF RIVERSIDE • DISTRICT I); Permit No Job 925-39 F - OWNER w a 0 Dia £.UJL K ti It tttu S'Itt.e 00112 Owner Ar hi ct Conte cc�� 12Rau br , 0 dox .LIS • iL ?JkIA r Adc r su "} • Addre AAddrespub ubt Sprin' s ► F�CIS aC1 t'r, � prin B City City_ City ( Phone •f4) "� Phone • Phone + ' Lir. Nn 90n9F6 , , 1 1 (we) ,the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and Paving, and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building and Safety shall not make a Final Inspection until said requirements have been met. I am also aware that no work is to be done within the County R/W without an encroachment permit. ,,/� ".' NOW, therefore, it is agreed that I (we) will not occupy said property and will not cause said propgrty,to•;7e e, jai : e l I , e) have complied with all laws of the County of Riverside and the State of California governing said property. . lii� 9 Feb 1979 DATE SIGNATURE OF OWNER AND/OR AGENT •4.'► . Nt•tt - t vit `'ih Approval by Signature from the Following Departments Listed Below I ti Must Be Obtained Prior to the Issuing of a Construction Permit. LAND USE DIVISION BUILDING AND SAFETY `-4ISPACE NO. r c I JOB ADDRECE0I9O Avenida Alvarado 1 FUSE OF STRUCTURE _ _•••-- .• LEGAL,9,E.SC P_ZIONAF PR;OPER,T.Y„r '>% SINGLE FAMILY DUPLEXEl ��J1 �iTTGC �.� fifiitllii{C � �t 4_ -� `r 4t 71 • AGRIC. "'r' APARTMENTS El ;Rd t.(t,csitcS t COMMUNITY •ALTERATIONS COMMERCIAL I INDUSTRIAL n NO. OF SUBMITTED PLANS USE OF PERMIT j ❑ — — CASE NO • -•. •s / - �- .kT NO. OF PARKING SPACES REQUIRED NO. OF BUILDINGS NOW EXISTING _ ZONE / SETBACKS: FRONT et :iSIDE :•••''''' REAR / - GRADING PERMIT REQUIRED? YES ❑ NO ❑' LOT SIZE e" 7s 4-) - SETBACK ORDINANCE # OF' r FEET REQUIRED ON STREET - DATE • /• ff SIGNATURE OF LAND USE OFFICIAL ROAD DEPARTMENT • DEDICATION REQUIRED: YES 0 0 NO. OF FEET - 1/` .NO CURB,AND GUTTER REQUIRED: YES ❑ti -NO 0 lv` �''`�'� STREET ' CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES NO ❑ 1 HAS AN ACCEPTABLE APPLICATION ,BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY- AND STREET v',- _-- IMPROVEMENT? /Y'i]S 0�.NO 0 DATE /j2.J /c. 'SIGNATURE OF ROAD DEPT. OFFICIAI " %��`./���".r!> = W W !f I .1 „... r.. I, t 2. Z, ....7.___ SEWAGE DISPOSAL /0 -619 AL /%V2 A� Ft'IOLTE$`fl1Bt'tSfTigENT /, f , w' v .IBJ! WATER POLLUTION ' REMARKS FL000 CONTROL rn AIR POLLUTION . W , at W 1DIV OF HWY '- o a • - t ' • YOUR PROPERTY MAY BE SUBJECT TO a.- •t t ia y FLOOD: RIVERSIDE COUNTY'ASSUMES • , •- _.,,.,, NO RESPONSIBILITY IN EVENT OF FLOOD. ,, , 284 199 9/74 CANARY — FILE, PINK—APPLICANT iiiiHI IIII III III IIII 40 Building 54790 Alvarado Address Owner David Hamm stAtibirw P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 1 Mailing Address same City La Quinta Zip 92253 Tel. 564-2026 Contractor Nelson Roofing • Address 0. Box 584 BUILDING: TYPE CONST. A.P. Number Legal Description Project Description ReRoof o. 11437 OCC. GRP. City P D. Zi 92261 State Lic. & Classif. C39 516729 City / Lic. r 1654 Arch., Engr., Designer Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter 0 Repair 0 Demolition 0 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 (eft e ct. ,,/ ./11 , (/ .,J//' 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, 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 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 subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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 0r improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offeredfor 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.) ❑ I 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.) Pol;cy No. .Company &Copy is filed with the city. 0 Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars (8100) valuation or less.) I certify that in the performance of th9 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: ll, 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 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.) Lender's Name Lender's Address 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 certlfy 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 city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State Zip Estimated Valuation 3,980.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 20.00 Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 20.00 REMARKS tf;t' 7e./Al )fi-' :;"-,rll4HIV '11- 7 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES . NO. PLUMBING FEES . 1ST FL SQ. FT. SO. FT. SQ FT SQ. FT. SO. FT. SQ. FT. SQ FT VALUATION ®• $ STORAGE TANK FORMS UNITS ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP 2ND FL OTHER APPJEQUIP: ' REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER YARD SPKLR SYSTEM FINAL INSP. POR ® GRADING cu yd _$ MOBILEHOME SVC. FINAL INSP. $ plus x$ BAR SINK FINAL INSP. GAR. @ REMARKS: VENTILATION f POWER OUTLET FIRE ZONE ROOFING ROOF DRAINS SPARK ARRESTOR CAR P. ® GAR. FIREWALL LATHING MESH DRAINAGE PIPING FINISH GRADING WALL @ - FINAL INSPECTION //--/—,2,j...0 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS. DRINKING FOUNTAIN. @ URINAL ESTIMATED CONSTRUCTION $WATER PIPING NOTE: Not to be used as property tax valuation' FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM. FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) , APPLIANCE ' DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED _ , LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. - TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. S. FT. RESID @ 11/4 c • • SEWAGE DISPOSAL SQ.FT.GAR @ 1c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR e. -SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP: ' REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu yd _$ LUMBER GR. FINAL INSP. $ plus x$ FRAMING FINAL INSP. /j i' ROOFING / '(I.G2/af TvC` REMARKS: VENTILATION f FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION //--/—,2,j...0 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS. GARDEN WALL FINAL