12619 (SFD)Building 54-385 AVENIDA CAP-RAi ZA
Address
Owner
JP"MES SELKN"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address
City
Contractor
Address
P.O.BOX 29.7
City Zip Tela
vALK DESERT 922.61 564-2783
State Lic. City
& Classif. 65.2815 JB Lic. # 2845
Arch., Engr.,
Designer JORGE E. SEPTIEN
Address Tel.
P.Q.EDX 3187
City Zip State
palm springs 1 92263 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 full force and
effect.
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 hund: ed 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 or 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.)
O 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
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that I have a certificate of consent to -self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy ther-eof.•(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 it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thq 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.
Dale 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.
i
CONSTRUCTION LENDING AGENCY
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.)
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 slate 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. 12619
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 774-242-017
Legal Description lot 7 block 287
Project Description cSr
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 N
FINAL DP
Issued by
Validated
Validatior
a _ .�,}.i
Sq. Ft. 160 'is.
Size
No. No. Dw.
Stories Units
New QC Add ❑
Alter ❑ Repair ❑
:Demolition ❑
PERMIT
INCLUDES 1801 fo 6'
V?T
TXTnf`V W T.T.
Estimated Valuation
$961615.00
PERMIT . '
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
a
Const.
buBuu
Mech.
!) b .bu
Electrical
1215.AU
Plumbing
14l.i�{)
.S.M.I.
9.66
Grading
dt}. ti53
Driveway Enc.
Infrastructure
r. i1bZ 25I.Ou 25I.
Los.
TOTAL
3575.10 33
.lU
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 N
FINAL DP
Issued by
Validated
Validatior
a _ .�,}.i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
ROUGH PLUMB.
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2 ND FL. SO. FT. @
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. @
REINF. STEEL
GAS (FINAL) TEMP. POL z—
GAR. SO. FT. @
POWER OUTLET
I ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. SO. FT. @
WATER SYSTEM
GRADING
FINAL INSP. cu. yd.
FINAL INSP. ��/� $ plus x$
_$
WALL SO. FT. @
FRAMING _ L 1,
DRINKING FOUNTAIN
u f
",V 2--2-1-93
�OSTG{ Rr""
30 LU°
URINAL
SO. FT. @
VENTILATION
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
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SO. FT. @ c
BATH TUB
FINAL INSPECTION
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
GARDEN WALL FINAL
SO.FT.GAR @ 3/4c
HOUSE SEWER
INSPECTOR'S SIGNATURESIINITIALS
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/ -12,0/e//%4 ✓UNDERGROUND
VBONDING
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
HEATING (ROUGH)
STORAGE TANK
FORMS a
SEWER 0Tr%l!PTIe-""W`—(7(ROUGH WIRING
1
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POL z—
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
FINAL INSP. cu. yd.
FINAL INSP. ��/� $ plus x$
_$
LUMBER GR.
FRAMING _ L 1,
ROOFING
u f
",V 2--2-1-93
�OSTG{ Rr""
30 LU°
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL 3 G
LATHING _ _Cj(
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
GARDEN WALL FINAL
INSPECTOR'S SIGNATURESIINITIALS
CALVIN C. KAMINSKAS
Asslslanl Commissioner e
(714) 275.3000 v
i
OFFICE OF
AGRICULIURAL COMMISSIONER
JAMES O. WALLACE. Commissioner
83-612.Avenue 45 Suite 7
Indio., CA 92201
(619) 342-8291
CASE NO. C_Y PC V?- 14
DAN RILEY
Sealer, Welghls be Measures
(7141275-3030
DEVELOPER'S N11ME s
1.
ADDRESS:
TELEPHONE: //�
S� (4- � b S ITV�c �R r}�..r 2a4 LA l�i� t k R
Dear Developers
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.
�jv
Agricult 1 Comnissioner s Office
cc: Indio and Riverside
4080 LEMON STREET, ROOM 19, RIVERSIDE, CALIFORNIA 92501 — FAX (714) 275.3012
i
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 1/3/94 1 Type of Permit I La Quinta
No. 112590 Permit #
Log
Owner Name James Belknap
No. 54385 Street Avenida Carr`anza
city La Quinta Zip 92253 Study Area 112
APN # I Tract # I = Lot # 0 Square Footage 11608
Type of Development I Single Family Residence No. of units 0
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 53080
in the amount of 1.65 x 1608 or $ 2,653.20 have been paid to D.S.U.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 Tames C. Belknap Telephone
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Vickie J. Durrett -
Payment Received
Signatuiefjf_,k:llZ; check No. 686
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
'RECEIPT CitrofLaQuinta,78-105Calle
REC EIVED.FRO
ADDRESS
FOR
AMT. PAID I I/lICHECK
UALANUt I jk_qmONEY
DUE ORDER
DATE — /
BY
P. 0. Box 1504, La Quinta CA 92253
19 07// No42 -3.6
DOLLARS $
DEC 2 3