09211 (SFD)Building
Address...
Owner
William
Mailing
Address
Zip Tel.
1
same
City lZip Tel.
State Lic.I City
& Classif. .ti* ".%.. V ^-% Lic. #
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70(10) t. of Division 3 of the Business and Professions_Crode, and my license is in full force and
effec%
SIGNATURE i y",0 ! •S \.!+ 4 1 1 �! 4 DATE
W OWNER -BUILDER DECLARATION []
1 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 file 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, 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 five hundred dollars ($500).
❑ 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
orimprovement 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 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 property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
7
r i i %if I A ysr
Date %r Owner
WORKERS' 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. Company
❑ Copy is filed with the city. '•❑ Certified copy is 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: If, 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.)
Lender's Name
Lender's 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
BUILDING: TYPE CONST
A.P. Number
IQJ
No.
OCC. GRP.:
Description Lot 23 Block 257
Project Description
09211
SFD
Sq. Ft.i�� No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
250,00
Plan Chk. Bal.
174.73
Const.
576.50
Mech.
109.89
Electrical
159,150
Plumbing
1 %6, A
S.M.I.
A 7 A?
Grading
7A, Ml
Driveway Enc.
20.00
Infrastructure
Z$5a Q5
V*-% WAJ* PDT 09� 4 2`;U i $ . 60 -q
TOTAL
3324..69 3074.6
REMARKS
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. SO. FT. ® $
UNITS
SLAB GRADE ��
2ND FL. SO. FT.
ROUGH PL MB.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK t
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. S0. FT.
ROCK STORAGE
DRAINAGE PIPING
WALL SO. FT. ®
GAS (ROUGH)
DRINKING FOUNTAIN; '
SO. FT. ®
OTHER APPJEQUIP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WAIER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
_$
LAUNDRY TRAY -
AIR HANDLING UNIT CFM
FINAL INSP.
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.
SQ. FT. ® c
BATH TUB
FIRE ZONE ROOFING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/Ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
IL
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 '2 09 f/ //U
GROUND PLUMBING ' /V//
NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ��
Al
ROUGH PL MB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING 6
FINAL INSP.
VeOFING,�2,�)
l
�/� �� / //� �,� QZ /��(j
(
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
4
` P.O. BOX 1504 APPLICATION ONLY
Building ,� �,� �, ,, r 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Sl�.
L_L`h c,.-, I�l-Q� BUILDING: TYPE CONST. SI>� 'rOCC GRP.
Mailing
. Address A.P. Number
City Zip Tel. �1 n �1 �1
Legal Description rll� I-) (JL� kS 1
Contra t . b Project Description
Address
r
!V�
City Zip 1r Tel.
State Lic.
City
& Classif. i3 �n 1(�'L
Lic. #
Sq.Ft.Ft. ���( No. No. Dw. j
1c Stories Units 1
Arch., Engr.,
Designer
New Ci Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in f II force and
effect. I
i -, r• 1
, A
SIGNATURE { 70y,!_ 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 any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division3 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 five hundred dollars ($500).
❑ 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
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 one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
❑ 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 or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
S•M.1.
Grading
Driveway Enc.
Date � Owner
frastructure
WORKERS' 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. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
REMARKS
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: If, 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.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code
Side Setback from Property Line
Lender's Nam eip ��Q� SIJ jbeJ�
Lender's Address ! r'c�i � Y sc�T
This is a building permiten properl�out, signe and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
FINAL DATE INSPECTOR
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 representativgs pt his city to enter the ab e-
mentioned property for ins ct on purposes. t !/ f//
Issued by: Date Permit
Validated by:
Signature of applicant f/-' ✓yV!1 Date
Mailing Address
Validation:
City, State, Zip
FINANCE
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 2/12/91 Type of Permit La uinta
No. 10417 Permit #
Log #
Owner Name William L. Shields
No. 52-820 street Carranza
City La Quinta zip 922853 Study Area 112
APN # I I Tract # I Lot # ® Square Footage 114W
Type of Development Single Family Residence No. of units
Comments
At the present time, the Desert Sands Unified School District does not collect fees on
garages/carports, covered patios/walkways, residential additions under 500 square feet,
detached accessory structures or replacement mobilehomes. It has been determined
the above-named owner is exempt from paying school fees at this time due to the
following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53M
in the amount of 1.58 X 11.466 7 or $ 2,316.28 have been paid to D.S.0 S.D, for
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By Shields Inv. Telephone 3604M
Name on the check
By Richard M. Beck
Director, Facilities Planning & Development
r
Fee collected /exempted by Shelley D. Bennett = -
Payment-,. cei:vac1,1 : r
Signature P� ',
- - - Check' Flo. 106
Collector: Attach a copy of county or city plan check application form to district�cupy:pfusyall waivers.
Embossed Original- Building DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
❑Copy to:
Cash
Check
Money
Order
Water Service
Cashier /C —
CVWD-438(11189)
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
62! , f)9%
Received From: S�It�G�S IMILS'TI'►
n T
-CMTS *
Oate:
Address: LAS -6-75 C u2 LC'-/
eA.
97-7, /a
Account No. %f i'/ to
Lot(s) Tract Sc,
--�
.� C
BLh
Service Address A ILAA
I(>' 2A_ G.A. Code
414eter(s) z –�
.9 0
$
rvice(s) f �" l ��
V �� �•�
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
r
❑ Meter Surcharge =
00
75
anitation Capacity'Charge
❑ W.S.B.F.C.
r
❑ Temporary Construction Meter
❑ Tum on Charge
❑ Uncollected Account - Name
❑ Inspection Fee -Tract -
g
Fee -
.
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
O
TOTAL
$
Remarks:
❑Copy to:
Cash
Check
Money
Order
Water Service
Cashier /C —
CVWD-438(11189)
%
o `
OFFICE OF
AGRICULTURAL COMMISSIONER
AND
4r, 1 • WEIGHTS & MEASURES CALVIN C. KAMINSKAS
JAMES O. WALLACE 4080 LEMON STREET, ROOM 19 AsiRlant Corninisslotinf
Agricultural Commissloner RIVERSIDE, CALIFORNIA 92501 CLEMENT BENVENISTE
D410001 of welghts & Measures (714) 787-2561 Sealer
83-612 .Ave .. 45 , Suite 7
'Indio', CA 92201
(619) 342-8291
DATE CASE NO. �C
DEVELOPER' S NAME:
ADDRESS %jn tD
va_ syJ91k,
TELEPHONE: G-0,eL-o
Dear Developer:
After reviewing your landscaping plans, all.plant material listed is not in
violation of quarantine laws governing the Coachella -Valley. If substitutions
do occur and they differ from plant -material listed, this office must be notified
imnediately.
Thank you for protecting and preserving the -Coachella Valley's pest -free environment.
Agricultural CcmnissionerU Office
ccs Indio and Riverside Office
P.O. sox 1504
76105 CALLE ESTADO
LA OUINTA. CALIFORNIA 92253
CV
Contractor VJN.., 1711%14bS Owner w vw-
Address zl��. Job Address S2 -a'l.0 PmlttLerYL.b
c.r • (_bA Lek CVU -1,-i
La Quinta City License No.: Expires: Bldg. Permit No.:
This form shall be posted on the job with the Building Inspection Card and it
shall be the duty of the General Contractor or if Owner -Builder Permit, the owner
to see that all sub -contractors sign this card, giving his City of La Quinta
Business License Number, Contractors License Number and a current certificate
of Workman's Compensation Insurance Certificate when he starts the job. Failure
to comply may cause Building Inspectors to stop work, or complaints to be filed
against such contractors or owners.
CITY CONT.
SUB -CONTRACTORS NAME LIC. NO. EXPIRES LIC. NO. EXPIRES
1. Grade i Excavate
2. Pipelines
3. Cement -Foundations �',ll Q.UGir(LT
4. Cement Walks i Drives ,�u� (L'o=s
5. Asphalt Paving
6. Framing o
7. Steel Structural
S. Masonry '�,�,` (I•C�C
9. Plumbing AiNy"y'L O(LCptJ
L0.' Lathing
L1. Drywall jg Saec-AJ
L2. Plastering (ZIJ?s- PL6rt1%
L3. HVAC
L4. Electrical C•ME &&Aft C,
L5. Roofing
16. Sheet Metal St►E+
L7. Floors -All Types
18. Glass - Glazing LQA0)AJtjdlloK(_
19. Insulation/Weatherstrip VLOVA44 K)&91,%
20. Sewage Disposal
21. Painting/Decorating
22. Tile
23. Cabinets -Installations Am %EiL<
24. Ornamental Metal
25. Fences/Blockwalls pla QpC,L(U
26. Landscaping
27., Others
28.
DO NOT REMOVE THIS CARD
Before Final Building Inspection Will Be Made
Thi` :orr u,_%st Be Completed and Filed With Title 24 Calcs and Plans
Buena Engineers, Inc.
79-811 B Country Club Drive
Bermuda Dunes, CA 92201 • (619) 345-1588
Client
Client Address
Client Phone
DATE
d-1- S
JOB NO.
-7 -30o'?-
PROJECT
LOCATION
/1-01
CONTRACTOR
OWNER
WEATHER
C— t-14
TEMP.
o at AM
° at PM
PRESENT AT SITE
OPTIMUM
MOISTURE
CONTENT
%
nn
,�,� U✓�
TEST
NUMBER
TEST LOCATION
q,
LOT
NO,
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
%
DRY
DENSITY
IbsJCu. tL
MAXIMUM
DRY
DENSITY
%
MAXIMUM
DRY
DENSITY
IbsJcu. ft.
OPTIMUM
MOISTURE
CONTENT
%
nn
,�,� U✓�
03
5
/s
REMARKS:
v L
N/
CLIENT REPRESENTATIVE SIGNATURE
FIELD REPORT
TECH ICIANS SIGNATURE 18919