12069 (RPL)Building
Address 78-55955 Bottlebnush
Owner
Mark Skochil
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address ,Same
City Zip Tel.
La Quinta, Ch.92.253
Contractor
Address
p
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City ( Zip ( State
Lic. #
i
LICENSED CONTRACTOR'S DECLARATION
jI 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
yl OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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
i the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
i 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
it subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I 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.)
O 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.)
I O 1 am exempt under Sec. B. & P.C. for this,reason>''f'
�c—
� '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. (Se5„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 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 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
BUILDING: TYPE CONST
A.P. Number
I Description
Project Description `SOPA
No. 12069
OCC: GRP.-
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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:
Estimated Valuation $3000 .00
PERMIT
AMOUNT
Plan Chk: Dep.'
Plan Chk. Bal.
35.10
Const.
514.00
Mech.
24.00
Electrical
45.00
Plumbing
27.00
S.M.I.
.30
Grading
Driveway Enc.
Infrastructure
TOTAL
185.40
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
1ST FL. SO. FT. @ $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
SEWER OR SEPTIC TANK
ROUGH WIRING
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. I SO. FT. @
HEATING (FINAL)
WALL SO. FT. @
REINF. STEEL
DRINKING FOUNTAIN
SO. FT. @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
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
LUMBER GR.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP 3,v
o
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.
SQ. FT. RESID @ 1 Va c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
GAR. FIREWALL
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 PLUMBINGI�( GI
UNDERGROUN
Z 93 10
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./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE-
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
FRAMING
FINAL INSP 3,v
o
ROOFING
/�
►!�/IC^fie �% �l�i� l V
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION ! L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
NOTICE: THIS IS NOT A B* LDING PERMIT
APPLICATION TO CONSTRUCT
DEPARTMENT OF BUILDIN'G,•AP44 SAFETY
COUNTY OF RIVERSIDE
DISTRICT _
Permit No —
Job
7
1I
Owner A A rchr tcct Contractor_
Address Addres
So �Ciitiy�--
City - — - - Crty- —!
Phone n_ Phone—
(we) the undersigned, hereby certify and acknowledge. that I (we) have read the application and agree that if Curb and Gutter, and
WI
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Paving, and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building and Safety
3
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
O
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 property.
DATE ; SIGNATURE OF OWNER AND/OR AGENT' f __
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
..
[SPACE NO.
_
I USE OF STRUCTURE
JOB ADDRESS I -7
-- ---- SINGLE FAMILY DUPLEX L�
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LEG IP F R�x �.
0 J`r - APARTMENTS AGRIC. SC�
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COMMUNITY
{: ALTERATIONS C�
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N0. OF SUBMITTED PLANS __ US yOF_P RMIT
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CASE NO.
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NO. OF PARKING SPACES REQUIRED t. OF BUI N6 E7�ISTING _
Q
r"•
ZONE•ETBAC'KS: FRONT SIDE
J m
GRADING PERMIT REQUIRED? YES � NO ❑ LOT SIZE _
SETBACK ORDINANCg $k OF_ FEET REQUIRED ON _ f STREE '
DATE -"� _1t SIGNATURE OF LAND USE OFFICIAL.f
DEDICATION REQUIRED: YES ❑ NO [' NO. OF FEET
CURB AND GUTTER REQUIRED: YES ❑ NO ❑ —STREET
R-
oc
d
-
CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES ❑ NO ❑
W
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HAS AN ACCEPTABLE APPLICATION B ]DE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
CiMPROV
MENT� Y-ES NQ ❑
of
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DATE SIGNATURE OF ROAD DEPT. OFFICIAL
S
SWIMMING POOLS PUBLIC
d
SEWAGE DISPOSAL
= O
FOOD ESTABLISHMENT
Mai [ ITO W,
WATER POLLUTION REMARKS
Pn FLOOD CONTROL
cc W AIR POLLUTION
W DIV OF HWY
o a _ _ YOUR PROPERTY MAY BE SUBJECT TO
d
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199 9/74
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CANARY —FILE, PINK —APPLICANT
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