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BLDG (0402-072)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 Date Signature of Contractor 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:Cfor this reason, Date 11, i . v' Signature of OwnW 6 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. ( ) I 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: Carrier Policy No. (Thissection need not be completed if the permit valuation is for $100.00 or less). (,X) I certify that in the performance of the work for which this permit is issued, I1'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 fVhwith comply w}th,th • se provisions-•- 'Date: / • Applicant 4 C.t A A Ts 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, indemnity & 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 authdrize representatives of this City to enter upon the above-mentioned property/for inspection purposes. Signature (Owner/Agent) r`f °-t Date ` f _ .� BUILUIN PERMIT PERMIT# 0402,672 DATE 02Ia�. VALUATIOND ►amw+fJ� LOT TRACTJOB SITE ADDRESS -860t�V%_N1:�9.��' EN�DO�� APN OWNER CONTRACTOR / DESIGNER / EN (NEER JUAN & C_P1Z kT_ '.C'0XSLCA. OV ER. - 33i RDE, 2. ;52�•2s �Q,�'�P�:E+d?:fJt'�.A1.ff�,lF1�U L14, QL 11111I -A CA. 92253 USE OF PERMIT O FN71. R L BU I MIG 'JOU 6' GARUI: H W AL.n. PFAZ CITY S'I'A14DJ1RD fiJON0 CLY.e R P.R.t7PI"RTY C P7, iifALI, 30.00 LF E;9i'l...€tA2'.ED COST OF COMVIR CIT.O.K CONO•l RUCTION VEK 101.000-418a000 A\ FEB 091004 CITY OF LA QUINTA FINANCE DEPT. sL q� -'SAI, -CC"NM'I,t.UC`T�.E31v 1 9 ,PJ kll. C;fiI:CK V1.00 LESE3 Pi •-'ATD PKET;;S $0.00 ':ir'MA.'9., il':L+'.��:ou FEES VUE l` (Y Si .00 Af RECEIPT DATE,,/ B� o DAT INALED2- INSPE l� 7ez O 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 BacksElectric 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 OX 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: l'. • {1 Vii. _i'te_.Ree�t�rr ents for: C6p'f OF L QUII�� BUILDING & SAFETY DEPT. PPROVED Fencing. Requirements �- O CONSTRUCTI N umgintrnrnsn,r.,n DATE MOR SIDE YARDS- . f, must be completely enclosed and screened by a Five (5) Foot High e . View -obscuring fence or wall. € CHAIN-LINK FENCING R IS PROHIBITED. e • s t f_ Minimum Required t t. Fencin Fences and walls can be a maximum of 'Five (5) feet high f .n.dnraun�68m, in the Front and, Street Sideyards, Six (6) feet high in the Rear and i Interior Sideyard i i t . i All fences a.nd•walls must.be �. maintained in good repair. '2D• OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as" ''Owner/ Builder" you are the responsible party of record on such a r permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. V If you are an employer, you must register with the State and Federal Government as an employer -and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale-, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing 'their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly.yours, ., CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 7012 (7VQ777-7011 ! ` ✓' OWNER'S SIGNATU /DATE PROPERTY ADDRESS PERMIT NUMBER(s) Building Address 52— Owner {r%uan Mailing Address 52_86£ Mendoz City Zip La Quinta, CA 322 Contractor Owner/Bu11der Address. ME T4tyl I Z�hGIG�G!/ P.O. BOX 1504 No. 1,1732 78-105 CAL' LE ESTADO LA QUINTA, CALIFORNIA 92253 .firmer. Fonseca BUILDING: TYPE CONST.. OCC: GRP. A.P. Number Tel. 971-1942 ILegal Description Project Description LP,- f? 00� State Lia City Minimum Setback Distances: & Classif. Lic. # Sq. Ft. No. No. Dw. Side Street Setback from Center Line Size . Stories Units Arch., Engr., _ -. FINAL DATE INSPECTOR Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. Validation: 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 :a — effect. i,, ; •. SIGNATURE DATE ' OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the, following Estimated Valuation $1,000.04) reason: (Sec.- 7031.5,Business and Professions Code: Any city or county which requires a permit toalter, Improve, demolish, or repair any structure, prior to its issuance also thconstruct, requires e 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--' r 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).• Plan Chk. Bal. O 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 Const. �} �� 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, 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 th�,projecL (Sec. 7044, • Business and Professions Code: The. Contractor's License Law does not apply to an owner or property who builds or improves thereon, and who contracts.for such projects with a contractor(s) licensed pursuant,tp the Contractor's License Law.) ,� S.M.I: \m exe pt 1 1' , Grading ❑ 1 under Sec. B, & P.C. for this reason Y t Driveway Enc. /--•t}T4 • Date' L- �a - 5 '� •--�. owVr, ;Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of 1 Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company � -r. ' jf rx (Mk# �� S t� 41 ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. .� ,51} TOTAL 30-00 CERTIFICATE OF EXEMPTION. FROM REMARKS 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 tha 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. city to 'enter the -above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip 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. ® 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 WATER SOFTENER VENT SYSTEM FAN EVAP.000L 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 BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ic HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE PERMIT FEE I PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE. CONST. FEE ELECT. FEE -F- 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. $ 1 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 3131q CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Building Address Mailing ' Address 52-860 ;iter City lZip Contractor 17x. Rooter Plumb Address T4hf 4 �wQ�rw P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Palm Desert 92260 779-0190 State Lic. City BY.Classif. 610457 Lic. pl l!5a2 Designer Address CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am -licensed under provisions of Chapter 9 (commencing with Seclion 7000) of Division 3 of the Business aV 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, 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 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 (5500). ❑ 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, 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.) ❑ 1, 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 ,;kCopy 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 provisions of the Labor Code, you must forthwith comply with such provisions or this permit 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 stale 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 No. 11589 1 % I., BUILDING: TYPE CONST. - OCC: GRP. A.P. Number Legal Description Project Description gPwP.r c.-nnT),ert Sq. Ft. Size No. No. Dw. Stories Units New ❑ -Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation �2,eo�.Ofl PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const.. 30.01 } Mech. Electrical Plumbing S.M.I. . Grading Driveway Enc. Infrastructure 11) 00ti TOTAL 30.00 REMARKS. 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 IST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SQ, FT, ® CAR P. SQ. FT. WALL SO. FT. ® SQ, 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 APPJEQUIP. 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 BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/. c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac 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�9LrT19�AD1K`// [ 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. $ 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 -& 9� CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL c� a O yaj 0:o O >- Z LL J a N m ad 0 Z z~ za A u' J a APPLICATION FOR TREE PLANTING Job 925-21 I (we), the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if trees are required under River. side 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. Owner's Name W & H BUILDERS Building Permit Na. 3 Mailing Address 12540 Palm Dr P 0 Box 818 Desek�ty Hot Springs state Ca zip 92240 Job Address 52860 Avenida Mendoza community La Quinta Legal Description Lot 20 Blk 147 Unit 15 Santa Carmelita at Vale Assessors Map, Book & Page .% —3 C-704� -7-Type Structure Type of Soil sand Is water available Yes Road Dept. Plot Plan No. Type of existing trees in road right—of—way Trees preferred by applicant (1) Olive (2) Palo Verde 4 -m-Brazilian Pepper Date 9 Feb 1979 Owner's Signature Planning Commission Case No. PERRY C. OBERTSON ROAD DEPARTMENT APPROVAL Approved species Olea europaea (Olive) Number of trees 1 Spacing of trees Distance from lot lines: Front 2' in R/W Side Additional requirements Per plot plan on reverse. r Date Building and Safety notified 5/79 Signature REQUEST FOR EXCEPTION Reason Request for hearing: YES ❑ (attach additional page if necessary) Owner's Signature (Forward application to Planning Dept. if exception requested) NO REQUEST FOR HEARING Planning Dept. Concur ❑ ' Non -concur ❑ Explanation D ate 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 Building & Safety notified Signature NOTICE: THIS IS NOT 'A BUILDING PERMIT APPLICATION TO CONSTRUCT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF RIVERSIDE DISTRICT Permit No Job 92,5 -?l , tI, k 1�. r 284 199 - 9/74 CANARY—FILE, PINK—APPLICANT li K tit) i AN11 k Owner Ar bbi ect Cg r�StQr 2i! M IM F U X Viv i SSIIU nDr Addres d ess Addr s •� , 92 ire, a SP —10 10 City ^ •+ City City_ Phone Ph Me Phone C W 1 (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and Z Paving, and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building and Safety 3 O 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 property to -be occupied until/I (we) have complied with all laws of the County of Riverside and the State of California governing said propertyi;� r�• Feb 1979;,SIGNATURE �•�'�9 �' �f DATE OF OWNER AND/OR AGENT -�r'�r-''.—"� �alty Approval by Signature from the Following Departments Listed Below f Must Be Obtained Prior to the Issuing of a Construction Permit. I SPACE NO. 52860 Ave—niw Mendoza 1 USE OFSTRUCTURE JOB ADDRESS I SINGLE FAMILY F DUPLEX �j �� , �W LEGAL ,j.CT6T(2WF PR?P%y1 — APARTMENTS 0 AGRIC. lUlii3i H .4 COMMERCIAL E] INDUSTRIAL C Z COMMUNITY ALTERATIONS CJ NO. OF SUBMITTED PLANS--_— USE OF PERMIT N Q i CASE N0. p Z.' NO. OF PARKING SPACES REQUIRED NO. OF BUILDINGS NOW EXISTING Q ZONE ' 61 } SETBACKS: FRONT SIDE �' REAR �^ m GRADING PERMIT REQUIRED? YES ❑' NO ❑ LOT SIZE j SETBACK ORDINANCE # -- OF r FEET REQUIRED ON rl STREET DATE — r SIGNATURE1OF LAND USE OFFICIAL `A _311 _ 3 Z DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET— f Li. ? CURB AND GUTTER REQUIRED; YES ❑ NO ❑ l /< t I .t� ---- -- STREET � , � H oc . a CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑ HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET CIMPROVEMENT? YES 4—NO ❑ SIGNATURE O, ROAD DEPT. OFFICIAL2( L,��r�t rt W SEWAGE DISPOSAL .vo .®"' %� _ AeAG ` _ J NT Al WATER POLLUTION REMARKS �n FLOOD CONTROL z AIR POLLUTION � W �. = I-- DIV OF HWY :. I- 0 a — YOUR PROPERTY MAY BE SUBJECT TO o FLOOD. RIVERSIDE COUNTY ASSUMES "'NO RESPONSIBILITY IN EVENT OF FLOOD. 284 199 - 9/74 CANARY—FILE, PINK—APPLICANT