002136 (PLBG)Building
Address 52-330 1lreni&
Owner
4
P.O. BOX 1504 NO. 002136
78-105 CALLE ESTADO
Rio LA QUINTA, CALIFORNIA 92253•
Mailing
Address
City Zip Tel.
La 92253
Contractor
. HerASGicaus . 00_&. I=. y _
_. Address. .
Tela
92M 328".747
City
Lic. #
City. .
State Lic.
& Classif.
Arch., Engr.;' "
Designer
BUILDING: TYPE CONST." OCC: GRP." "
A.P. Number
Legal Description
Project Description
Sq. Ft.
Size
New ❑ Add C9
No.
Stories
Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑
Address
Tel.
AMcin to + .St t-* SYSteM
City
-... ..... .. _.
Zip
-. ..
State
Lic. # ..
LICENSED CONTRACTOR'S DECLARATION
5
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing'with Section
7000) of Division 3;6f the Business and Professions Code, and my license is in full force and
effecti
'
.. .. .. .. _.
SIGNATt1RE% __ r.,+•.- DATE
OWNER -BUILDER DECLARATION—Estimated
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 Me a signed statement that he � is licensed pursuant to
Valuation
- - -AMOUNT
� -PERMIT � � � � '
theprovisions of the Contractor's License. Law, Chapter;. (commencing with Section 7000) of
' Di%ision 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 rive hundred dollars'($500).'
-O 1, as owner of the property, or, my employees with wages as their sole compensation, will
'
-
-
.Plan Chk: Dep:
Plan Chk...Bal...
(✓Oust." � .
• 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
,
Mech.
•" buildsor improves thereon and who does such workhimself 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 or sale.)
Electrical '
'
Plumbing 30.
❑ 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.knproves.thereon, and who contracts for
.. .
S.M.1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
fJ Lam exempt under Sec. B. & P.C. for this reason
.
Grading
-
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
.Thereby 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
0 Copy is filed with the city. ❑ Certified copy is hereby furnished. .
TOTAL 40.00
_
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 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: it, 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.
ZONE: ' BY:
Minimum Setback Distances: - '
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 -Une
Lender's Name
Lender's Address
FINAL DATE INSPECTOR
d —�
Issued by:, Date 3Permit
_
Validated by:'
Validation:
A45'2U 3 7 4000 Ck
T,
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. �+ r
Signature of applicantl• r{ . P �� ' �'-.. �= ✓ Date
Mailing Address t ' ^"`- I=Ac J�e%
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
�.
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
FOR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP./EOUIP.
DRINKING FOUNTAIN
SO. FT. @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
v1ECH.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 SEPTI�W
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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 SIGNATUR3S/INITIALS,
GARDEN WALL FINAL
Hondrickson
SkWERS GREASE TRAPS AND SEPTIC TANKS
Construction, Inc. -
POST OFFICE BOX U gT.Q yam.
sy
CATHEDRAL CITY, CALIF. 92234
Telephone (619) 328-1747
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CRANE AND DOZER RENTALS
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FslVF-rulsmii£ COUNTY DEPARYM ENT OV PUUIG HEALTH
t
W-: DIVISION OF EIdV!FcMAENTAL HFALYH
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----- Food EsteblishmentSewage Disposal
Trailer Pak 4; :rt�,� q j
Gal. Septic Tank .
Motel, Apt., Hot e'.1 S Ft.'cf Lcac:•! Line
.,9. X .. Seel)s5e Fit
9 Connec."ic!•, to Se,,ver
n'!ay he di-:chanjurl into 1 -he <--
i. t..,, i... _... _ ,:., c:it....:.,...: fiov, .._.I Aj u';v Con.rol c_ -rd.
sr-'.�L :, .. `i }i:: Ril ...,,. ..L'rr-.nt Uniicrra Murr,b:r-o rc1-
(A) _-war;e d:c-
ayiet:ai boaterQua:ity Centro Board for instar o. r;_.: f tl:a _
acp. ,;is : l s stern.
..io ;:rtiifv tl;at i! -.c iliverside County Department of Public .Health approves for occt!pz=cy, censtrt.•c!ie
i;:sallation the item(s) checked above.
^ate `iL By
s 3
°TI
IS APPROVAL GRANTED BY THEI
;!',cc:;:IRTNIE 'T OF F. I T 1
!.:�� „!, ,ter, 'LS?LIG HEi;t_ I �
(.i S VALID FOR GIN'F (1) YEARI
tFr%OM DATE OF APPROVAL ",—J