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215665 (SATT)BUILDING PERMIT CONSTRUCTION ESTIM —� 4V5 SIGN 1ST FL. r/j0 SQ. FT. @ 2ND FL. SQ. FT. @ POR. 5V U SQ. FT. @ GAR. SQ. FT. @ CAR P. SQ. FT. @ WALL SQ. FT. @ FEING SQ. FT. @ ESTIMATED VALUATION $ C MECHANICAL FEES DEPARTMENT OF BUILDING & SAFET COUNTY OF RIVERSIDE E O ELECTRICAL FEES ,:,7 NO. I I I I NO. MOTOR 1 OR LESS H.P. MOTOR 5 OR LESS H.P. MOTOR 20 OR LESS H.P. K.W. FIELD OFFICE PLUMBING FEES DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING FLOOR DRAIN WGTFR CnFTFNFR VENT sysTE0 5 FAN ❑ EVAP. COOL HOOD 90 SIGN 72 WASHER(AUTO) ISH) 00 APPLIANCE JF. TRANSFORMER [=K•W• H�& VEN�FEE GARBAGE DISPOSAL �% F FURNACE❑UNIT ❑WALL❑FLOO C] SUSPENDED' C. OUTLETS FEING LAUNDRY TRAY 1 AIR HANDLING UNIT CFM FIXTURE OR SOCKET KITCHEN SINK f -0 GAS PIPE ❑NATURAL ❑ L.P.G. ❑ OIL OOM CONST. SERV. ENTRANCEWATER OFFICE CLOSET G/ 15T% COMPRESSOR Cr? t�� HP Q!U POLE LAVATORY U CJ APPLIANCE VENT AMPERES SERV. ENT. S` SHOWER Q Q ABSORPTION SYSTEM O B.T.U. SQ. FT.@ ¢ BATH TUB INCINERATOR ❑ DOMESTIC C] INDUS. OR COMM. HOOKUP FEE ' SQ. FT.@ (r WATER HEATER 'TJ HEATING SYSTEM, -7K FORCED ❑ GRAVITY DBL SQ. FT. RESID. @ i g SEWAGE DISPOSAL O BOILER O B.T.U. p SQ. FT. GAR AGE @'z ¢ CK BY HOUSE SEWER PERMIT FEE QF^ BALANCE OF MIN. FEE GAS PIPING 5�J MOBILEHOME HOOKUP FEE $ 1 1 1 1 / IPERMIT FEE 1 .7 FU II 72 PERMIT FEE .-1-7 10AV PERMIT NUMBERTOTAL�EE'§ 'MOB. HOOK FEE H�& VEN�FEE JDBL�L �% F DBL C. DBL FEING F,�E OBL J 1 X665 75 C/tO..M,,MUNITY �,.� DSft UNITS OOM VALUAT/IOt�N,/p SUPP. TO PERMIT OFFICE 76 '5 MOBILEHOME $ J F M A M J J A S O N D JOB ADDRESS DDRESS OWNER / P 72 47-001 'e e/7 C r f�- 73 USE OF BUIIfLDINGJ �r. .C. DATE P.R IT N 74 r %'%GsE% L.tl� 9! A� ,2� 7.x. 1 X665 75 C/tO..M,,MUNITY �,.� DSft UNITS OOM VALUAT/IOt�N,/p SUPP. TO PERMIT OFFICE 76 MOBILEHOME $ LEGAL DESCRIPTION HOOKUP FEE ' .. y. 4 Lf f MECHANICAL FEE DBL SET BACK LOT SIZE ZONE USE NO. GRP TYPE CK BY F S R/ O QF^ r/j I r r PLAN CHECK FEE $ 3-, BOND AMT. PLAN NO. PLAN CHECKER FINAL DATE IN PECTOR / s CONSTRUCTION FEE DBL NAME OF CONST. LENDER BRANCH OFFICE NO LENDER INVOLVED Or- 49 cdbtz k- l ELECTRICAL FEE DBL $�� ADDRESS CITY✓ STATE C9 $ THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS. FEE CESSATION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. ` 1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIF- DBL ORNIA. I ALSO 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 PREPARED THE PLANS AND SPECIFI- CATIONS HAS DONE SO IN ACCORDANCE WITH SE5 BlJ�INESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. ` r f[[ TOTAL FEES $�� CASH F-1 CHECK Ek M.O.O N.C. O OWNER CONTRACTOR Received By f ADDRESS ADDRESS ll 7 - ?.y r Sewage System T LL P Trees Required Yes No�-- CITY CITY INFORMATION TEL. NO. TEL. NO. LICENSE FORM 284-208 (REV 4/71)$ al -A-4- A-, — G.1'11,.. � � v.✓,{" -9- P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits I11IaP0.RUNT! NOTICE TO )i')EtQPET'S� OWNER Dear Property Owner. An. application for a building Permit has been submitted in yo S!4 yo if the builder of the property improvements specified at O �L- We are providing you with an Owner -Builder Xcknowledgmeneand Information V tion Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building -permit until you -have read, initialed your. understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this. notice unless you, the property owner, obtain the prior approval of the permitting authority. OZ'S ACKNOWLEDGIf W4T AND VERMCATION OF INFOR AMN DfRECT70NS. Read and initial eachstatement below to signify you understand or verify this information: A-1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may beheld liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my. property �2. I understand building permits are not required to be signed by property owners unless they are responsible for the c&truction and are not hiring a licensed Contractor to assume this responsibility. 90. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 6Z4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. �5.1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 6_ I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. &7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot .legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be he'd liable for any financial or personal. injuries wstained by any subsequent owner(s) that result from any latent construction defects in the woriinanship or materials. kB 9. I understand I may obtain more information regarding my obligations as an "employer" from the LAM121 Revenue ervice, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSFLB) at 1- 800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. �L10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially tespo ibte . for proposed construction activity at the following address: 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builderi as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I ave provided on this fon:rr. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be heldliable for damages. If you obtain a permit as Owner -Builder and wish to hire ConhwAors, you will be r!spmib4e for verifying whether or not those Contractors are property licensed and the status of their workers' compensation insuranoe coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issnit<g; flee mit. Note: A copy of tlu property owner's driver's leo farm n� or other verification acceptable to tk a4y is requir# to be presented when the permit is issued to verify the property owners signature. Signature of property owner Date: Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand. is my personal responsibility, I hereby authorize the following persons) to act as my agents) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: .... ...... _.i Vf i _ s , t,...r � 4,._ .l, .f � ,...r � ' j I Ip� � � ° E t F � J +�. �, � I t f , t•• + f � � IT, FT, t J.�• . ..I ' .,L.v ,..•!. -.fir: Y{i''r�.�[ a v.:. /. R,la � ,_r�: � f I 1 ..... , , .. ... . .. .�... 1,.. • .. , - . f { _ 77 _ -- c'p • r a All } _ , _ t- yJ SS b, .17 , _77,-.. r , » i T [ , { I t • I — _ - _.. tJ"Cu— ; . v 2 `-1 m • Y 2