12710 (SFD)1 44 1
P.O. BOX 1504 N o . 12710
Building 52-995 Ave. Rubio 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner David Ross Miller
mailing
Address P.B. Box 722
City Zip Tel.
La Quinta, C 92253
CIV&a,acTTic Trades
Ad reU. Box 722
11LDING: TYPE CONST. OCC. GRP.
P. Number 773-312`'026
Project Description
--iia ouinta, ml- 92253 -.. 342-8363
State Luc. B x}25381 City 1955
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City (Zip (State
Lic. #
�\ k\ i `""LICENSED CONTRACTOR'S DECLARATION
b
I hereb'taffirm,that I am'Iicensed under provisions of Chapter 9 -(commencing with Section
Z000) of ivision`3'ofjtthu Business and Professions Code, and my license is in full force and
j 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 ,permil 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 thathe 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).
❑ 1, 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 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
Date 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
❑� Py
is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
I (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 thg 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 or 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
ateMailing Address
City, State, Zip
Io.,)t 13 dock 170
SPD
Sq. Ft. No. No. Dw.
Size 1257 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Permit includes patio and wooden fence.
Retaining walla and/or pool permits to be
obtained separately.
Estimated Valuation
$77,215.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
215.73
Const.
540.50
Mech.
_
55.50
Electrical
117.53
Plumbing
144.00
s.M.l.
7.72
Grading
20.00
Driveway Enc.
00
Infrastructure
11690.10
Precise Plan
25.00
TOTAL
3,066.13
\j2,816.13
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 /
Validated by:',
Validation: �1 A " r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PIL IBING MEES
1ST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB. BONDING
t 0 t
STORAGE TANK
YARD SPKLR SYSTEM --
2ND FL. SQ. FT.
DUCT WORK
e
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL
GAS (FINAL) /IS TEMP. POLEI "—Z7' ? C/
v
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. _
FINAL INSP.
DRAINAGE PIPING
CARP. SQ. FT. ®
LUMBER GR.
FRAMING .� 7 ��j
O�
WALL SQ. FT. ®
,n �, Z/�
7 `L� 5`"Y'
C
nl '
��� --4
7 ✓VL-
(� ` L/
Pell
DRINKING FOUNTAIN.
REMARKS:
URINAL
SO. FT. ®
VENTILATION
ESTIMATED CONSTRUCTION VALUATION $
FIRE ZONE ROOFING
WATER PIPING
NOTE: Not to be used as property tax valuation
FIREPLACE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(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.
SQ. FT. @ c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GARDEN WALL FINAL
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 r NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWEFr;19" PYfCfitkfi UGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) /IS TEMP. POLEI "—Z7' ? C/
v
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. _
FINAL INSP.
ADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING .� 7 ��j
O�
ROOFING p[// �/�
�l�
,n �, Z/�
7 `L� 5`"Y'
C
nl '
��� --4
7 ✓VL-
(� ` L/
Pell
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL p,(/
LATHING
MESH
INSULATION/SOUND %�.
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
TA
4
u�l'Gv.
P.O. BOX.1504
Building. Jc` QU�t1 V LA QUINTA CALIFORNIA
DO
Address 92253
Mailing ,
Address e
City Zip
Contr?tor
Address
C A 0-k
City lZip Tel..
State Lic. City C
8 Classif. 6 y Lic. # _l
Arch., Engr.,
Designer
Address Tel.
CityZip State
Lic. #
/\ LICENSED CONTRACTOR'S DECLARATION
I hereby agirr�t' th,&a�,Lam licensed undet provisions of Chapter 9 (co menci g with Section
7fXX)pof Df iis�io�/3 01 he Busine s and Professions Code, and my lice se is i full torce,and
effec��`K W - � i 1 t �Cl �!
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, 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 or Section 7031.5 by any applicant for. a permit
subjects the applicant to a civil penalty or not more than five hundred dollars ($500).
I"; 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 or completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
t'I 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.)
17 1 am exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
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
l7 Copy is filed with the city. O 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 it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
1 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, Slate, Zip
BUILDING DIVISION
APPLICATION ONLY
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number �i 3
Legal Description E b T I .� 11c (1 v
Project Description
Sq. Ft. No.' No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS y
ZONE: t BY:
Minimum Setback Distances:
FINAL DATE
I Rea' -tba kc� RearLqrop.
It
_Sid3e� treet Setback from Cent .r
R
Issued by: rsv Date
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES,
1ST FL, SO. FT. @ $
UNITS
SLAB GRADE
2ND FL, SQ. FT. @
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC,
BAR SINK
GAR. SO, FT, @
POWER OUTLET
ROOF DRAINS
CAR P. I SD. FT. 0
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ. FT. @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP,
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.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 1'A c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR @ 3/<c
USE SEWER
LATHING
#GASPIPING
PERMIT FEE
PERMIT FEE
RMIT 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
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND, REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS„ UNIFIED SCHOOL DISTRICT
82-879 Hi liwa '111
NOTICE: Indio, CA 9220.1
Document Cannot Be 'Duplicated 619-775-3500
x:4.
Date 1/25/94 Type ofPermit•l La.Quinta
No. 12631 ' - Permit #
l
Log
Owner Name. David Ross Miller':
No. 152995. � Sti eet,,Avenida Rubio: a .
City La Quinta Zip 92253 :Study Area 113
APN # 773'=312-026 Tract #` Lot41013' Square Footage 1257
-
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 patiostwalkways, residential additions unde'r.500 square feet,
detached accessory structures or` replacement mobilehomes. It has-been determined
the above-named owner is e.xem. f from paying; school' fee's at this time due to the
following reason:
EXEMPTION NOT APPLICABLE t
This certifies that school facility fees imposed pursuant to
in the amount' of 1:65` . ' X' 1257 or $x2,074.05 ,'
the ;property listed above and that building;permits andlo,j
this square footagi in this,proposed prolect_may now be4s
Government Code 53080
have•beeri paid'to-.D.S.U.S.D. for
Certifieafes of Occuvancv for
Fees Paid By David .= Ross Miller. - Telephone
Name on`,the check:
s
By' Dolores A. Ballesteros -
Superintendent
Fee collected4exempted.by. 'Vickie. Durrett
i Payment Received'
117r
Signature -Check `No. 3943
Collector: 'Attach a copy.of county or city plan'check application -form to district--copyfor all waivers.
Einbossed Original- Building-Dept./Applicant" Copy Apphcarit/Receipt Copy - Accounting
i
j� �45' � }� tis• I I li, II.
DO PF
r r
it It ;I i;A.1
j.
It 1*11htlttj �ilt1 ctf i` ti�tt�it
I l;I
This Certificate issued pursuant to the requirements of Section 306 of .the UhiformfiBuilding
I _
h
Code certifying that at the'time,of issuance this•structure was in compliance`with the various
z ordinances of the City regulating building construction 6i'use. For the following:
'I
BUILDING ADDRESS 52-995 Avenida Rubio II
Single Family Dwellings 127:10
j` Use Classification Bldg. Permit No::
Group R3 Type Construction VN Fire Zone Uss Zone SR
Owner of Building David Ross Miller address P • O. Box 722
City La Quinta, CA 92253
By; Mark Harold'
(I I
Dote: January 309, 1995 I'
I I I �� 'I• may" t �I r'
Building Official
POST IN A CONSPICUOUS RAC[
�,,. -'' .'�°""--r - - ..'_ -Ytl����l .?i�'>M''JM':c-.i.�s..o/MMi.c•, -..�._rf... �li.vm;..r