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9641 (BLCK)• iF P.O. BOX 1504 No. 9641 Building 7&105 CALLE ESTADO 1 ` Address 77�-243 ��`� LA QUINTA, CALIFORNIA 92253 G Owner I Rat Ross Mailing BUILDING: TYPE CONST. OCC: GRP. Address 77899 Wolf Rodd #102 A.P. Number City Zip Tel. Re rmnda 3hinef 92201 Legal Description Contractor Project Description Pool and 235' of 5' block wall and Address 77899 Wolf toad *102 -1001 of 4' block gall City Zip Tel.: B.D. 92,201 345-5521 State Lic. City & Classif. 447803 Lic. # 1134 Sq. Ft. No. No. Dw. Arch., Engr., Size Stories Units • Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. CityZip 7 State I a Lic. # dICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am li ensed funder p ovisions of Chapter 9 (commencing with Section of Division 3 of tf OE3 iness and Pr essions Code, and my license is in full force and effect. �%` SfGNATURE DATE OWNER•BUILDER DECLARATION !� Estimated valuation 37,732.00 I hereby affirm that lyam exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Busfness 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 PERMIT AMOUNT 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 Plan Chk..Dep. subjects the applicant to a civil penalty of not more than five hundred dollars.($500). 3 g r .❑ I, as owner of the property, or my employees with wages as their sole compensation, will . Plan Chk. Bal. 4.93 'do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 284 .5U . -.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, Mech. 24.UU 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 Electrical 30 • aO 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- Plumbing - 21.00 struct the project. (Sec. 7044, Business and.Professions Code: The Contractor's License Law - does not apply to an owner of property -who buildsorimproves thereon, and who contracts for S.M.I. 3.130 such projects with a contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C.: for this reason Grading Driveway Enc. Date owner Infrastructure 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.) Polic No. Company Copy is filed with the city. ❑Certified copy is hereby furnished. TOTAL 5 4 7 e 4 3 CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (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 or 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 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 REMARKS A_Z 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. SQ. FT. ® $ UNITS COLL. AREA 2ND FL. S0. FT. ROUGH PLUMB. YARD SPKLR SYSTEM POR, SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. S0. FT. ® DRAINAGE PIPING WALL SQ. FT. FOUND. REINF. DRINKING FOUNTAIN. SO FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ REINF. STEEL WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES GROUT WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER BOND BEAM (� I� GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL GAR. JWL SQ.FT.GAR ® 3/ac HOUSE SEWER 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 Q UNDERGROUND C g� A.C. UNIT COLL. AREA SLAB GRADE L171 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS 'r SEWER OR SEPTIC TANK ROUGH WIRING. DUCTWORK �L,o. ROCK STORAGE FOUND. REINF. GAS (ROUGH) (Q QI 66 METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM (� I� WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. g I FRAMING UI (u/Ct FINAL INSP. / `( �r� ROOFING � l� f/ � aB��nr�p 06lac i►1bt�(V[C f j��.`4( LO (JIJv ✓ I ' REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE( SPARK ARRESTOR GAR. JWL LATHING a19 MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION (( 'N CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 1/4/91 1 Type of Permit I La Quinta No. 110357 Permit # Owner Name M/M Pat Ross Log # No. 77-240 street Arteaga city La Quinta zip 92253 study Area 109 APN # I Tract # 14496-5,6& Lot # = Square Footage *1 Type of Development Single Family Residence No. of units Comments .$62,9_00 per unit as per grandfather ngrPPmPnt_ Chame is 5303 sg_ft_1 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 Mitigation Agreement in the amount of 628.00 X10 or $ 628.00 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 Patrick/Patricia Ross Telephone ( Name on the check Ln Richard M. Beck Director, Facilities Planning & Development t v i Fee collected /exempted by Shelley D. Bennett j v - Payr pnt Remixed Signature �- Chock- No. 105 Collector: Attach a copy of County or City Plan check application form to Disl?.4 t caP Y• Embossed Original- Building DeptJApplicant Copy - Applicant/Receipt Copy - Accounting