06665 (SFD)Buildin
Address 78-830 Sanesta Tray
Owner
Triad Pacific Desert Dev.
Mailing
Address 74-923 8ovley 0130
City Zip Tel.
Contractor
Address .
City
P.O. BOX 1504
78-105 CALLE ESTADO
LA,QUINTA, CALIFORNIA 92253
State Lic. City
& Classif. 5€ 5699 Lic. # 1383
Arch., Engr., -
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirmahai'l2m licensed under provisions of Chapter 9 (commencing with Section
7000),of Division 3 of the Business and.Profe`ssions Code, and my license is in full force and
effect. .. �,'�.•h, ' � .ss�,r,�;l' �l � _�
SIGNATURE = 11'�-";`"" DATE
OWNER -BUILDER DECLARATION
I hereby affirin that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busfness and Professions Code: Any city or county which requires a
permit to construct, after, bnprove, 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 Contractors 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 ciw7 penally of not more than five hundred dollars ($500).
O 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
Professfons 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 Nat such bnprovements are not intended or offered for sale. If, however,, the building
orimprovement is sold wither 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, BusinessandProfessions 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.)
O 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. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be cornpleted If 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: ft, 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.)
Lender's Name
Lender's 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 car ity 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. 06666
BUILDING: 'TYPE CONST. OCC: GRP.
A.P. Number LA ClUi lta Hifthlaaa TT 2320
Legal Description
Project Description kfili + Ptmn A tit 94
Sq. Ft. 1220 No. No. Dw.
Size `Stories- Units
New ❑ Add ❑ Alter ❑ Repair O Demolition ❑
TOTAL 1 $2,706.35 (r,
REMARKS
3, 9,!' •, s .,r'irrir 3t �' y, " Fty d"i h� s. "` = r -,.ger . v a.� — ..
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
111/17/89
Issued by: Date Permit
Validated by:
Validation:
Estimated Valuation
b7 445
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
421015
Const.
495.50 .
Mech.
60.00
Electrical •
".94
Plumbing
120.50
S.M.I.
C, 76
Grading
Driveway Enc.
Infrastructure
1,517.51
TOTAL 1 $2,706.35 (r,
REMARKS
3, 9,!' •, s .,r'irrir 3t �' y, " Fty d"i h� s. "` = r -,.ger . v a.� — ..
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
111/17/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
i
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
MOBILEHOME SVC.
BAR SINK '
POR. SO. Fr. ®
AS (ROUGH) METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GROUT
DRAINAGE PIPING
CAR P. So. FT. ®
FINAL INSP.
WALL So. FT. ®
WATER SYSTEM -
DRINKING FOUNTAIN
GRADING
Cu. yd.
$ plus x$
=$
URINAL
SO. FT. ®
FRAMING
INAL INSP.
L
ESTIMATED CONSTRUCTION VALUATION $
�t,
�],� ®
" ,/*y 3( ;'� �G
!)
V �
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
FIREPLACE
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
IBATH TUB
So. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
So. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
�(
FINAL INSPECTION V21
SO.FT.GAR ® 314c
HOUSE SEWER
CERT. OCC. t
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 PLUMBI G UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
i
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. �/
l
AS (ROUGH) METER 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. ?
FRAMING
INAL INSP.
L
/�
ROOFING Qi(<a/ `e
�t,
�],� ®
" ,/*y 3( ;'� �G
!)
V �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND 4D
FINISH GRADING
�(
FINAL INSPECTION V21
CERT. OCC. t
FENCE FINAL
INSPECTOR'S SIGNATURESIINTTIALS
'
GARDEN WALL FINAL