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06667 (SFD)P.O. BOX 1504 No. 06667 Building 78-105 ALLE &-, , LA QUINTACCAL CALIFORNIA 92253 DO Address 7755 ��i@t8 �T�QB Owner Triad Pstcife De-giam Day, - BUILDING:, TYPE_CONST. OCC: GRP. AddreMailinss 74--923 Goviey 0130 Le 1;ats Highlands T 23269 Y A.P.-Number City Zip Tel. .Palm Desert 92260 �4 917k. Legal Description Contractor Sam Project DescriptionSM Pl= C Lot ' Address City Zip Tel.: State Lic. City & Classif. 50569,9: Lic. # 1383 Y Sq. Ft. 1563 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 -thatJ1 m,licensedunder provisions of Chapter 9 (commencing with Section 70110) of Division 3 of the Business and Professions -code, and my license is in full force asd SLGNATUREE--' DATE OWNEiFBuiLDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following tn1 reason: (Sec. 7031.5,6usihess and Professions - Code: Any city or county which requires a is permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to ft a signed statement that he is licensed pursuant to PERMIT AMOUNT the provisions of the Contractors 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 vfofab-on of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. subjects the applicant to a civilpenalty ofnot more than rive hundred dollars ($500). Plan Chk. Bal. '�, Q' ❑ I, 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 Const. 585.50 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, Meeh. ��((�� provided that such improvements are not intended or offered for sale. If, however, the building 60.00 or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 1i1. ?,� of proving that he did not build or fmprove.for the purpose of safe.) • tn ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 1.Zt9 y% struct he project- (Sec- 7044, Business and Professions Code: The Contractor's License Law . 50 does not apply to an owner of property who builds or improves thereon, and who contracts.for S.M.I. 6.16 such projects with a contractor(s) rice sed pursuant to the Contractor's License Law.) - Grading ❑ tam exempt under Sec_ w• S P.C. for this reason Driveway Enc.. Date' Owner Infrastructure 1,970.80 WORKERS' COMPENSATION DECLARATION I 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 1 © Copy is filed with the city. ❑ Certified copy is hereby furnished. - Fj TOTAL 10,333.24, CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be umnpreted ff the permit is for one hundred dollars ($100) valuation or less.) - 1 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 aliforniaDateOwner NOTICE TO APPLICANT: If, after makilg this Certificate of Exemption -you should become ZONE: BY: subject to the workers' Corrpensagon provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provfsfors or the Permit shag be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued- (Sec. 3097, -CM Code.). - _ Side Setback from Property Line Lenders Name Lenders Address FINAL DATE INSPECTOR 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- 11/17/89 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 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 1ST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE �( �✓ p �% YARD SPKLR SYSTEM 2ND FL SO. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SO, FT. ® DUCT WORK ROCK STORAGE FOUND. REINF.GAS POWER OUTLET ROOF DRAINS GAR. SO. FT. ® HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL DRAINAGE PIPING CAR P. SO. FT. @ GROUT DRINKING FOUNTAIN. WALL SO. FT. FINAL INSP. URINAL SD. 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, 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 ® 1 Vi c SEWAGE DISPOSAL SO.FT.GAR ® Vic 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 _J SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE �( �✓ p �% ROUGH PLUM i BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF.GAS (ROUGH) F� (11�d ETER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM LUMBER GR. FINAL INSP. FRAMING 2 / FINAL INSP 1 ROOFING D� /nI,ss 7 �31Qo VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING !�3 . Vzw MESH INSULATIONISOUND /( � FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL GARDEN WALL FINAL GRADING cu. yd. $ plus x$ REMARKS: