002095 (PLBG)Building R
Address
Mr• sf sriwhd
Mailing
Address
City Zip Te
la QO.� 92M
Contractor
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 002095
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 773-225-018
Legal Description 7 ast 8
Project Description
P.O. BAC L _
City
Zip
Tel. _
l rmi. _ in-
972-U
11.E-2747
Side Setback from Property Line
State Lic.
& Classif.. si #"'� /
'
City r
Lic. # i }
Sq. Ft. No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer -
New (�L Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
- -
-
expiration if work thereunder is suspended for 180 days.
Aa3 Systm #'2 and id3St8U i a'i+l
I City
Zip
State
I _
I agree to comply with all city and county ordinances and state laws relating to building
Lic•. # .. _.
St4
construction, and hereby authorize representatives 9f this ,city to enter the above-
LICENSED CONTRACTOR'S DECLARATION
-
1 hereby affirm that I am licensed under provisions of. Chapler,9 (commencing with Section
7000) of Division 3 of the Business and Professions Code"and'my license is in full force and
effect..
Estimated Valuation
r
SIGNATURE 0a7k"tel.✓' - .d - 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 AMOUNT
permit to construct, alter• improve, demolish; or repair any structure, ' prior to its issuance also
requires the applicant for such permit to rile a.signed statement that -he is.licensed pursuant to
j 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
I for the alleged 'exemption. Any violation of Section 7031..5 by any applicant for a. permit
i subjects the applicant'to a civil penally of not more than rive hundred dollars (8500).
I
O 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 pot 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
Plan Chk. Dep. -
.• .
Plan Chk. Bal.
_
Const.
Mech.
Electrical
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�
Plumbing 40.00
❑ 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
S. M:I. -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) .
❑ 1 am exempt under Sec..B. B. & P.C. for-lhis reason
j
Grading
Driveway Enc.
I
1. Date owner
Infrastructure
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'COMPENSATIONINSURANCE
(This section need not be completed ff 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
Date Owner
NOTICE TO APPLICANT: !f, 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.
TOTAL 40.00
REMARKS.
ZONE: BY:
Minirimum 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 Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
- 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..
Issued by:
Date i>Ks Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives 9f this ,city to enter the above-
mentioned property for inspection, purposes. r+ j.�' `f
Validated by:
j/y p'
/+*
:r��� �7 �� .f+ �� . i' _.i Date
Signature of applicant ):/'
Mailing Address ^rt • _ �;` sir. . "!. I'+"
Validation:
City, State, Zip
A44%5
3 3 40.00 (l
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTE¢,
2ND FL. SO. FT. ®
FORMS
ER O EP
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
4%
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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
ER O EP
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 SIGNATUflESIINITIALS,
GARDEN WALL FINAL
Hondrickson
•%5El(VERS GREASE TRAPS AND SEPTIC TANKS CRANE AND DOZER RENTALS
Construction, Inc. �S (�We I >' R 4-�lrJS(�
POST OFFICE BOX U ?j -e V-) S TI L
CATHEDRAL CITY, CALIF. 92234
``
Telephone (619) 328-1747 '`1s( -ern
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DIVISION OF ENVIRON
Food Establishment
Trailer Park
Motel, Apt., Hotel
Dwelling Ex 5 i3 9.214 '-' L P,-nr fftr
Commercial Buildi
Swimming Pool
xNo on -sit regenerating water softening devices r
system h rev;ith approved wit t clearance from
Water sui ply sery��c(4' iair ai [,tion must be fror
All sewag disp}sa enstaii r must conform with
Any cu`ti g, grading, or fi.•iirg in excess of four
Approval. as been obty/dq�l 1Fir4.14Z Regional Wa
age dispo
'I -his is to certiia
�z;r installation tltt
m
;al system
S-a/s'S� LiS-Pr�Moul.er'
j1aeo 50/ 5 ysM )
�.a P%, r- Tari r< -at I?
IN i • '� Q CM��_ _
rAL,�ifALTH
Sewage Disposal
Z§DL Gal. Septic Tank
Sq. t.,of Leach Line
x Seepage Pit ('l
Connection to Sewer
y be discharged into the individual sewage dipgfial
ie.Water Quality Ccntrol Board.
an ap.provsd source..( C vo-16) I
equirements of current Uniform Plumbing C641v,
feet will nullify sewage disposal approval. 1
�r Quality Control Board for installation of the,
that the Riverside County Department of Public Health approves for.oc-esrpaficy, constr C,06.n
item(s) checked above. )
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IS APPROVAL Gi Ai I i ED BY. i HE
ePftmat r�u }sEPART�1^ti�T OF PUBLIC fEALTH
Vit'verside Cou-.tp does not relieve the Engia. r:`S VALID FOR ONE (1) YEAR
_er or Architect of the responsibility for the BUSWCU- -fR'0.,`.j DATE OF APPROVAL.
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