232270 (SFD)BUILDING PERMIT
DEPARTMENT OF BUILDING & SAFETY FIELD OFFICLI
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMAj.Erp.�
ELECTRICAL rEE.S.,
I PLUMBING FEES , DST
I ST FL. SQ. FT:
2ND FL.
SQ. FT.
POR . S6. FT. MOTOR I OR LESS H.P.
.0 do SQ.FT. @ 4 MOTOR 5 OR LESS H.P.
GAR. c5_
CAR P*. SQ". FT. @
tT MOTOR 20 OR LESS H.P. DRAINAGE PIPING
WALL SQ.FT. @
DRINKING FOUNTAIN
FT. @
URINAL
ESTIMATED CONSTRUCTION VALUATION 30 P—e- OK.W. UNITS WATER PIPING 51>
NOTE: Not to be used as property tax 'voluotion
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM 45FAN Cl EVAP. COOL '2) HOOD
SIGN WASHER (AUT(V(DISH) CJ7 90
APPLIANCE
TRANS -...
FORMER K.W. GARBAGE DISPOSAL
FURNACE 0 UNIT CIWALL" OFLO011 0 SUSPENDED
OUTLETS LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIXTURE OR SOCKET KITCHEN SINK
GAS PIPE ONATURAL_ OL.P.G. 0 OIL
CONST. SERV. ENTRANCE WATER CLOSET
COMPRESSOR HP
POLE LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT. 0 SHOWER
ABSORPTION SYSTEM B.T.U.
SO. FT. @ Q BATH TUB
INCINERATOR 0 DOMESTIC 0 INDUS. OR COMM.
SO. FT. @ 4 WATER HEATER
HEATING SYSTEM g.FORCED 0 GRAVITY
—;SQ. FT. RESiD. @(.Q 7,,
) SEWAGE DISPOSAL 2e 00
BOILER O B.T.U.
SO. -FT. GARAGE @1/,4,2 HOUSE SEWER
PERMIT FEE
00 BALANCE OF MIN. FEE GAS PIPING
-MOBILE HOME HOOKUP FEE 1$
PERMIT FEE PERMIT FEE
23"I"ce. 7
TOTAL F;?
MOB. HK. FEE MI
EC FEE I
-Im
DBL: PL.
CONST. FEE
DB$ELECTO
E, B FEE.
r
FEE PLUMB. FEE
JDBL
7
J ! F I M A .1 M 1. J I -J A I S 1 0 1 N I D-
JOBADDRESS
OWNER
73
74
USE OF BUILDING
F.C.
ATE
% R MK 21
0
27(
75
M.H. HOOKUP FEE
COMMUNITV.
DST
ROOMS VALUATION
SUPP. To PERMIT OFFICE
I 1,��j
MICROFILM*FEE -
COPIES'
$
LEGAL DESCRIPTION.
MECHANICAL FEE
DBL
$
SET BACK
OT SIZE L
ZONE
USE NO.
GRP
TYPE.
I 'CK BY,
12A
PLAN CHECK FEE -
BOND AMT.•
..I
PLANN0.
I
PLAN CHECKER
FINAL DATE. INSPECT
PR
0
CONSTRUCTION FEE
DBL'
. $.
NAME OF CONST. LENDER r BRANCH OFFICE
ER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY, STATE
/10 K.
a
SMI FEE
$
7THISPERMIT SHALL BECOME V I OID IF WORK IS NOT,40MMENCED.WITHIN 60 DAYS. CESSA-,
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT -TO BECOME VOID.
FEE'.$
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
PLUMBING FEE
DBL
1$ -7
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 V_P DT E PL S&�SP CIF JFATIONS
TOTAL FEES
0
HAS DONE SO IN ACCORD ANCE5
DONEWITH SECTION 01 A !QnSSIONS
{5`54-T/-0
—Z
CODE STATE OF CALIFORNIA. A,
CASH 0 CHECK ♦ M.O. O'' N.C. 0
OWNER,
CONTRACTOR
RECEIVED BY
ADDRESS
ADDRESS
SEWAGE -IT—
LL-
P
CITY
CITY
TREES REQUIRED
Y . ES
NO
.-INFORMATION
TEL. NO.
TEL. NV. LICENSE
Illy
FORM 284.208 IRev 11/72)
Building
Owner
f
Address
City ,
7J:.
T4bt 4 4v Q"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Zip(, Tel.
:`/ r/ AF / j �✓
i
Contractor
EL t . 't irk Af s A -,,7
Address
City . Zip � � ,7 �.� Tel:
State LicJ City
& ClassifLic. #
Arch., Engr.,
Designer
Address Tel.
City I Zip I State
Lic. # c
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. �,✓'' ,r' , �# � 't,r .� i "' � : K l
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8uskness 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 pemrft to file a signed statement that he is licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 or 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 civril penally ornot more than rive 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 Contractors License Law does not apply to an owner of properly 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 win have the burden
or proving that he did not build or improve for the purpose or 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 Contractors License Law
does not apply to an owner or property who bunds 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
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company 4--f— t' I l
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
1 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
aliforniaDateOwner
NOTICE TO APPLICANT: H, 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 perm 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
Lenders 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
No. 05400
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number Alt
,Legal Description
7 tri r:
Project Description �L, ! ' L+ 17t —41
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 2 5
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.f;"
G3
Mech.
Electrical
Plumbing
S.M.I.
f
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
"•#s
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 SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. 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 APP.IEOUIP.
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Y4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
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 APP.IEOUIP.
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.
OOFING .�
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINI H GRADING
SPECTIONj
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL