001658 (BLCK)4 6(4P QUM&
P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address 54"360 A`� J11W= LA QUINTA, CALIFORNIA 92253
Owner
mblat J. vaiayla
Mailing
Address 54.30 Aveai& wtw=
City Zip Tel.
Contractor
Address ..
State Lie.
& Classif.
Arch., Engr.,
Designer
Address
jZip "I Tel.
—Ly
Lie. #
Tel.
001 658
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number
Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
City ]ZIP State
Lie. #
LICENSED CONTRACTOR'S DECLARATION Pik17Y7it to =15trace. block l
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.
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
i.'
permit o construct, alter, improve, demolish, or repair any structure, prior to its issuancalso
requires the applicant for such permit to file a signed. statement that he • is licensed pursueant to
Estimated Valuation
00.
'
-
.. .- PERMIT '
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 or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).'
IJ I, as owner of the property, or my employees with wages as theit sole compensation, will _
do the work, and the structure is not intended or offered for sale. (Sec: 7644,'Buisness'and
. Professions Code: The Contractor's License Law does not apply to an owner of property, who
-
Plan Chk. Dep.
-
Plan MAW.
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 .
-
or improvement is sold within one year of completion, the owner -builder will have the burdenElectrical
of proving that he did not build or improve for the purpose of sale.) .
Plumbing
O 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
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. & P.C. for this reason
Grading
Driveway Enc.
[,,
`S Date '• Owner °n j x�j A . A` Er i*I •'-�
Infrastructure
r
WORKERS' COMPENSATION DECLARATION
1 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
q Copy is filed with the city. , p Certified copy is hereby furnished..
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred'dollars (8100) valuation
AMOUNT
AA -r.^
•JV
REMARKS
or less.)
I certify that in the performance of the work for which this permit is issued, l 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
HARD COPY
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:
—
A 2 1 9. ( .8 .. ..5
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SO. 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.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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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 PLUMBI;TGG-1
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRACE
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
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
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
OWNER -BUILDER VERIFICATION
Address
An "owner -builder" building permit has been applied for in your name and bearing
your• .s.ignature.
Please complete and return this information in the envelope provided at your
earliest opportunity to avoid unnecessary delay in processing and issuing your
.building permit. No building permit will be issued unt.il.this verification is
received.
1. I personally plan to provide the major labor and materials for 'con-
struction of the proposed property improvement (yes or no) -
2.
o)•2. I (have/have not)( � n.0P signed an application for building permit
for the proposed work.
3. I have contracted with the following person (firm) to provide the pro -
posed construction:
Name Phone: -
Address City
Contractors License No.
4. I plan to provide portions of the work, but I have'h'ired' the following
person to coordinate, supervise, and provide the major work:
Name Phone
Address City
Contractors License No.
5. I will provide some of the work but I have contracted.(hired) the fol-
lowing persons to provide the work indicated:
Name Address Phone Type of work
Signature Property1Ownetr] �� Date
` I(0�'i.y
Social Security Number
284-2002 7/80
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
OWNER -BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder
of the property improvements specified.
For your protection you should be aware that as owner -builder you are the responsible party of re-
cord on such a permit. Building permits are not required to be signed by property owners unless
they are personally performing their own work. If your work is being performed by someone other
than yourself, you may protect yourself from possible liability if that person applies for the pro-
per permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and, where
required, to have a business license from the city or county. They are also required by law to put
their license number on all permits for which they apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract,
you should be aware of the following information for your benefit and protection.
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is $200 or more for the entire project, and such persons are
not licensed as contractors or subcontractors, then you may be an employer.
If you are an employer, you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding, federal
social security taxes, workers' compensation insurance, disability insurance costs, and unemploy-
ment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law, contact the Internal Revenue
Service (and, if you wish, the U.S. Small Business Administration). For more specific information
about your obligations under state law, contact the Department of Benefit Payments and the Division
of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed
to perform their work personally or through their own employees, without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "owner -
builder" building permit, erroneously implying that the property owner is providing his or her own
labor and material personally. Building permits are not required to be signed by property owners
unless they are performing their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street, -Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that
you are aware of these matters. The building permit will not°be issued until the verification is
returned.
Sincerely,
DEPARTMENT OF BUILDING AND SAFETY
Leopoldo Rojo, Jr.
Director
284-2001 7/80
NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT
APPLICATION TO CONSTRUCT Permit No
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
Owner Architect —_ _ Contractor_—_
Address - Address___— Address -
ddress_Cit
Ci t-r� � -- __ City__._._ —
Phone—
Phone Phone _
cc
W
I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
Z
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 (w have
compliedwithall laws of//the County of Riverside and the State of California governing said property.
�__I__._—_—
DATE ` SIGNATURE OF OWNER AND/OR AGENT
Approval by Signature from the Following Departments Listed Below
Must Be Obtained Prior to the Issuing of a Construction Permit.
(SPACE NO.
�� _ USE OF STRUCTURE
��6' �� I Z
}
JOB ADDRESS vv
4 - SINGLE FAMILY DUPLEX
LEGAL DESCRIPTIO OF PROPERTY 33
H
_7_�
Z---- - APARTMENTS AGRIC.
' ` z S C i�� L N o °Z
O
N Q
(SSM s2 _�
— -- COMMERCIAL E) INDUSTRIAL n
� J(4r
'^
CCALTERATIONS
COMMUNITY .
n
Z
NO. OF SUBMITTED PLANS _ USE OF PERMIT
UA a .
S�-�,�eb r-, .' e
CASE NO. -
CA
-- ?lee
p Z
NO. OF ARKING SPACES REQUIRED .— NO. OF BUILDINGS NOW EXISTING -
Q
ZONE f SETBA(fKS: FRONT SIDE REAR
J
m
GRADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE
SETBACK ORDINANCE # OF FEET REQUIRED ON STREET
DATE $� SIGNATURE OF LAND USE OFFICIAL�� ✓ -_
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET_
,;CURB AND GUTTER REQUIRED: YES ❑ NO ❑ STREET
Q 9 .
o, ..•
"CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES [I NO ❑
W ;o"
...
r HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
Q
IMPROVEMENT? YES ❑ NO ❑
O
°L
DATE SIGNATURE OF ROAD DEPT. OFFICIAI
=
SWIMMING POOLS PUBLIC
QW
SEWAGE DISPOSAL
_
FOOD ESTABLISHMENT
WATER POLLUTION REMARKS
rn FLOOD CONTROL
F
W AIR POLLUTION
_ DIV OF HWY
II -
0 a — YOUR PROPERTY MAY BE SUBJECT TO
o.
c FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
APPLICANT NAME (L. F, M 1
el 71
ADDRESS
ti —
CITY/COMMUNITY STATE/ZI"
l
JOB SITE ADDRESS/SPA
U
e
CITY/COMMUNIT /STATE/ZIP
BOK
PAG
PRC
C
TWA,
PING
SE
S
TRACT LOT
TRACT NAME
MOD
•�
'
OWNER NAME (L. F, MI)
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC a
ARC/ENG FIRM NAME
-
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC a
USE OF PERMIT
BL
ZON
.i
FSB
SSB
SSB
RSB
OF
ZONE ORD a
I LOT SZ
11
END
- _ SID J
APPI/PRMT a PS DATE 4 0010,01
r
el 71
TFEEL
IN; f EC:1UR'S G(JNY
n —19
FORM 284-208.(2/81)..
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICALAPPR OVALS
1
Set Back
33
Ventilation System
2
Figs 8 Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42 Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T. 0.
°o
ADDITIONAL INFORMATION
-- ---------
SEWAGE SYSTEM SIZE &. LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION
Thick
R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
..PLUMBING -APPROVALS -------------------------------------------
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test '
25 Final
Tank Pit L. Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/L
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
i �J STREET NAME
.FPERMIT APPLICATION
County
of Riverside
Department of
Building and Safety
4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 Witate Street
227 North '0" Street 46-209 Oasis St. Rm. 310 160 N. Broadway
Riverside. CA 92501 Banning. CA 92220 Hemet. CA 92343
Perris, CA 92370 Indio. CA 92201 Blythe, CA 92225
Ph: 787.6146 Ph: 849.1312 Ph: 658.4464
Ph: 657.3898 Ph: 342-8271 Ph: 922-2670
This permit becomes void if work not commenced within 180 days from date of issuance. OR, it work
has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the
with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
permit is for one hundred ($100) or less. I certify that in the performance of the work for which this permit is issued. I
6 MOD
shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California.
License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the following
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be
deemed revoked.
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
DIVISION OF INDUSTRIAL SAFETY, PERMIT CERTIFICATION:
signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing
❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend. will be
with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2. Grp 2. Art 2, Sec 341, Title 8.
penalty ol'not more than five hundred dollars ($500).):
C.A.C.)
� I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
Y
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial
Safety, as noted above, unless such person has a permit to do such work from that division.
is not intended or offered for sale (Sec. 7041, Business 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
Division of Industrial Safety Permit No.
his own employees. provided that such improvements are not intended or offered for safe. If, however, the building or
Date Applicant
improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not
-RSB
build or improve for the purpose of sale.).
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, Civ. C.).
PI, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 1044.
Lender's Name
siness 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
Lender's Address
License Law.). -
I certify that I have read this application and state that the above information is correct. 1 agree to comply with all
0 1 am exempt under Sec. B. 8 P.C. (Attach Certificate),
city and county ordinances and state laws relating to building construction, and hereby authorize representatives of
this county to enter upon the above-mentioned property for inspection purposes.
Date � Owner
_
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a
Signature of Applicant or Agent Date
certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab. C.).
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and slate that the
'
information given is correct. I agree to comply with all state laws and county ordinances relating to building con -
Policy No. Company
struction. and authorize a representative of the County of Riverside, Department of Building and Safety to enter upon
_
❑ Certified copy is hereby Iurnished.
the property for which) have applied for this permit for the purpose of making inspections.
❑ Certified copy is filed with'the County Building Inspection Department or County �,` Department.
Signature of Applicant or Agent Date
`
Date Applicant!^• • .
_ 1 „r ---`-
Print Applicant/Agent Name
APPLICANT NAME (L, F. MI)
ADDRES.514S
CITY/C(-i NIT /STATE/ZIP .... �.
JOB SITE ADDRESS/SPACE
—-G L
CITY/COMMUNITY/STATE/ZIP"/• -
I;n
BOK
PAGPRC
C
RNG
SE
S
TIgj `
LIT
6 MOD
ASSESSOR C Y TOTAL
FEE
.
TRACT NAME
OWNER NAME (L, F. MI) '
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE X
LICNC M -
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP ,
t
PHONE ft
LICNC q
USE OF PERMIT t _
BL
ZON
1
FSB
SSB
SSB
-RSB
OFC
ZONE ORD It
LOT SZ
END
E
APPL/PRMT q PS IcT_ •DATE O O A 0 0
j
�- 49
ASSESSOR C Y TOTAL
FEE
.
�.
--------------
t7
c2l'a 4
0
Xti