06659 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 44-185 $onesta Way LA QUINTA, CALIFORNIA 92253
Owner ~
Triat3 Pacific Desert Dev.
Mailing
Address 74-923 A 130
City Zip Tel.
Pale Desert1. 91264 340-917,
Sty
Address
Zip
State Lic.
& Classif. 505699
Arch., Engr.,
Designer
No. 06,659
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number t.stl�Snfl•d+ li?i� 3stnri�as �3�6�
Legal Description
Project Description SPD Ltltt 23., plim n --R
%'lty
Lic. # 1383 Sq. Ft. 1813 No. No. Dw.
SizeStories Units
Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that Ilam licensed under provisions of Chapter 9 (commencing with Section
7(100) o1,Divisloon 3 of the Business•and Professions Code, and my license is in full force and
SIGNATURE' .✓' t" DATE
OWNER -BUILDER DECLARATION
1 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 to construct, after, 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 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 violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenaltyof nol more than rive hundred dollars ($500).
❑ 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 not apply to an owner of property who
bufkfs or inproves 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.)
❑ I 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No company
a
b'Copy is filed with the city. ❑ Certified copy. is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N 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: lf, 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.
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.)
Lenders Name
Lenders Address
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.
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
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
t21.GlL?s 7®@
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 535.34
Const.
643.00
Mech.
60.00
Electrical
109.84
Plumbing
132.50
S.M.I.
7,09
Grading
Validated by:
Driveway Enc.
Infrastructure
2,256,59
t vestf ion fe
132.50
TOTAL3%fI'.8
REMARKS
40 siftlg-010.�{`d4MAIf..M 49—, : i--A'TJ
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
11/17189
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2N0 FL Sp. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
REINF. STEEL
GAS (FINAL) TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRAINAGE PIPING
CAR P. SO. FT. ®
LUMBER GR.
FINAL INSP. G�v
/
FRAMING
FINAL INSP. 1 Q( LP
DRINKING FOUNTAIN.
WALL SO. FT. ®
REMARKS:
URINAL
SO. FT. @
FIRE ZONE ROOFINGGI�
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
SPARK ARRESTOR
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.
SO. FT. ® c
BATH TUB
FENCE FINAL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
Sp. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
RMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE FPL.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 �Z
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
✓q/�r ETER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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. G�v
/
FRAMING
FINAL INSP. 1 Q( LP
ROOFING$ f%�
VENTILATION
/1 / (G
/-)
Rte/(✓� V (�J
REMARKS:
FIRE ZONE ROOFINGGI�
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL qq �/
LATHING % ((� 7 s [ D
MESH
INSULATIONISOUNDS
FINISH GRADING j ar
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t