06587 (SFD)T4ht 4 4 Q"
Address 44--095 Catmeo Place
Triad Pacific Desert DeQ.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address 74-923 Novlav
City Zip Tel.
Palm Dese t 92260 1 344-9174
Contractor
City
State Lic. City
& Classif. 505699 1 Lic. # 1383
Arch., Engr.,
Designer
Address I Tel.
CityI Zip I State
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (comment
7000) of Divisio#n 3 of the Business a`;:Professions Code, and my litems€" is
effect. A tis, t rif'11 r 0 1`7
.OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busk7ess and Professions Code: Any city of county which requires a
permit to construct, after, 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
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 vitiation 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).
❑ 1, 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 not 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
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.)
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
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
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' COMPENSATION INSURANCE
(This section need not be completed if the pent 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 malting 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 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.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 06587
BUILDING: TYPE CONST. - OCC. GRP.
A.P. Number 1,8 Quint• Highlands TT 23284
Legal Description
Project Description Plaa C. Lot. 15
Sq. Ft. 1.563
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$87,391
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
0
Const.
5)
Mech.
60.00
Electrical
Plumbing
120.50
S.M.I.
6.16
Grading
Driveway Enc.
Infrastructure
TOTAL
$3.333,24
REMARKS
. 'e.—_^ r n
[ t
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date10j25�$!Perm it
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
'4
OUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF, bt' / 0 C
/
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL
GAS (FINAL TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
FINAL INSP.
BOND BEAM f
WATER SYSTEM
DRAINAGE,PIPING
CAR P. SQ. FT. ®
I
FINAL INSP.
WALL SQ. FT.
FINAL INSP., ��(_ (C
DRINKING FOUNTAIN.
, // b /®
ll' �I ( 2
'p
URINAL
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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.
SO. FT. ® c
BATH TUB.
FINAL INSPECT10
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FENCE FINAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
INSPECTOR'S SIGNATURESIINITIALS
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
man
SETBACK
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE <� B
'4
OUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF, bt' / 0 C
/
�G (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM f
WATER SYSTEM
GRADING
-CU. yd.
$ plus x$
=$
LUMBER GR,
FINAL INSP.
n
FRAMING �y �(/ /
FINAL INSP., ��(_ (C
ROOFING g� ®1 e
, // b /®
ll' �I ( 2
'p
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
/ v
FINISH GRADING
FINAL INSPECT10
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t