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351332 (SFD)BUILDING PERMIT �� DEPARTMENT OF BUILDING 8 SAFETY FIELD OFFICE PERMIT NO. 3513 321 PERMIT NO. 1351332 1 COUNTY OF RIVERSIDE Space Zip Owner DST CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES -f /J �7 O+' NO. PLUMBING FEES Dist. 1ST FL. 2ND FL. POR. GAR. CAR P. ' WALL ESTIMATED CONSTRUCTION SQ. FT. Q 1A�P $ V UNITS MH Permit Fee $ Micro Film Fee Cop $ YARD SPKLR SYSTEM SQ. FT.. � ,r= SQ.. FT.. @ db � MOBILEHOME SVC. BAR SINK Parcel No. ofUse 7%3 _ 3- POWER OUTLET ROOF DRAINS SQ. FT. tai �by SQ. FT, DRAINAGE PIPING PI. Ck. Fee S DRINKING FOUNTAIN SQ. FT. Lot Size SQ. FT. URINAL Legal Description j ��- fA�y'i/ VALUATION $ 7 — � WATER PIPING S NOTE: Not to be used as property tax valuation R�lj 18WIM POOL, PVT Zone FLOOR DRAIN Type Unit MECHANICAL FEES SMI Fee $ SWIM POOL, COMM Dbl $ _ WATER SOFTENER Pions NNJo. - ` 7cs"' %e7 VENT SYSTEM ❑ FAN ❑ EVAP. COOL HOOD �.a SIGN .. WASHER IAUT044ISHI Demol. Fee $ APPLIANCE 1 DRYER "I certify that in the performance of the work for which this permit is issued I shaH not employ any penon in ony manner so as to become subject to the workmen's com• pensotion lows of California." Owner Signoture Builder Signature Tel. Zip Registr. Fee $ Mileage°Fee , $ GARBAGE DISPOSAL Total Fees FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED Address 7a -.S' - 01'Z -4.41 A,1 �% City Zip /" �tLtill .. ,. LAUNDRY TRAY Received by s AIR HANDLING UNIT CFM IDLE METER License P KITCHEN SINK Sewage System r /!/ U•✓. .//{{ - !/- X JV ABSORPTION SYSTEM 0 B.T.U. TEMP USE PERMIT SVC Workers* Comp. yes ❑ no Q WATER CLOSET L COMPRESSOR 3 Z HP POLE, TEMP/PERM LAVATORY HEATING SYSTEM FORCED ❑GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. a BATH TUB ` SQ. FT. Gn a WATER HEATER SQ. FT. RESID p 1'/.a SEWAGE DISPOSAL SQ. FT. GAR C 1/.¢' HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL.TOTAL FEES �/� 33 MOB. HM. FEE MICRO FEE MECH. FEE PL. CK. FEE CONST. FEE %a ' ELECT. FEE 30 �� ' SMI FEE a FEE PLUMB. FEE PERMIT NO. 3513 321 Supp. Permit Job Address Space Zip Owner Commu/nity � h�Q ��/ITT%••t uation 7$,.7,9 � -f /J �7 O+' Date �� -�� Dist. Off. 7— F.C. 4�� MH Permit Fee $ Micro Film Fee Cop $ Use of Permit -• � � � ,r= Parcel No. ofUse 7%3 _ 3- No. �by Mech. Fee Dbl $ PI. Ck. Fee S Set Backs Lot Size Construction Fee Dbl $ Legal Description j ��- fA�y'i/ F_ S S� R�lj :Electrical Fee Dbl $ �. Zone Grp Type Unit SMI Fee $ Plumbing Fee Dbl $ _ Bond Amt. 8 Pions NNJo. - ` 7cs"' %e7 Plan Checker .L/AL-GALf:.� F2nol Date \JA(�.//�) Inspector ✓ �' o `- .. Sp.Insp.Fee $ Demol. Fee $ Const. Lender Branch - Address City Zip Owner/Agent V4611W L "I certify that in the performance of the work for which this permit is issued I shaH not employ any penon in ony manner so as to become subject to the workmen's com• pensotion lows of California." Owner Signoture Builder Signature Tel. Zip Registr. Fee $ Mileage°Fee , $ Witness Fee $ Reinsp. Fee- $ Total Fees $ Address 7a -.S' - 01'Z -4.41 A,1 �% City Zip /" �tLtill .. ,. M.O.-❑ N.C. ❑ Cosh ❑ Check Received by s Controctor Tel. License P Trees required Sewage System r /!/ U•✓. .//{{ - !/- X JV Address City Zip Workers* Comp. yes ❑ no Q T LLP Sewer District - Form 284.208 1Rev. 4.771 OO s THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF verified by:, WORK FOR 120 DAYS SHAH Aj.SQCAU$�MIT BECOME VOID, r ' I HEREBY AGREE THAT A RrN N ITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY ANET THE STATCOF 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. P.O. BOX 1504 APPLICATION ONLY Buildingnn 78-105 CALLE ESTADO Address -5"Z' �y �� f" V IF LA QUINT.A, CALIFORNIA 92253 Owner C (D Its IL IQ. �r4 � Le Ado- 5 i lu' Mailing BUILDING: TYPE CONST. OCC. GRP. n Address Cry ( C7"0 A(JA,0 S� l� A.P. Number z Q City Zip Tel: =7,,J 1 Q c��p ( 3cf7 3 (5 7 Legal Description h0 f 9" L Contractor Project Description Address City Zip Tel. State Lic. City 8 Classif. Lic. # Si Ft' t 3 S' ( Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. 1I� w�+ L� City Zip State (> h Q � k�lc I !� Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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 Estimated Valuation 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 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 . plan Chk. De for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit p subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 17 1, as owner of the property, or my employees with wagesas their sole compensation, will Plan Chk. Bal. 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 orimprovement 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.) 1,1 I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing '- strut( 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 S.M.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 1-1 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date owner Infrastructure 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 0 Copy is filed with the city.O Certified copy is hereby furnished. TOTAL 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 lhg 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 ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you mush forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from -,Property Line „r Lender's Name Lender's Address FINAL DATE INSPECTOR 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 thal,l, have read this application and state that the above information is correct. Issued by: Date Permit 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 propel y for inspection purposes. Validated by: Signature of applicant Date Mailing Address Validation: City, 'State, Zip d _ .r APPLICANT