SFD (001286)53705 Avenida Martinez
001286
A 3
PEiiMIT APPLICATION
City of La Duinta
Department of Building and Safety .
• . This permit becomes void if work not commenced within 180 days from date of issuance. ORJf work has been suspended or abandoned for a period of 180 days.
'ADDRESS '- Xr
Oj♦J.711 78
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if +. ;
-LICENSED CONTRACTORS DECLARATION: I hereby, affirm. that I am licensed under. provisions of Chapter 9•"
the permit is for one hundred ($100) It, less. I certify that in the performance of.the work for which this permit is -
•' (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force '-
issued, I shall'ot employ any person in any manner so as to become subject a he Workers'Compensation Laws of
and effect.
California. (l (w /',/" +
k'5 '
License Class Lic... Number
Date r Applicant' f ,
Date Contractor
NOTICE TO APPLICANT:; If„after making this Certificate of Exemp ion,.you should become subject to the Workers'.. -
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
. Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
, w ..
be deemed revoked.
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.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ..
such permit to file asigned statement that he is licensed pursuant to,the.provisions of the Contractor's License Law
0 lherebycertify that no excaJation five (5) or more feet in depth into which a person is required to descend, will be
(Chapter 9(commencing with section 7000) of Division 3 of.the Business and Professions Code) or that he is exempt
made in connection with work authorized by this permit, and that no•building structure, scaffolding, falsework; or
. therefrom and the basis. for the alleged exemption Any violation of Section 7031.5.by any applicant for a permit
demolition ordismi ntling thereof, will be more .than thirty-six (36) feet high. (Chap 3.2, Grp 2 Art 2, Sec341, Title B,'
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): •-
• ' C.A.C.) '” - • - ' -
0 Las owner of the property, or my employees:with wages as their sole compensation, will do the work, and the
0 As owner=builder, I will not employ anyone to do work which.would require a permit from the Division•of . .
structure is.not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Industrial Safety, as noted above, unless such person has'a permit to-do such'work from that division.
Law does not apply to an owner of property who builds. or improves thereon, and who does such work himself or
n
-through his own employees. provided that such improvements are not intended or offered for sale. If, however, the'
0 Division of Industrial Safety Permit No.
buildingor improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that .
Date' Applicant -
he did not build or improve for the, purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there.is a construction lending'agencyforthe performance
0 1, as'owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec:.
of the work for which -this permit is issued (Sec. 3097, Civ. C.). t,
7044. Business and Professions Code: The Contractors License Law does not apply to an owner of property who
builds or improves'thereon, and who contracts fovsuch.projects with a contractor(s) licensed pursuant to the
Lender's Name
Contractor's License Law.). i 'rTi -^'*'
Lender's Address
+,.. ..
0 1 am exempt under Secy ✓ I . B. 8 P.C.,(Attached Certificate).. ..
I certify that I have read this application and state that the above information is correct. I agree to comply with all. •.
Date'r Owner' r
city and county ordinances and state laws relating to building construction, and hereby.authorize representatives
ZONE ORD t
of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a,
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Signature of Applicant or Agent Date
Policy.No. Company.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read Misapplication and state that
0 Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling. ..
0 Certified copy is filed with the City Building Inspection Department or -City Department.
construction, and authorize.a'representative of the City of La Ouinta Department of Building and Safety to enter
`•3
y y'
Date Applicant
upont_rope rty for w `h IT hav ted for this permit for the purpose of, k g pe`
- -
_ 7 /y 6
Signature of4wicant or Agent Date
=P .r
APPLICANT NAME If., i, MI)T_• Ala
'ADDRESS '- Xr
Oj♦J.711 78
CITY/COMMUNITY/STATE/ZIP T a ll a' T '•
JOB SITE ADDRESS/SPACE 53-705 Avenida Fkwtinez
'
CITY/COMMUNITY/STATE/ZIP iT . t I4th
JC+
OJ(
PA ?l
D
'Uec-t. Fee 66.10
SM Fee 5.11
TMM
PING
SE
S .
TRACT . I
LOT/0
MOD
s8
'
TRACT NAME
LLjLpp•
OWNER NAME If., F. MI)
iicarr
CONTRACTOR -FIRM NAME •_ ' ..
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
°"° sb4-3594
LICNC I
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE. A
LICNC n
USE OF PERMIT Simi.,-_ Fatiily Diiiielling
BL
ZON
FSB
SSB. I
SSB I
RSB
OFC
ZONE ORD t
_-I
.. ,LOT SZ .
ENDJ
SIDE.
Print Applicant/Agent Name
APPL/PRMT DATE SIF
Pewit to construct 1412 Sq.Ft. of S/FL/D
'220 117--.Ft. of Pcarci3 and 440 Sq.Ft. of
garage as per approved plans.
Itch. Fee 26.00
Plan Cheek Feej34.95
Ian
. A-j,I,—
Const. Fee" 352.00
'Uec-t. Fee 66.10
SM Fee 5.11
P1i nbing E'ee 31.00
- f
Prop. Deve1., Fee 450.00
1315.16
•%A..Jy.yy/ Cid
- A-V V.J.1V - -
TOTAL1315:1.6
FEE
ftj A 0 3 2 5 3 .15
BLDG. DEPT.
CA
VALUATION7118y3. 0
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
T� Kf
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
Fireplace T.O.
❑
NPON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts) L'�y
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb - el -
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final A r /4
le
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
s
\ DEPARTMENT OF BUILDING & SAFETY osr
Y COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
P S
t Ot-
V
UNITS
3 QO
- SO. FT. ®
1 ST FL.
JOB ADDRESS
COMMUNITY
OWNER
LtA%,4
G ,S
USEOFPERMITVALUATION
G OA C
Z
YARD SPKLR SYSTEM
GROUP
2ND FL. SO. FT. ®
TYPE
MICRO FILM FEE
Cop
$
PLAN NO.
FT.
V0
co
MOBILEHOME SVC.
BAR SINK
Dbl
POR. SO. ®
J
CHEMIC
PLUMBING
ELECTRICAL
STRUCTURAL
FIRE MARS
DATE DATE
NOT APPROVED APPROVED
la
CLEARANCE REO'D
❑ GRADING
ROAD DEPT
HEALTH DEPT
PLANNING DEPT
LAND USE
PL CK. FEE
CONSTRUCTION FEE
FT.
^% %o
CG6
POWER OUTLET
Dbl
ROOF DRAINS
Ip•
GAR. 'C> SO. ®
S
PLUMBING FEE
Dbl
S S \
CAR P. SO. FT. ®
f
y $^
001
DRAINAGE PIPING
WALL SO. FT. ®
DRINKING FOUNTAIN
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION
= j
.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
LL
C I'
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDUNG UNIT CFM
IQTCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMYUSE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
C) C)
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT ® c
BATH TUB
SO. FT. ® c
WATER HEATER
s C-1
MAX. HEATER OUTPUT, B.T.U.
SO.FT.RESID @1V44
11t 160
SEWAGE DISPOSAL
30 no
SO.FT.GAR®W.c
Qt,
HOUSESEWER
GAS PIPING
Z
PERMIT FEE
PERMIT FEE
PERMIT FEE
V Q
DBL
TOTAL FEES
MICRO FEE
MECH. FEE
PL. CK. FEE
CONST. FEE
ELECT. FEE
SMI FEE
PLUMB. FEE
TOTAL FEES $ I - 7c- k6 —m1–T1(;1'$U-0 m– } c'R
Q Lci • c 'A 7.,-
M.O. N.C. CASH C] CHECK [3 C.R.T.
RECEIVED BY
TREES REQUIRED REMARKS- '
SEWAGE SYSTEM -
-T -fit•- --- P — - - - / //_
SEWER DISTRICT l/`//O . /1 /
FORM 284.58 (REV. 8179)
JOB ADDRESS
COMMUNITY
OWNER
LtA%,4
G ,S
USEOFPERMITVALUATION
G OA C
Z
F.C.C.
GROUP
TYPE
MICRO FILM FEE
Cop
$
PLAN NO.
PLAN CHECKER
DATE
SUPP. TO PERMIT
MECH. FEE
Dbl
$
.cy'a
J
CHEMIC
PLUMBING
ELECTRICAL
STRUCTURAL
FIRE MARS
DATE DATE
NOT APPROVED APPROVED
la
CLEARANCE REO'D
❑ GRADING
ROAD DEPT
HEALTH DEPT
PLANNING DEPT
LAND USE
PL CK. FEE
CONSTRUCTION FEE
J
S ?
SIZZ
'15\
DW
ELECTRICAL FEE
Dbl
S
Ip•
SMI FEE
S
PLUMBING FEE
Dbl
S S \
CSO
f
y $^
001
TOTAL FEES $ I - 7c- k6 —m1–T1(;1'$U-0 m– } c'R
Q Lci • c 'A 7.,-
M.O. N.C. CASH C] CHECK [3 C.R.T.
RECEIVED BY
TREES REQUIRED REMARKS- '
SEWAGE SYSTEM -
-T -fit•- --- P — - - - / //_
SEWER DISTRICT l/`//O . /1 /
FORM 284.58 (REV. 8179)
r, .
Ito
Desert Sande Uni&d School District
N BERMUDA DUNES
RANCHO MIRAGE 82.879 HIGHWAY 1 1 1 • INDIO. CALIFORNIA 92201.6678 • (619) 347.8631
INDIAN WELLS a
d PALM DESERT a
0 LA OUINTA March 13, 1985
INDIO l�
e
RECEIVED
ED
PILAR 2 3 11985
COMMUCITY OF LA UINTA
N 7Y DEVELbPMENT DEPT
City of La Quinta
.Department of Community Development
78-105 Calle Estado
La Qui-nta, CA 92253
Re: 53705 Avenida Martinez, La Quinta
Gentlemen:
The developer of .the above referenced lot
has miti'gate'd its impacts on our overcrowded schools by.payment
of the amount of $628 per unit to be applied to the cost of
district educational facilities made necessary by such new
development. I
JDB/crm
Sincerely,'
John D. Brooks
Assistant Superintendent
Business Services