13887 (RR)P.O. BOX 1504 "NO.' 1.3887 ',, `
Building '49-191, Washington St., 78-105 CALLE ESTADO '
Address LA QUINTA, CALIFORNIA 92253 r
Owner Triad Enterprises -c/o A>`ia Tutt e,
` BUILDING: TYPE CONST. OCC: GRP.
Mailing
' Address .. "BOX 88
A.P. Number
City; Zip Tel. t
La Q12�.l1ta,,` �. 9 253 564-2177 - Legal Description
Contractor Riero ? <
stom .R6.6fing Company Project, Description '
Adess
..� J . Raxtcho Los Coyotes
1ti7dio9p' CFS ZI092201 Tel
5-3751
State Llc ;'C 39.A25038. city
12
& Classlf. Lic. # Sq. Ft. No yNo. Dw.
:Stories-
Arch.,Engr.;r Size
Units ; =•
Designer New ❑ Add 0.,_Alter 0 Demolition O
Address `. Tel. L
City - Zip State
' Lic:,#
! LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm hat I am licensed under provisions of Chapter 9 (commencing with Section 3
701X1) of Division 3 of the Business anrd Professions Code, and my license is in full force and
effect.
�. ✓i.s.:.sl�i 1 /�'' }
SIGNATURE 1f -- +' - DATE- ' •� `
OWNER -BUILDER DECLARATION r
Estimated Valuation/�
hereby affirm'that I am exempt from the Contractor's License Law for. the following �� 8 ?��. Aptli7
,.,reason: (Sea .7031.S;Business and Professions, Code: Any city oricounty which ,requires a. '
permit to construct, alter,'.improve, demolish, 'or repair any structure,,,, prior toits issuance also :• AMOUNT.; •'
. requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT
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
7 fon the alleged exemption. Any violation 'of 'Section 7031.5 by 'any applicant fora perms Plan Chk. Dep. _
r, subjects the applicant to -a civil penalty of not more than five hundred dollars.($500).
❑. I, as owner of the properly, or my employees with "wages is their sole compensation, will Plan Chk. Bal: i
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and 'Const. " " 3 AA V .00
Professions Code:- The Contractor's License Law does.not apply to..an owner o/'property who
.builds or improves. thereon andwho does such work himself or through his own employees,
Mech.
provided that' such Improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year o/ completion, the owner -builder will have the burden Electricalof 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• Plumbing
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 S. M. 1.
such projects with a contractor(s),licensed pursuant to. the.. Contractor's License Law.) - - - -.
Grading
❑ 1 am exempt under Sec.- B. & P.C. for this reason
Driveway Enc.
V
` 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.lnsurance, or a certified copy thereof. (Sec. 3800, Labor Code.) -
Policy No, '.Company -
1110py.is filed with the city. ❑. Certified copy is hereby furnished. '
TOTAL
v ' CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed I/ the permit is /or. one hundred dollars ($100) valuation
or less.)' "
I certify that in the performance of thV 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 r,_. Owner' K.
NOTICE TO APPLICANT: I/, after making this Certificate of Exemption you should become ZONE: BY: ' -
subject to the Workers' Compensation' provisions of the Labor Code, you must forthwith Minimum Setback Distances:..
comply with such provisions or this permit shall be deemed revoked. `
Front _Setback -from Center,.L'in_e
r Rear Setback from Rear.Prop. Line'
CONSTRUCTION LENDING AGENCY Side Street Setback Jrom Center Line
I hereby affirm that there is a construction lending agency for the performance of the r
Work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line_
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.
1 certify that I have read this application and state that the above information is correct. ~` Issued b Date Ift�I
Per t' /
I agree to comply with all city and county ordinances and state laws relating to building y r1u�►^ +
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes. Validated by:
Signature of applicant Date • ' `
Mailing Address Validation:
City, State, Zip \�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
—�
-
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
OTHER APP./EQUIP.
DRAINAGE PIPING
WALL SQ. FT.
'
DRINKING FOUNTAIN.
SQ 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.
SQ. FT. ®c
BATH TUB
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SQ.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
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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 �^y—�G/ (�
rr
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION RIL-30.2
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL