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PLBG (9901-053)51730 Avenida Madero 9901-053 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date /•1u t?9 C42 71.29/00 r `Daie Signature of Contractor f t OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 64 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Cartier Policy No. C0L1)1.N EAC E IN"II NWC51306649) (This section need not be completed if the permit valuation is for $100.00 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, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with -those provisions. lAlate: I rApplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the ve-mentioned property for inspection purposes. 1 ,Signature (Owner/Agent)` ! ""' Date r BUILDING PERMIT PERMIT# ' N">fl i-11S, DATE VALUATION Z.1 LOT TRACT JOB SITE ADDRESS 51-7'.0 .11i''[' NIDA .tMA ERO APN 77XI IXO") OWNER CONTRACTOR/DESIGNER/ENGINEER M3011<t liir IDA MA:DER( 84035 CAt3AtAi RD. iNt)1 , C r 92201 LA OU1N'F'.A CA 922si PALM DESERT CA 92261 (760)146-2703 CI T, 14,416 USE OF PERMIT T ( ,i 1 SEP T(t; t1fiANUO1Y, ;iE1k'M CONNECT (LU -MOD P:f2UlLCT #98-210) 2v"0.G0 c.e, 1 MSTIAIIATUD COST OF C0NNN1'1-Z1JC-T1OA"%1 PERMIT FFA; ScULNIMARY f'f:.i?MHNO VbA- -- SEWFA 1014000-419-000 s3rj ur+ ST i(t:1'CYI'r1.1 C't1N;TRl3C"Ttt1N !1N1) Nt,ATwr r3li;f'ir zn (►4 LES` FIRE: -PAID E.E S $0.00 TOTAL 11FRM IT F FF_S E)O K NOW S.T1M►f) %k RECEIPT DATE BY t DATE FINALED INSPECTOR r INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS -Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection — — Encapsulation Gas Piping Gas Test Appliances Final Final — Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: ECONO SEWER SERVICES P.O. BOX 192 PALM DESERT, CA 92261 (7l n) 'AAA.7701 (7Fn) 19R-77fn JOB WORK ORDER 10811 t FAX (760) 347-4978 - - DATE OF ORDER CUSTOMER'S ORDER NO. PHONEM ECHOX HELPER STARTING DATE BILL TO ORDER TAKEN BY No 'rA'rCRfiCIhj'r LL BE MAILED. TAX t DAT7 COMPLETED OR DERED BY ADDRESS $ one home Jx ❑ DAY WORK CONTRACT CITY ❑ EXTRA JOB NAME AND LOCATION JOB PHONE DESCRIPTION OF WORK PAYMENT TERMS NET 10 DAY5 FROM DATE OF 5ERVIGE MIX, PER MONTH CHARGE AFTER 30 DAYS. Signature V ' for above work: or be mailed after completion I hereby acknowledge the satisfactory completion 0 of work of the above described work. TOTAL MATERIALS TOTALLABOR PLEASE PAY FROM THIS INVOICE. No 'rA'rCRfiCIhj'r LL BE MAILED. TAX DAT7 COMPLETED OR DERED BY TOTAL AMOUNT $ one home Jx Total amount due ❑ Total billing to Signature V ' for above work: or be mailed after completion I hereby acknowledge the satisfactory completion 0 of work of the above described work. E. C. Sewer Service, Inc. dba Econo Sewer Service PO Box 192 Palm Desert, CA 92261 (760) 346-2793 or 328-7760 Fax (760) 347-4978 License C-42 #746159 Date: RE: City of La Quinta Project #98-20 Sewer Connection R - V I" l `51 N the owner of property at J J 7 . ( Print Name) (Print Address) in the City of La Quinta, release Econo Sewer Service of responsibility for restoring my property to to it's original state prior to the sewer connection: Please note the following areas they are released from: 1. 4D. it.4 Signatrue of Econo Sewer Service Employee Sign lure of Property Owner T4ty,,, 4 4 Qumm 78-105 CALLE ESTADO — LA QUINTA, CALIFORNIA 92253 - 16191 564-2246 FAX (619) 564-5617 August 21, 1991 To Whom It May Concern: The structure and lot located at 51-730 Avenida Madero is now located in a "X" flood zone per the revised F.I.R.M. (panels 060709 0005B) for La Quinta. This change became effective August 19, 1991. If you have any questions, feel free to contact me. Sincerely, .WG A AFE Tom Hartung _. Director of Building and Safety TH/es LTRTH30 MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 Building 51-730 Madero Address Owner Jeff Carlson Mailing Address same / 4 9* P.O. BOX 1504 S N o . 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 O J BUILDING: TYPE CONST. OCC: GRP.: City Zip Tel. .a . Quints 92253 1 564--2985 Owner/Builder City state LIC. city & Classif. I Lic. # Arcn., tngr., Designer Address I Tel. City IZip 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. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that 1 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, after, Improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile 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 or not more than five hundred dollars ($500). as owner of the property, or my employees with wages as their sole compensation, will o 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. 7064, 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.) 0 1 am exempt under Sec. r _ B. g, P.C. for this reason Date owner `R+ 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 ❑ 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 ($100) 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 is''to become subject to the Workers' Compensation Laws of California. E Date Owner NOTICE- TO APPLICANT: H,ger making this Certificate or Exemption you should become subject to the Workers'C. nation provisions of the Labor Code, you must forthwith comply with such provisions or this pe inft shall be deemed revoked. CONSTRUCTION LENDING AGENCY 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.) 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 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 city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip A.P. Number 9563 Legal Description Project Description Enclvee existing carport Sq. Ft. 260 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ L stimated Valuation . /aN, - • wnn V . PERMIT t YJ % AMOUNT Plan Chk. Dep. I: Plan Chk. Bal. G/ +. / : If f ,;, Const. A" Mech. Electrical / j a' U Plumbing S.M.I. .4 Grading Driveway Enc. Infrastructure -1 TOTAL -- REMARKS 35 :C1 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. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. SO. FT. @ WALL SO. FT. ® Sp 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 WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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 IBATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Vi c SEWAGE DISPOSAL SO.FT.GAR ® 3yic HOUSE SEWER REMARKS: 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 APPJEOUIP. 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- S Z 7 4. CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL :d 4, t 4 4 Q" P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 51-730 Madero LA QUINTA, CALIFORNIA 92253 Owner Jeffrey Carlson Mailing Address Saw City Zip Tel. La Quints 92253 564-2985 Contractor Address Tela State Lic.I City & Classif. Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # No. LABUILDING: TYPE CONST. OCC: GRP.: I IN 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'Busines`s a9d Professions Code, and my license is in full force and effect. SIGNATURE - + ` DATE OWNER -BUILDER DECLARATION 1 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, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile 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 rive hundred dollars ($500). O 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 orimprovement 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 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 ❑ 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 ($100) 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 provisfons 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. 1 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 city to enter the above- mentioned property for inspection purposes. Signature of Mailing Add City, State, P. Number 773-113-406 Legal Description Project Description 6' Wall 175€ lon. 07061 Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $6,375 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 0 Mech. Electrical Plumbing S.M.I. % Grading Driveway Enc. Infrastructure TOTAL REMARKS f r+.V; 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 2112/90 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL SQ. FT. BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR. Sp, FT. ® DUCT WORK ROCKSTORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEQUIP. DRAINAGE PIPING CAR P. SQ. FT. ® TEMP. POLE WALL SQ. FT. GROUT DRINKING FOUNTAIN. SO. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation =$ FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM VENTILATION 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 GAR. FIREWALL SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ic 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 ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM 1 GQ 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 1 BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY COUNTY OF RIVERSIDE CONSTRUCTION ESTIMATE NO. I ELECTRICAL FEES 14ZT FL SO FT I UNITS 2ND FL. POR. GAR. CAR P. WALL SO. FT. @ OWNER SO. FT. @ MOBILEHOME SVC. SO. FT. @ POWER OUTLET SOFT. @ F.C. SO. Fr. @ PE MIT NO. 272826 { I:v 1 SO. FT. @ :•. ESTIMATED CONSTRUCTION VALUATION $ CFM NOTE: Not to be used as property tax valuation f SWIM POOL, PVT MECHANICAL FEES SWIM POOL, COMM ABSORPTION SYSTEM VENT SYSTEM O FAN ❑ EVAP. COOL O HOOD SIGN FIELD OFFICE NO. PLUMBING FEES YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING FLOOR DRAIN WATER SOFTENER WASHER IAt1T01 tDI5H1 DST _J APPLIANCE .JOB ADDRESS SP NO OWNER 74 GARBAGE DISPOSAL /f q i,r, t - 2 FURNACE O UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED USE OF PERM,I - ., a/ oz, F.C. LAUNDRY TRAY PE MIT NO. 272826 AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK DST ABSORPTION SYSTEM 0 B.T.U. TEMP USE PERM SVC SUPP. TO PERMIT WATER CLOSET COMPRESSOR HP POLE, TEMP/PERM A i?, LAVATORY HEATING SYSTEM ❑ FORCED ❑ GRAVITY AMPERES SERV ENT SHOWER MICROFILM FEE BOILER B.T.U. $ SO FT @ a LEGAL DESCRIPTION BATH TUB SO FT @ a MECHANICAL FEE WATER HEATER $ SET BACK SO FT RESID @ 1¢ SEWAGE DISPOSAL GRP TYPE CK BY SO FT GARAGE @ 'ha HOUSE SEWER PERMIT FEE GAS PIPING 11 MOBILE HOME PERMIT FEE $ f PERMIT FEE .. U PERMIT FEE C'C PERMIT NO. 272826 TOTAL FEES MOB. HM.FEE MICRO FEE MECH. FEE DBL PL. CK. FEE. CONST. FEE -, . D8L. ELECT. FEE DBL. SMI FEE -. FEE PLUMB. FEE - DBL. J I F I M A I M I J I J A I $ 1 O 1 N I D .JOB ADDRESS SP NO OWNER 74 151"f - % to U RA r r& /f q i,r, t - 2 75 76 USE OF PERM,I - ., a/ oz, F.C. DATE - - PE MIT NO. 272826 M H PERMIT FEE $ COMMUNITY DST UNITS ROOMS VALUATION SUPP. TO PERMIT OFFICE ' A i?, av I MICROFILM FEE COPIES $ LEGAL DESCRIPTION N-r' .!-/f, -vv 4= s ; -AUT-- G i , `•' ,rt MECHANICAL FEE DBL $ SET BACK LOT SIZE ZZOO NNE USE NO. GRP TYPE CK BY 11 S PLAN CHECK FEE $ /w C %7 BOND AMT. PLAN NO. PLAN CHECKER I FI T INSP TOR CONSTRUCTION FEE DBL $ NAME OF CONST. LENDER BRANCH OFFICE NO LENDER PVOLVED ELECTRICAL FEE DBL $ ADDRESS CITY STATE STRONG MOTION INSTRUMENTATION FEE $ OWNER/AGENT'S SIGNATURE CONTRACTOR - '- 171) r .3e. ,/ 1j r: 7N 1 pct/ $ ADDRESS ADDRESS FEE !/ ? L ' c ,✓• C S PLUMBING FEE DBL $ CITY ZIP CODE CIT ZIP CODE 7 C , TOTAL FEES $ 1 y TEL. NO. TEL. NO. LICENSE rrri CASH Q CHECK M.O. p N.C. O , THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC RECEIVED BY TREES REQUIRED ?A— SEWAGE SYSTEM T LL P AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE I I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPAREDTHEPLANS AND SPECIFICATIONS FORM 284-208 (Rev. 10-74) @L HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. BUILDING PERMIT CONSTRUCTION ESTIMATE 1 ST FL. SQ FT. @ 413- L33 2ND FL. SQ. FT. @ 2.50 POR. 274 SQ. FT. @ 4.25 GAR. SQ. FT. @ 2.50 CAR P. SQ.FT. @ WALL SQ. FT. @ SQ. FT. 6 - ESTIMATED CONSTRUCTION VALUATION 1 $ 1 NOTE: Not to be used as property tax valuation MECHANICAL FEES VENT SYSTEM Z FAN ❑ EVAP. COOL CEJ HOOD EPARTMENT OF BUILDING & SAFE' COUNTY OF RIVERSIDE N.O. ELECTRICAL FEES 40•20 1 UNITS 1 MOBILEHOME SVC. POWER OUTLET SWIM POOL, PVT SWIM POOL, COMM SIGN FIELD OFFICE DST NI O. PLUMBING FEES I1 BOILER I I B: BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING FLOOR DRAIN WATER SOFTENER WASHER (AUTOI ISH) APPLIANCE Dryer GARBAGE DISPOSAL FURNACE Cl UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK ABSORPTION SYSTEM 0 B.T.U. TEMP USE PERM SVC WATER CLOSET COMPRESSOR HP 4 UU POLE, TEMP/PERM LAVATORY U HEATING SYSTEM 19 FORCED 0GRAVITY 4 00 AMPERES SERV ENT L UU SHOWER SQ FT @ C 1 BATH TUB Z 0 SOFT @ a 1 WATER HEATER 1 SQ FT RESID @ 1 ¢ SEWAGE DISPOSAL SQ FT GARAGE @ 'h¢ HOUSE SEWER PERlvtIT FEE TEMP ELEC SVC GAS PIPING MOBILE HOME PERMIT FEE Is PERMIT FEE PERMIT FEE P R T O. TOTAL -FEES 135.00 MOB. HM. FEE MICRO FEE MECH. FEE 14.00 DBL. PL. CK. FEE 31.00 CONST. FEE 62.00 DBL. ELECT. FEE 16. DBL. SMI FEE i.l FEE PLUMB. FEE 25.50 DBL. J I F I M A I M I -J I J I A I S O 1 N JOB ADDRESS i $P NO 51-730 Ave. Madero 1 OWNER Pacifica Western 73 —1 74 USE OF PERMIT - 31x1. & att. ralre 001 F.C. 1 DATE 1-10-74 PER T NO. n 75 M H PERMIT FEE $ COMMUNITY La Quinta DST LI UNITS ROOMS I VA AZIO 2.00 l1J SUPP. TO PERMIT MICE MICROFILM FEE COPIES $ LEGAL DESCRIPTION S Lot 5,Block 25 Santa Carnclita #2- PC 773-113-000 MECHANICAL FEE DBL $ I cg nn SETBACK LOT SIZEZONE R— l USE NO. GRP TYPE CK BY Ayers F 20155-10- R 25 PLAN CHECK FEE $ lt nn BOND AMT. PLAN NO. PLAN CHECKER FINAL DATE ' P TR KZ46—/4z CONSTRUCTION FEE DBL $ 00 -1i5 NAME OF CONST. LENDER BRANCH Bank of California OFFICE NO LENDER INVOLV96 ELECTRICAL FEE DBL $ ln ADDRESS CITY Encino STATE Calif.. SMI FEE $ THIS PERMIT SHALL BECOME VOID IF WORK 15 NOT COMMENCED WITHIN 1?O,DAYS. CESSA• TION10 OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC. CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED. 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. FEE $ PLUMBING FEE DBL $ TOTAL FEES 15 00 OWNER/AGENT'S SIGNATURE jam, . ^^dam CONTRACTOR CASH ❑ CHECK Cl M.Q. ❑ N.C. ❑ ADDRESS t ADDRESS RECEIVED BY 3 TREES REQUIRED SEWAGE SYSTEM ' T LL P CITY ZIP CODE . Tarzana CITY 21P CODE INFORMATION FORM 284-2081Rev. 9731 CS , TEL. NO. TEL. NO. LICENSE '