06675 (SFD)T4tyl 4 lwQ"
Building 78-835 t iUeta Dr1Ve
Address
Owner
Mailing
Address
City
Contractor
Address ..
Trl" Pacific Dewirt fDev.
Tel.:
P.O. BOX 1504
78-105 CALLE ESTADO
LA.QUINTA, CALIFORNIA 92253
State Lic.I City
& Classif. 505698 Lic. # 1:383
Designer
Address
City IZip I State I
Lic. #
�r _LICEh6ED CONTRACTOR'S DECLARATION
rm th I am licensed under Drobisions of Chapter 9 (commencing with Section
I hereby z!ffii;
7000) of Division•3 of the Busiue5s and£Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNEWBUILDER 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, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to We a signed statement that he is licensed pursuant to
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 violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
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 improves 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 ane year of completion, the owner -builder will have the burden
of proving that he did not build or Jinprove for the purpose of 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.)
D 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION I
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. company
opy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be corgWeted ff 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 mariner so as to become subject to the Workers' Compensation'
Laws of California
Date Owner
NOTICE TO APPLICANT: 8, aiYer 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 is:.ued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder isauspended for 180 days.
I certify that I have read thisapplication 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 autborize representatives -of this city to enter the above-.
mentioned property for inspect on purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST
No. 05575
OCC: GRP.
Number %a OulfltA H1rh3 mdz 'T 23269
Legal Description
Project Description_ _ pi>m A Lot 152
REMARKS
gi�x i x 44,3w i if f Ay, I ;rd- 4
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 11/17/89 Permit
Validated by:
Validation:
Sq. Ft. 1450
Size
No.,,
Stories • r'
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$ cc
%8fL727
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
V458.5Q
Const.)4.),*UO
Mech.
b •
Electrical
+ ti
Plumbing
lu Q
S.M.I.
Grading
Driveway Enc.
Infrastructure
L f lb9* Ll
TOTAL
$3053.12
REMARKS
gi�x i x 44,3w i if f Ay, I ;rd- 4
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 11/17/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ®. $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE n2 EJ ( Q
YARD SPKLR SYSTEM
2ND FL SO. FT. @
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. Sp, FT, ®
SEWER OR SEPTIC TAN/K�
ROUGH WIRING.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
��(AS (ROUGH) �(i7
METER LOOP
DRAINAGE PIPING
CAR P. SO. FT. ®
REINF. STEEL
WALL SO. FT.
�
DRINKING FOUNTAIN.
URINAL
SO. FT. @
WATER HEATER
ESTIMATED CONSTRUCTION VALUATION $
SERVICE
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
LUMBER GR.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FRAMING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
ROOFING �7
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
PO
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ®c
I WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11A c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE TNST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMB NG
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE n2 EJ ( Q
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TAN/K�
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. r L
��(AS (ROUGH) �(i7
METER LOOP
HEATING (FINAL)
OTHER APPJEGUIP.
REINF. STEEL
GAS (FINAL) / IQ
Y
�
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
yd.
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. iB
!/
FRAMING
FINAL INSP.
ROOFING �7
IfGp,_
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING P
MESH
INSULATIOWSOUND '3
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL