06628 (RER)4
P.O. BOX 1504 No.
Building 78-105 CALLE ESTADO
Address 46-255 Washington LA QUINTA, CALIFORNIA 92253
Owner
Address Sam
City Zip Tel. ^ • `
. ..La Quinta 92253 40!4. 22
Contractor
Tribble Construction Co.
Address
80--655 Avenue 43
Z
City ip Tel.:
Iudlo 92281 , 3.47--9755
State tic. City
& Classif. 484957 Lic. # 83o
Arch., Engr.,
Designer
Address I Tel.
CityIZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
e000) of ivision 3 of the Business and' jiofessions Code, and my license is in full force and
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usihess and Professions Code: Any city or county which requires a
permit to construct, after, irprove, demolish, or repair any structure, prior to its Issuance also
requires the applicant for such permit to. Me 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 ova penally 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, Buisness and
Professions Code: The Conbactm's License Law does not apply to an owner of property who
builds or "reproves 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 -budder will have the burden
of proving that he did not build 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 no apply to an owner of property who builds or Improves thereon, and who contracts for
such projects with a contractor(s) 8censed 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
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 fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit 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 arty manner so as to become subject to the Workers' Compensation
Laws of. California
Date_
NOTICE TO APPLICANT: tl, after mabig 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 shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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
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
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number ^ ^ t 4:
Legal Description .
Project DescriptionTitfldei
� + a
Sq. Ft. 400 No. No. Dw.
Size Stories.- - Units
New ❑ Add ❑ Alter ❑. Repair ❑ Demolition ❑
Estimated Valuation
$7512
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
AMOUNT
21
20.00
REMARKS
'Y(3�'I�i4-Pj�T#�h`i»f.".7f�LI:.YgE�i e31t+,San'"i x''�
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:
Date 1117/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING., EES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO, FT.
DUCT WORK
ROCK STORAGE
FOUND. REN / �y
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN.
WALL SO. FT.
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SOFT ®
GRADING
cu. yd.
$ plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
INAL INSP.
FLOOR DRAIN
MECHANICAL FEES
1 f
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,TEMIPERM
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 ® 11/4 c
SEWAGE DISPOSAL
INSULATIONISOUND f 13
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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. REN / �y
GAS (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.
ROOFING / �'
1 f
/Q�
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING If, ap?w
MESH
INSULATIONISOUND f 13
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL