13883 (RR)4 44 QUM&
P.O. BOX 1504 N o . 13883
Building Washington St. 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Triad Enterpris a. c/o AnnL ' `tattle :
Mailing BUILDING: TYPE -CONST.- OCC: GRP.-
Address P.O. .BOX a9.
A.P. Number
CityZip Tel.
La Quinta., : CA' 92253. .564-2177 Legal Description
ContractorRerdof
t
Cstom Roofing Company -
Ad rggo aYzcl' o LOS Coyotes
City Zip Tel.:
di.o,. CA 922.Q1 345-3751
State Lic. C--39 ..625038 City 12
& Classif. Lic. # Sq. Ft. No. No. Dw.
-Arch., Engr:,. - -
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City •• Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION '
I hereby affirm.that I am licensed untler provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business i nd Professions Code, and my license is in full force and
effect.:,WIY+S�V'
SIG NATURE - DATE
% OWNER -BUILDER DECLARATION Estimated Valuation �2 �� Q�
I hereby affirm that I am exempt from the Contractor's License Law for the following o .
reason: (Sec. 7031.5,Business and Professions. Code: Any city or county which requires a
Permit to construct, alter, 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 PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9. (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for the alleged exemption. Any violation o/ Section 7031.5 by any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than live hundred dollars ($500). -
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. !ryt R ^^
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 3'V a yti
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, Mech.
provided that such improvements are not intended or offered /or sale. If, however, the building
or improvement is sold within one year o/ completion, the owner -builder will have the burden Electrical
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- Plumbing
'struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner o/ property who builds or improves thereon, and who contracts for S. M. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
O I am exempt under Sec. B. & P.C. for this reason Grading
Driveway Enc.
Date Owner Infrastructure
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 N Company
fJ�C� py is filed with the city. ❑ Certified copy is hereby furnished. A MIA
TOTAL r v
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if.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 any manner so as to become subject to the Workers' Compensation
Laws of California.
Date _,Owner _
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you Should become ZONE: _By. '
subject to the Workers' Compensation provisions o/ the Labor Code, you must forthwith Minimum Setback Distances:.
comply with such provisions or this permit shall be deemed revoked. -
' Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line-
Lender's
ine Lender's Name
Lender's Address
This is a building`.
permit when properly filled -out, signed and validated, and is subject to FINAL DATE INSPECTOR
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. Issued'by: Date} ( Permit
I agree to comply with all city and county ordinances and state laws relating to building ; J TII(J� f1 r;
construction, and hereby authorize representatives of this city to enter the above V 1/n
mentioned property for inspection purposes. Validated by: j I J94 .
Signature of applicant ' Date'
Mailing Address Validation: �^+
City, State, Zip /
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
r
BONDING
HEATING (ROUGH)
2ND FL. SO. FT.
FORMS
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK : �.�
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT. @
OTHER APP.IEQUIP.
DRAINAGE PIPING
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SO FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM .
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
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
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/ac
HOUSE SEWER
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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
FINAL INSP.
ROOFING —l�-�j/f 40
l
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION—%.Gtl(
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL