09102 (SFD)Building
Address
Address
City
Contractor
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
54-075 Juarez
4
P.O. BOX 1504 N o . 09102
78.105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
73-625 Owy 111 SuitA-- G A.P. Number
Zip Tel.
_-qFAt 1. 92260 773-3225 Legal Description Lot 4 Block 257 Unit 24
Project Description'
Aaaevood nrive
Zip Tel.'
esart 92260 340-6807
City
81 48012:1 Lic. # 1526 Sq. Ft. 145,E No. 1 No. Dw.
Size Stories Units
Pinson Brothers New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel.
City Zip State
lv%A 4 a Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of. Chapter 9 (commencing with Section
70 00) of Division 3 of the Business and 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, 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
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 (3500).
❑ 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.)
❑ 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 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 J,.. Z owner e "'
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. .
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of thg 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
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I. -
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
3
549.50
62. CIA
127-45%
MAO
2n_no
2fl , a0
1355.59
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. 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
SLAB GRADEROUGH
FLOOR DRAIN
MECHANICAL FEES
I
I WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCTWORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® 3/ic
HOUSE SEWER
$
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 GOND. SOLAR
SETBACK/
GROUND PLUMBIN� �9 9
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEROUGH
PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER i+
ROUGH WIRING
DUCTWORK
ROCKSTORAGE
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.
plus x$
_$
LUMBER GR.
FINAL INSP. AZAI
FRAMING �/ �+ —
[
FINAL INSP.
ROOFING —�7 .-,Ip/
/l/%G1Gi/G/%`;�/„'• ��r ���j
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
/�,
LATHING � rov -P7
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Building
Address 5-4/-0
% S
L. A� Abd K !A e
M iling / A"
A�dress ��_ asp
C' Zip
no
4 -1/1-
T -,&t 4 4
"
P.O. BOX 1504. APPLICATION ONLY
7&105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC. GRP.
/ C7 A.P. Number
Tel.
3 - ? / as Legal Description 46-7—y ��� % Un i'T 4
Project Description S
. �i111l]"
State Lic. I City
& Classif. Lic. #
Arch., Engr.
Designer n S o A-&
Address �_ y, V 2rL Tel.
e j .- -;ISD Z7• / Z 1 1 (1 i
Sq. Ft.
Size
New V
No. No. DIN.
Stories % Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
Cit Zip State
Ci Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7M) t.of Division 3 of the Business and Professions Code, and my license is in full force and
effec
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuatb
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
1
permt to construct, cher. 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 (8500).
❑ 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 improvesthereon 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.)
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
0 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 License Law
S.M,I,
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 am exempt under Sec. B. ti P.C. for this reason
Grading
Driveway Enc.
Date Owner
frastructur
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. 0 Certified copy is hereby furnished.
X, O
TOTAL
r -
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 this permit is issued, I shall not
employ any parson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, alter 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
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
FINAL DATE
Side Street Setback from Center Line -
Side Setback from Property Line
INSPECTOR
Lender's Address
This is a building permit when properly tilled 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.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
.Mailing Address
Validation:
City, State, Zip
FINANCE
COUNTY,,OF .RIVERSIDE DEPARTMENT OF HEALTH A""'01 ParON NM
ENVIRONMENTAL SERVICES DIVISION
FPERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County speculations as Indicated on the attached check list
A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of
Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval.
Q VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
Z AW;_'�tt, Contractor, Contact Person Phone Address & Firm
W O_wner / Phone Mailing Address /
U) kt • wG c� [ 4�� Jf c 'pyK' S �t.I f�/ r4 CT- Y7 Cvaa SG�vI
City State Zip Job Property Address Legal Description Prop. (PM, Tract, Lot)
!Ya -+ 5�✓ �L-
'q2' uo CiGt/��ivG(G 0"X, _ f,�f d�ioc r2 :> -
Lot Size to Agenc1y/)�"(�'h Use of Permit P/P, CU, etc. �jt y F / th r
J ��.A IG r' U/A Dwelling, H Site Prep, etc. ✓N t)L At j
U
Z
O
b
rnf
CATEGORY: •-
Data
"O'
SUBSURFACE DISPOSAL
m
❑
MULTIPLE PARCELS WITHIN SAME
1238
$ 57.00
LAND DIVISION
Z
O
7349
a. fall 4 Parcels (Each)
5b.
�#
Each Parcel after 4
W
❑
Rereview (2nd review same parcel)
U)
❑
Site Evaluation in Conjunction with
SEWE 1�OPTf- VERIFICATION
7348
Critical Area
1238
❑
She Evaluation Lot Less than
A L an 1 year)
Other ,
10,000 Sq. Ft.
U
Z
O
b
rnf
°
Data
Holding Tank Agreements Completed
REV CODE FEE
0 No /ii>MJ R
' CATEGORY:
REV CODE FEE
1238
$ 57.00
WQCBCIearsnoe required. (Attach Form
❑ SITE EVALUATION UPON REQUEST
7349
$ 43.00
DOH SAN 007, Santa Ana Region Only)
�#
(NO-P_L10T PLAN)
4 Solis Percolation Report Required.
❑ Yes
oy No
Special Feasibility Boring Report Required.
SEWE 1�OPTf- VERIFICATION
7348
&�7x�l
1238
$ 57.00
No
A L an 1 year)
Other ,
❑ Yes
7344
$ 24.00
Staff Specialist Lot Inspection Requiredf
❑ PRELIMINARY ELECTIVE
7352
$ 23.00
7344
$ 24.00
j lot I Date
EVALUATION (Attach DOH SAN 53)
Solis boring report by 'f �f'
/
-
❑ HOLDING TANK
7351
$ 47.00
7348
$111.00
/ Dam
❑ ALTERNATIVE/EXPERIMENTAL
7345
$222.00
No. �ng Units
(1) Septic Tank
Soil Rate
SYSTEM
❑ New �Repbcerner t
7347
$ 87.00
Grease Inn cp
(2) Leech Line Sq. FL
Bottom trench area
Leschlines/bed special design for
Applicable
N/A Overburden _
No. 2. System
REMARKS:
Sidewall alk>wance�`
ft. rock/ sq. ft
per running ft
❑ NA
(3) Pit Diameter
❑ 5 ❑ 6
Install Line(s) It long n wide with I Lesch Bed sq. tL
min. inches rock below drainlines or of bottom area
No. Pita I Pit BebM
Inlet (BI)
Seepage Pit Total Depth I Other.
'Max. Allows is Depth
���,,fi
0 This application is PPROVED ENIED for the category chgtAted in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompan plot n, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Z above -designed system. No constriction is permitted in the required reserved 100% expansion area.
O:' (1.) Septic tank and sewer lines must be 50' minimum from any wells
(2) , Leach lines must be 100' minimum from any wells, including expansion area
CO ' , (3) Seepage pits must be 150' minimum from any wells, including expansion area
^} Health Official ///fir /7 --Date-
9� issued BY :.2. Date
4erside, [B` to . ❑ . Hemet 13 Perris ❑ .Rancho Calif. ❑ Blythe
i . DISTRIBUTION: wHrrE - 011ioe lib YELLOW Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
s -
INITIAL
DATE
Holding Tank Agreements Completed
❑ Yes
0 No /ii>MJ R
/ q
Certification of Existing S.D. System Required "` ;" ❑ Yes
No
WQCBCIearsnoe required. (Attach Form
❑ Yes
+ No
DOH SAN 007, Santa Ana Region Only)
4 Solis Percolation Report Required.
❑ Yes
oy No
Special Feasibility Boring Report Required.
❑ Yes
fJ No
Detailed Contour Plot Plans Required (1 to 5 R interval)
❑ Yesliii
No
Other ,
❑ Yes
+ No
Staff Specialist Lot Inspection Requiredf
❑Yea
No
j lot I Date
Solis boring report by 'f �f'
/
-
Project t Data
Soils Map Page Sol Type
Approved by
/ Dam
No. of Systems
Type of Sy�ism(s)
❑ Holding Ten ❑ Existing
No. �ng Units
(1) Septic Tank
Soil Rate
Greaee/Sand
❑ New �Repbcerner t
B drooms, Fixture
`
Units
Grease Inn cp
(2) Leech Line Sq. FL
Bottom trench area
Leschlines/bed special design for
Applicable
N/A Overburden _
No. 2. System
REMARKS:
Sidewall alk>wance�`
ft. rock/ sq. ft
per running ft
❑ NA
(3) Pit Diameter
❑ 5 ❑ 6
Install Line(s) It long n wide with I Lesch Bed sq. tL
min. inches rock below drainlines or of bottom area
No. Pita I Pit BebM
Inlet (BI)
Seepage Pit Total Depth I Other.
'Max. Allows is Depth
���,,fi
0 This application is PPROVED ENIED for the category chgtAted in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompan plot n, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Z above -designed system. No constriction is permitted in the required reserved 100% expansion area.
O:' (1.) Septic tank and sewer lines must be 50' minimum from any wells
(2) , Leach lines must be 100' minimum from any wells, including expansion area
CO ' , (3) Seepage pits must be 150' minimum from any wells, including expansion area
^} Health Official ///fir /7 --Date-
9� issued BY :.2. Date
4erside, [B` to . ❑ . Hemet 13 Perris ❑ .Rancho Calif. ❑ Blythe
i . DISTRIBUTION: wHrrE - 011ioe lib YELLOW Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
s -
OR
OFFICE OF
lr _ AGRICULTURAL COMMISSIONER
e
•;' � AND
WEIGHTS & MEASURES CALVIN C. KAMINSKAS
,LAMES O. WALLACE 4080 LEMON STREET, ROOM 19 Asshlanl Commisslonor
Agricultural Commissioner RIVERSIDE, CALIFORNIA 92501 CLEMENT BENVENISiE
Director of Weights h Measures (714) 787-2561 Sealer
49613 Highway 86, Suite B12
Coachella, Ca. 92236
(619) 342-8291
DATE /� �� �u, CASE NO. ?C- -j S 12 \ Z j a
DEVELOPER'S NAME: �Q ,�fspace K: o r� f•cf - :w, �c.Gcs:
ADDRESS :
f �C
• f
TELEPHONE: (6(q 773--3 5-
L04
-
LO -1 y 19/0 C --/C /6 0.1 � /.,y L` /3/--/c ?S-7
Dear Developer:
After reviewing your landscaping plans; all plant material listed is not in
violation of quarantine laws.governing the Coachella Valley. If substitutions
do occur and.they differ from plant material listed, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
Agr' t Ialt C ssione s Of ice
cc: Indio and Riverside Office
I
Building
Address
Owner
44
P.O. BOX 1504 No. 09331
78-105 CALLE ESTADO
kRF? LA QUINTA, CALIFORNIA 92253
CityZip Tel.
PALM DESURT 92260? 773-3126
Contractor
Address
City lZip Tel.:
State Lic. City
& Classif. 606486 Lic. # 1833
Arch., Engr., Y
Designer j
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)0f Division 3 of the Business and Professions Code, and my license is in full force and
Af
effect
y -0- b` �+- /1 .r 4
SIGNATURF"�•-_11'- ='t1` w" _. _�,r �-�' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. .703 1. 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
the, provisions of the Contractor's License Law, Chapter 9 (commencing with Section. 7000) of,
Division Sof 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 ($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 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.)
❑ I 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
:i
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 thg 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. �� f�
Date / • s�. Owner - !:.J 4�-ii� " �
NOTICE TO' -APPLICANT: O;_eNe`r`inakln'9""thisCafet '•tion fd`"bec'bine
r' 9 P you-sAvu
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
i
CONSTRUCTION LENDING AGENCY
4
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. ..40M OCC: GRP.
A.P. Number
Legal Description
Project Description
Sq. Ft. i�5� No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
n
;'NOTE.-' How
.i
contractor
Minimum Setback
Distances:
Front Setback from Center Line
Estimated Valuation
$79,728.00
PERMIT
AMOUNT
Plan Chk. Dep.
Side Setback from Property Line
Plan Chk. Bal
FINAL DATE
Const.
Issued by:
Mech.
Validated by:
Electrical
Plumbing
S.M.I. -
Grading
Driveway Enc.
Infrastructure
TOTAL
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. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS j
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WAIER 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./EQUIP.
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
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/e 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
ROCKSTORAGE
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
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
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL