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BLDG (1638)Building Address 73-990 Owner a 4.4. 0 .. '. . . . P.O. BOX 1504 .:No. 78-105 CALLE ESTADO AMS LA QUINTA, CALIFORNIA 92253 N Mailing BUILDING: TYPE CONST. OCC: GRP. Address 79-990 Uilms Am. A.P. Number City Zip Tel. • la Quinta 92253 345-333. Legal Description Project Description `. Contractorlxm .Address. RO -425 My M City iso Zip 92291 Tel.... .. . . 392-4311. " State Lic. City & Classif. Lic. # Sq. Ft. -No. No. Dw. •Size •''- Stories • Units ..Arch., Engr., - .... Designer New © Add ❑ Alter ❑ Repair ❑. Demolition ❑ Address Tel. City Zip State _ _ .. .. _ Lic. # . LICENSED CONTRACTOR'S DECLARATION 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 isin full force -and effect.:. _ - SIGNATURE/-' DATE ' OWNER -BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Law for'the following .reason: reason: (Sec, 7031.5,Business and Professions Code: Any city or county .which requires. a, ' to construct, alter,'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-besis for the alleged exemption. Any violation or Section- 7031.5by 'any applicant fora permit - subjects -the applicant to a civil penalty of not more than live. hundred dollars ($500). ❑ 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 or property. who • EStlmated V81U8tlOn - -. - •' PERMIT AMOUNT .. ' Plan. -Chk. Dep. - Plan Chk. Bal. COnSt . _ Mech. ' 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 Electrical 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'Ucense Law does not apply to an owner of property who builds or improves thereon, and who contracts for- such projects with a contractors) licensed pursuant to the Contractor's License Law.) - D Lam exempt under Sec_ � B. & P.C. for this reason _ S.M.L. - Grading - Driveway Enc. Date Owner - Infrastyyruccture mobIC Yp� rl 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. TOTAL 7/`vi.UU CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS - (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 thg work for which 1his permit is issued, I shall not --• employ any person in any manner so as -to become subjectao 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. ZONE: —BY:. ' Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY 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.) Side Street Setback from Center Line Side Setback from. Property Line ' 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. FINAL DATE INSPECTOR 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 in purposes. Signature of applicant 1 / •. - ' " Date � �' f' Issued by- Date Permit Validated by: A Mailing Address Validation: A2013 7 19 10,00 Sl City, State, Zip HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. ® FOR. 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 I 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 APP.IEQUIP. LAUNDRY TRAY 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1'A c SEWAGE DISPOSAL / y SO.FT.GAR ® 3/<c HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE JELECT.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 APP.IEQUIP. 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 / y 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 n MOBILEHOME PARK Unj DEPARTMENT OF -BUILDING AND -SAFETY _ _ 'COUNTY OF. RIVERSIDE + MOBILEHOME INSTALLATION APPLICATION MODULAR NO M I �I INDIVIDUAL LOT' APPLICANT'S INFORMATION NAME OF PARK ��/S %%y �/�(/ �S pp � ADDRESS �5c/,9,U /LJ /lc:f x,ye d`/� (�y�wTLTELEPHONE�No.3yr= 33�/ OWNER/AGENT (2a /!//? .� ADDRESS SPACE NO. MOBILEHOME INSTALLER C.J wee ;7 - ADDRESS ADDRESS O-. y�/f /�Gt/•-y /// �Ri•�i �' TELEPHONE NO. INSTALLERS CONTRACTOR'S LICENSE N0, 9'.T P r PATE OF MANUFACTURE OF MOBILE WIDTH '/ y LENGTH (LESS HITCH) 45 NEW_L_X_RELOCATE MANUFACTURER STATE INSIGNIA MODEL/� / OR HUD LABEL: U -UNIT SERIAL' NUMBER �e (/ ROOF LIVE LOAD WIND LOAD APPLICANT APPLICANT:;f'�!"�/!� (PRINT NAME) f (SIGNATURE) PARK_ OWNER/MANAGER PARK,OWNER/MANAGER' r '(PRINT NAME) ^' (SIGNATURE) OFFICE USE ONLY 4 COMMUNITY ZONE CASE N0. LEGAL DESCRIPTION SETBACKS FRONT r. SIDE REAR . ASSESSOR PARCEL NO. SITE PREP. NO. r DATE SIGNATURE OF LAND USE OFFICIAL 284-77 (Rev. 3/82) MOBILEHOME INSTALLATION INFORMATION SHEET APPLICANT'S INFORMATION Street or Driveway n - - z m n ELEVATION W ELEVATION I I I I I I I I I � I I- �� i I MH x OR AWNING? Z MOBILE I HOME w MINIMUM a I SET71 K i --�� Gas W, ----�� Drain inletl Z LU Water I U ►' ' � Electrical) IF MH OR CARPORT? I 0 I MINIMUM SETBACK ELEVATION i ELEVATION_ A I / WIDTH Site Utility Service Notes: (a) Utility connections shall be located outside the rear 1/3 of the mobile - home within 4 feet of the left wall. (b) Show relative elevations of each cor- ner of lot or site. 1. Gas: natural X LPG Riser size 3 2, Drain Inlet: size, 3. Electrical Equipment: (a) Receptacle_ Rating (amps D (b) Connection for power supply assembly. Circuit breaker rating (amps )D _ (c) Equipment rating (amps) C Mobilehome Data 1. Size: length_ width/ �y . 2. Electrical: Power supply cord_. Ampere rating, OR power supply assembly . Ampere rating Flexible conduit size 3. Gas supply inlet: Size Gas connector, describe:_ 4. Water connector, describe: f/_ _ ,, y 5. Drain connector, describe: 7 If// e 6. Manufacturer: Model:2 VRf;.G Serial No.: State insignia numbers: X unit: _ U unit: Roof live load: p.s.f. Wind load: !,{-� p,s.f.