06590 (SFD)Tibf
"
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 44-060 Carmen .Place LA QUINTA, CALIFORNIA 92253
Owner - -
Triad Pacific Desert Dev. _ _ _
Mailing
Address 4-923 oyley #13ti
City Zip Tel.
Palm Desert 1 92260 1 348-9174
Contractor
Address
Tel.
State Lic. City
& Classif. 505699 1 Lic. # 13$3
Arcn., tngr-,
Designer
Address Tel.
City Zip State
• Lic- #
1 affirm that) am lipensed under provisions f Chapter 9 (commencing with Section
70011) of bivision 3 of the Business-Prolessions Code, and my license is,in full force and
effect }t i t 11" " "T /, /., / , rt. -F'.
SIGNATURE I - -•{I I N DATI
;OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the following
reason (Sec- 7031-5,B+us Ness and Professions Code: Any city or county which requires a
Permit to construct, atter, 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 taw, 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 ($500).
❑ 1, as owner of the property, or my not
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 Contractors License Law does not apply to an owner of property who
bolds 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- 11, however, the building
or rrprovement is said within one year of completion, the owner -bummer wig have the burden
of proving that he did not build or irWove 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 Contractors 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 owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
wodu:rs 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
(rhis section need not be completed ff the permit is for one hundred dollars (E 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.ff, after makig this Certificate of Exemption you should become
suWO to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply wtth.such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ifor which this hereby affirm that there is a construction lending agency for the performance of the
work permit is issued- (Sec. 3097, Ciw7 Code-)
Lender's Name __—
Lenders Address
This is abuilding permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity that I have read this application and state that the above information is correct.
1 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,
Signatureof applicant Date
Mailing Address
city. State. Zip
No. 06560
BUILDING: TYPE CONST: - OCC: GRP.
A.P. ,Number La Onintit HIShloinds TT 23269
Legal Description
Project Description Plan C. Lot 18
REMARKS .nrrxe'sn srt nv•,c 441
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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
[[��
1�j �Sd$7
.Issued by: Date Permit
Validated by:
Validation:
Sq. Ft. _ 1563 _
Size
Igo. , . No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
1
Estimated Valuation
$87,591
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
489..07
Const.
585.50
Mech.
60.00
Electrical
101.21
Plumbing
120.50
S.M.I.
6.16
Grading
Driveway Enc.
Infrastructure
1,970-80
TOTAL
$3,333.24
REMARKS .nrrxe'sn srt nv•,c 441
�ti
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
[[��
1�j �Sd$7
.Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE ( /
ROUGH PLUMB. BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR SO FT ®
AS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
BOND BEAM
WALL SO. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
_$
LUMBER GR.
URINAL
SOFT ®
FINAL INSP.
ROOFING t �2
VENTILATION
ESTIMATED CONSTRUCTION VALUATION $
j/ �%./J /rte
/� �� b�e/ (� �� •` / '�
Qi% j
WATER PIPING
NOTE: Not to be used as property tax valuation
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
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1+/. c
SEWAGE DISPOSAL
FINAL INSPECTION
SO.FT.GAR ® 3/ac
HOUSE SEWER
CERT. OCC.
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
ROCK STORAGE
FOUND. REINF. ( r`
AS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS(FINAL)3j /�',-;rA t TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING Z L-7 (���
FINAL INSP.
ROOFING t �2
VENTILATION
Lv
j/ �%./J /rte
/� �� b�e/ (� �� •` / '�
Qi% j
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING u ZlZZ Z
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
'
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
�3�69
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113.40 13.11
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LOT U
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