06573 (BLCK)r
4
P.O. BOX 1504 No. 06573
Building78-105 CALLE ESTADO
Address 78-715-Villeta Dr. LA QUINTA, CALIFORNIA 92253
Owner
Triad Pacific Desert Developpent.
Mailing BUILDING: TYPE -CONST:- OCC: GRP.
Address 74-923 ftyley #230 A.P. Number Hiah3ands
City Zip Tel.
Palm Desert 92260 340 -9174 Legal Description
Contractor Project Description Ppt`'itnk*tf_z' V.01ind wn 1l slung
rrfb f eye 4.9
Address Fred W Tina .D & Adams St..
Arrarowimately 44100 lin, ft
City Zip Tel.:
State Lic. City
& Classif.�rJf. Lic. # X3$3 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
1 hereby affirm,that I am licenspd_under provisions of Chapter 9 (commencing.with �Sec
tio /
7000) of Divi'sion:3 of the Businna§s�and --Prroof-essions Code, and my license is in'(U/II'forceJand #
effect. ,i'1' ;r A� , ""'^,�,,,.! ,j .sl
_SIGNATURE" 1' I'': ;. �. 1� .r DATE
r� '01111INER-BUILDER DECLARATION Estimated Valuation
1•hereby affirm that I am exempt from the Contractor's License Law for the following an
reason: (Sec. 7031.5,Brsirness d Professions Code: Any city or county which requires a $101-,000.00 -
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 PERMIT AMOUNT
the provisions of the Contractor's :License Law, Chapter 9 (commencing with Section 7000) or -
Division 3 of the Business and Pr&essions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any vkoldon of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penally of not more than fire hundred dollars ($500). plan Chk. Bali
❑ I, as owner of the property, or, my employees with wages as their sole compensation, will
do the work, and thestructure is not intended or offered for sale. (Sec. 7044, Brisness and COrISt. y� ,� •
Professions Code: The Contactors License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself orthrough 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 of completion, the owner -builder will have the burden Electrical
of proving that he did not build or brwrove for the purpose of safe.)
❑ 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 of pnperly who builds or improves thereon, and who contacts for S.M,I, •
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
❑ I am exempt under Sec- R- S P.C. for this reason
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 Insurarce, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Ompany
❑ Copy is filed with the city- ❑ Certified copy is hereby furnished, r ;.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is construction lending agency for the performance of the
work for which this permit is isse ed. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
Thisls a building permit whei properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 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—
Ma , ili
ateMailing Address
City,. State, Zip
rout Setback.from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR�r
Issued by: Date 10/24iPermit
Validated by:
Validation:
TOTAL ,
U,_1/ 1'l -.;
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
'r '
lt;..+- -ts443.54D
(This section need not be competed If the permit is for one hundred dollars -(S100 valuation
)
s Ki:>3#,� i t
Y d;�
i y, Q, u• ¢•
7 i 1 '}. fits 79 . �i
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 man•er'so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: If, af@r making this Certificate of Exemption you should become
ZONE: BY:
.
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions orthisoemutshall bedeemed revoked. •
Minimum Setback Distances:
F.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is construction lending agency for the performance of the
work for which this permit is isse ed. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
Thisls a building permit whei properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 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—
Ma , ili
ateMailing Address
City,. State, Zip
rout Setback.from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR�r
Issued by: Date 10/24iPermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SQ. FT.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROUGH WIRING.
DUCT WORK
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
TEMP. POLE
DRINKING FOUNTAIN.
WALL SQ. FT.
GROUT
WAIER HEATER
SERVICE
URINAL
SQ. FT.
BOND BEAM r/ �V,.,ATER
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
plus x$
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
REMARKS:
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
MESH
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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WAIER HEATER
SERVICE
FINAL INSP.
BOND BEAM r/ �V,.,ATER
SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
'
C /
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL