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06658 (SFD)Building Address Owner Mailing Address City PAIr Contractor Address City State Uc. & Classif. Arch., Engr., Designer Address City ceityl 4 4 ah P.O. BOX 1504 44-380 Camm Place LA QUINTACCALIFORNIA 92253 No. ©665$ Triad Pacific Desert Develvpailint BUILDING: TYPE CONST. OCC. GRP. - 74 -923 Ebvlev #130 A.P. Number Lit QLdata Hie.h., rfrlA TT ?.1269 Zip Tel. � ' Desert 22 0-9i Legal Description- -Project s Project Description RIM P1 on A Zip Tela City 5056999 Lic. # 1383 Sq. Ft. 3220 No. No. Dw. ` Size Stories "Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Tel. Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect SIGNATURE + DATE ) OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason: (Sea 7031-5,Buskxw and Professions Code: Any city or county which reguires a Permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also requires the appicam for such Pernik to tae 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 Busirmss and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption- Any vkMation o1 Section 703 1. 5 by 'any applicant for a permit subjects the apPicant to a civil penalty of not more than five 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, euisness and Professions Code: The Contractor's License Law does not apply to an owner of property who binds 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 irprovanmert is sold within one year of completion, the owner -builder will have the burden of proving that he did not bold or improve 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 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 contractors) licensed Pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company 10°Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 471rs section need not be completed ff the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of lhp 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 aliforniaDateOwner NOTICE. TO APPLICANT: it, atter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith coney 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 abuilding permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that 1 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 imated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure Efty"tic—pottlart TOTAL 7s AMOUNT 2 • 495.50 60.00 t -94 120.50 A. 7fi 1517.5 • 1213, 50 REMARKS _ -, , .,,y „T a, , nrSim 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 11/17/89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. a $ UNITS COLL. AREA SLABGRADE �( �r� 0 OUGH PLUMB. YARD SPKLR SYSTEM 2ND FL SO. FT. HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK MOBILEHOME SVC. BAR SINK POR SQ FT 0 DUCT WORK ROCK STORAGE FOUND. REINF. �O GAS (ROUGH) • POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL /' DRAINAGE PIPING CAR P. SQ. FT. ® WALL SQ. FT. DRINKING FOUNTAIN. FINAL INSP. URINAL SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ GRADING -Cu. yd. $ plus x$ WATER PIPING NOTE: Not to be used as property tax valuation �✓ /� FINAL INSP. S i- 7 FLOOR DRAIN MECHANICAL FEES ROOFING ((�� (?a VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING w( MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. 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 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. SQ. FT. ® c BATH TUB SQ. FT. ®c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/. c SEWAGE DISPOSAL SQ.FT.GAR ® V4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE H.FEE PLCK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING / /fes ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLABGRADE �( �r� 0 OUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. �O GAS (ROUGH) • METER LOOP HEATING (FINAL) OTHER APPJEQUIP. 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. S i- 7 FRAMING Z� �y INAL INSP. ��l ROOFING ((�� (?a VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING w( MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. REMARKS: V� IINSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL