06671 (SFD)Tit�t 4 4 Q"
Building
Arlrirocc 78-795 Vilieta Drive
Owner
Triad Pic.if is Dsser t Dev.
P.O. BOX 1504
78-105 CALLE ESTADO
LA.QUINTA, CALIFORNIA 92253
Mailing
Address 74-923 0130
City Zip Tel.
Palm gil 92260 3464174
Address
ty lZip I Tel.:
State Lic. City
& Classif. 505699 Lic. # 1343_
Arch., Engr.,
Designer
Address' Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that�l. am licensed under provisions of Chapter 9 (commencing with Section
700p) of Di"vision 3 of,the Business and`Prbfessions Code, and my license is in full -force and
effect. <J
SIGNATURE`" '"` ✓ .f - DATE
OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
Permit to construct, atter, improve, demolish, or repair anystructure, prior to its issuance also
requires the applicant for such permit to rile 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 Professions Code, orthat. he is exempt therefrom, and the basis
for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars (3500). .
O 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
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or bnproves thereon and who does such work himself or through his own employees,
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
of proving that he did not build or improve for the purposeof sale.)
❑ I, as owner of the property, am 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 properly who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I, am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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.)
Poli�cy,No. Company
Copy is filed with the city. ❑ Certified copyis hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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: t, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lenders Name
Lenders Address
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. '
I certify that I 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
Mailing Address
City,. State, Zip
No. 06671.
WING: -TYPE CONST. OCC: GRP.
4.P. Number 7.a giiinta 1Tf%X'►AAn 9 23240
w - a > e e
_egal Description
Droject Description P38ti Ii 1st'
Sq. Ft. 181.3 No. No. Dw.
Size Stories' ' Unit's
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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 11117/89Permit
Validated by:
,1Validation:
Estimated Valuation
$1,293
. PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
`44535.34
Const.
643,00
Mech.
60.00
Electrical
109-94
Plumbing
132_50
S.M.I.
7.07
Grading
Driveway Enc.
Infrastructure
2.256, 59
TOTAL
*39744,34
REMARKSl
faftagi" kgiiN NAf?sf•3]:r22- a%ift �A. i ?
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 11117/89Permit
Validated by:
,1Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE�Z ?U
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS 10,
SEWER OR SEPTI TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
l^ AS (ROUGH)
c ETER LOOP
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
SERVICE
FINAL INSP.
BOND BEAM
DRINKING FOUNTAIN.
WALL SQ. FT.
GRADING
10- cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. 7
URINAL
SQ. FT. @
ROOFING 2D
VENTILATION 1
ff%%
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
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAR. FIREWALL
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 ® 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
FENCE FINAL
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�Z ?U
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 10,
SEWER OR SEPTI TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
l^ AS (ROUGH)
c ETER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
10- cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. 7
FRAMING �r?i%
FINAL INSP.
ROOFING 2D
VENTILATION 1
ff%%
REMARKS:
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 2 ((C�% C
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1