10553 (SFD)4
P.O. BOX 1504
Building78.105 CALLE ESTADO
Address 53-165 Rubio LA OUINTA, CALIFORNIA 92253
Owner
Melling
Address P. 0. Box 722
City Zip
LAQUINTA 92253
Contractor
Pacific Trades
Address
10553
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 774--A42"1021
I.
Legal Description I,ce 9 l�i.rsr�k 1 77
State Lic. City
& Classlf. B425381 Lic. # 1955
Arch., Engr.,
Designer
Address Tel.
City IZIp IStatee I
LICENSED CONTRACTOR'S DECLARATION
I herebyy efflrm�hgt I am licensed under provisions of Chapt r 9 (commencing with Section
�7000) of Dlvlslo 0 df the Business end Professions Code,e tl my license Is In full force and
. effect. �, <e �!�
(SIGNATURE - * DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buslness and Professions Code: Any.clty or county which requlres.8
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 B (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).
❑ 1 as owner. of the property, or my employees withwages as their sole compensation, will
do the work, and the structure Is not Intended or offered for sale. (Sec. 7044, Bulsness and
Professions Code: The Contractor's License Lew 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.)
O I, as owner of the property, am exclusively contracting with Ilcensad 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(a) licensed pursuant to the Contractor's License Lew.)
❑•I am exempt under Sec. B. & P.C. for this reason
Date Owner 1 1,
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.)
Polley No. Company
X 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 la for one hundred dollars ($100) valuation
or lase.)
I certify that In the performance of the work for which this permit Is Issued, I shall not
employ anypparson In any manner so as to become subject to the Workers' Compensatloh
Laws of Cellfornla.
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. 3087, Civil Code.)
Lender's Name
Lender's Addreae
This Is a building permit when properly filled out, signed and valldated, and Is subject to
expiration It work thereunder 18 suspended for 180 days.
I certify that I have read this application and stale 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'
Melling Address
City, State, 21p
Description QVITN
Sq. Ft. i 200 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Permit does not include block tqails Or
atimated Valuation
72,284.00
PERMIT
AMOUNT
Plan Chk. Dep.
t;n n n -
Plan Chk. Be,.
QA _ 2
Const.
;1 R nn.
Mach.
Kc;r%n
Electrical
1 1 c; 1 n
Plumbing
1 A 1 'nn
S.M.I.
17 14
Grading
A n
Driveway Enc.
nn
Infrastructure
TOTAL
A 11
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 ESTIMATENO.
ELECTRICAL FEES
NO. PLUMBINq FEES
1ST FL. SQ. FT. ® $
UNITS
2ND FL. SQ. FT.
COLL. AREA
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
FORMS
DRAINAGE PIPING
WALL SQ. FT.
ROUGH WIRING.
DRINKING FOUNTAIN.
SO. FT. ®
ROCK STORAGE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (ROUGH)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
REINF. STEEL.VZIGAS
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(OISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
SERVICE
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
/ /�
FRAMING L� N
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Vac
HOUSE SEWER
VENTILATION
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 PLUMBIN
69
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
fA
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 APPJEQUIP.
REINF. STEEL.VZIGAS
(FINAL)
TEMP. POLE iiy/
GROUT'
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
/ /�
FRAMING L� N
FINAL INSP.
ROOFING 2/-z 01
Z01OL
OL 4-0
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND 3
FINISH GRADING
FINAL INSPECTION-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
BuildingS-3-165 4 v C e" � ()
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address g. �X _? Z Z
City Zip Tel.
La. 'izZ�3
Contractor
Address
City lZip Tel..
State Lic. 3
& Classif. � � 2.�j
Arch., Engr.,
Designer
Address
City lZip
Tel.
State
Lic. #
LICENSED CONTRACTOR'S DECCARAT-10
»,licensed unQQer provisio sof Chapter 9 (cofnmencing with Section
VBU anc� P -ori fessifind Code, and my license is in full force and
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 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).
C 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 l 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. & 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
❑ 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 thl 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 foifhwith
comply with such provisions or this permit shall be deemed revoked. Y
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 1 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 DIVISION
,.AI PLICATION ONLY
i�
BUILDING: TYPE CONST. �, OCC. GRP:
A.P. Number / 41—
Legal Description. //D7
Project Description
13
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.
.I,nfrastructure i
1yeC 5 P f'l,410 �• v E)
TOTAL
REMARKS
t40rts;: rQcu ;
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 FAZES
1ST FL. SQ. FT. @ $
2ND FL. S0, FT.
POR. SO. FT. @
GAR. SO. FT. @
CARP. SD. FT.
WALL SO. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)IDISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM 1
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11A c
SEWAGE DISPOSAL
SQ.FT.GAR @ ?Gc
OUSE SEWER
REMARKS:
VENTILATION
PIPING
PERMIT FEE
PERMIT FEE
E4GAS
ERMIT 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 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
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
ivlCs,iGNAt UKt511Nl1lAL5
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82=879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 2/7/92 1 Type ',of Permit I La Uinta
No. 111174 Permit # 110553
Owner Name David, R. Miller Y.og #
No. 53--165. street .:Rubio
City La Qunta zip 92253 study Area 111
APN # 774042-021 Tract # 1, Lot # : Square Footage 1200
Type of Development ISip9le 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,; res d .ntial� 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-puzsuanfto .Government Code 533080
in the amount of 1.58 X 1' 00 or $ 1;896.00 have been paid to D.S.0 S.D. for
the property listed above. and that building perm is xi"r, Certificates of Occupancy for
this square footage in this proposed project" may now. be issued.
Fees Paid By David R. Miller Telephone
Name on the check
gY James E. Lively,
Assistant Superintendent, Business Services
Fee collected Jexempttd by
Signature
Collector. Attach a copy o`l coundy or city p4
Embossed Original- Building Dept:/Applicant
Payment Received
Check No. 1367
k application.form.to district copy for all waivers.
,Applicant/Receipt' Copy - Accounting