05774 (SFD)4
f�Gl�lt�GV
P.O. BOX 1504 No. 05774
Building 78-105 CALLE ESTADO
Address 79-735 VIUETA DRUt LA QUINTA, CALIFORNIA 92253
Owner
maning
Address A.P. Number
City
1792260
p Tel.
P DESERT .340-9174
Contractor
TRIAD PAWIC WME S CORP,
BUILDING: TYPE CONST. OCC:. GRP.•
State Lic. City
& Classif. 505699 Lic. # 1.363
Arch.- Engr.,
Designer
Address Tel. - -
City Zip State
. I i Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divisio13 of the Business and Professions Code, and my license is in full for ,and.
effecL� a� ...ti «�! f;,<.,.
SIGNATURE t O DATE
` r OWNER -BUILDER DECLARATION '
1 hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usamess .rod Professions Code: Any city or county which requires a
permit to construct, ager, bWrovr, demolish, or repair any structure, prior to its issuance also
regrdres the applicant for such penrd 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 Pmtessions 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 ciW penalty of not more than five hundred dollars ($500).
0 I, as owner of the property, oi my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sac. 7044, 0uisness and
Professions Cade. The CmKractoi's License Law does not appty to an owner of property who
builds or improves thereon and shho does such work himself or through his own employees,
Provided that such improvements are not intended or offered for sale. 11, however, the building
or improvement is said wiffin one year of completion, the owner -builder will have the burden
of proving that he rid not btdd or &prove for the purpose of sale.)
❑ I, as owner of the property, an exclusively contracting with licensed contractors to con-
struct the project (Sec_ 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of paoperty who builds or improves thereon, and who contracts for
such pn*cts with a contractWs) frensed pursuant to the Contractor's License Law.)
❑ I am exempt under sec B. & P.C. for this reason
h .
Date Owner
WORKE:W 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 CbmpanY %r =i �..
Copy is filed with the city= ❑ Certified. copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be compieted if the permit is for one hundred dollars ($100) valuation
'or less.)
1 certify that in the performance of thg work for which this permit is issued, 1 shall not
employ anyperso
ornian in any manner so as to become subject to the Workers' Compensation
Laws of Calif
Date Owner
NOTICE TO APPLICAM: 0, atRr making this Certificate of Exemption you should become
m4ect to ' the Workers' Compensation provision's of the Labor Code, you must forthwith
comply with such provisions of this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there isa 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 property 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 implication 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, Tip
Legal Description
Project Description••*
1+0T 162
Sq. Ft- 1813'.
Size
No.
Stories
No. Dw.
Units -
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$100,293
PERMIT
AMOUNT
Plan Chk. Dep.
250.00 -
Plan Chk. Bal.
Const..
643.00
Mech.
60.00
Electrical ,
109.84
Plumbing
132.5
S.M.I.
7.07
Grading
Driveway Enc.
Infrastructure
2,.256.59
TOTAL
$3.744.34
REMARKS
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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 Permit
Validated by:
Validation: .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
DUCT WORK
ROCK STORAGE
N
FOUND. REINF. N
CCC
MOBILEHOME SVC.
F
BAR SINK
POR. SQ_ FT. ®
—
GAS (FINAL) TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRAINAGE PIPING
CARP. SQ. FT. ®
LUMBER GR. FINAL INSP. 3 Qp
FRAMING FINAL INSP.
ROOFING (� Gr
VENTILATION G
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
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DRINKING FOUNTAIN
WALL SQ. FT. ®
URINAL
SO. FT.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
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
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
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 PLUMBINGZ—A UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE Z( JC
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
N
FOUND. REINF. N
CCC
AS (ROUGH)6 ¢O ETER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
g plus x$
=$
LUMBER GR. FINAL INSP. 3 Qp
FRAMING FINAL INSP.
ROOFING (� Gr
VENTILATION G
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
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REMARKS:
SIGNATURESIINITIALS
GARDEN WALL FINAL