11956 (SFD)r
- 4
P.O. BOX 1504 No. 11956
Building 54-880 Rt1bj C3LA QUINTA, CALIFORNIA92253 1
Address _
Owner
MailinRoger L. Kringer BUILDING: TYPE CONST. OCC: GRP.
Address 75-641 Canino De Pecs 774-292.-007
A.P. Number
City Zip Tel.
Indian Wells 92210 Legal Description Lot i8 Blaek 278 -
Contractor Project Description SPS
Team Builders -
City f - Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm tha 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 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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to fife 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
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 or 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
j O Copy is filed with the city. O Certified copy is hereby furnished.
1 CERTIFICATE OF EXEMPTION FROM
' WORKERS' COMPENSATION INSURANCE
l+' (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 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
ateMailing Address
City, State, Zip
Sq. Ft. No. Nb. Dw.
Size 1849 Stories Units
u
New O Add ❑ Alter ❑ Repair ❑ Demolition ❑
Permit includes stucco wall. Pool
�rcx rs.i. " x;� al n>t:tci is �cA Fc>v�
Estimated Valuation o lUJ 3 F1310.9 • iJV
PERMIT
Address
79-600 Cortez Laze
City
La Quinta,
Zip
92253
Tela
3473701
State Lic.
& Classif.
City
Lic. #
Arch., Engr.,
Designer
Address
Tel.
City f - Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm tha 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 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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to fife 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
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 or 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
j O Copy is filed with the city. O Certified copy is hereby furnished.
1 CERTIFICATE OF EXEMPTION FROM
' WORKERS' COMPENSATION INSURANCE
l+' (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 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
ateMailing Address
City, State, Zip
Sq. Ft. No. Nb. Dw.
Size 1849 Stories Units
u
New O Add ❑ Alter ❑ Repair ❑ Demolition ❑
Permit includes stucco wall. Pool
�rcx rs.i. " x;� al n>t:tci is �cA Fc>v�
Estimated Valuation o lUJ 3 F1310.9 • iJV
PERMIT
BY:
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
JA I V
Const.
Side Setback from Property Line
4..50
Mech.
INSPECTOR
gad. UJ
Electrical
Validated by:
1 51d 4 t)
Plumbing
Validation:
4 .Ou
S.M.I.
1Z.Ulu
Grading
2 . Ou
Driveway Enc.
—
Infrastructure
_
2t34.12
♦yi. i.iJ 11:J
ii167.Y oY: k'dC�,iet'..'F
C� . iiL`3 -
TOTAL
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:
a
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
•
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
r
YARD SPKLR SYSTEM i
2ND FL. SQ. FT.
FORMS
SEWER CiR-6ERIlG79DU4!� t ROUGH WIRING.
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
OTHER APP./EQUIP.
DRAINAGE PIPING
WALL SQ. FT.
7t,?,G
DRINKING FOUNTAIN.
SQ. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
_ $
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
�/_^�
12
/
t` 3
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
VENTILATION
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
GAR. FIREWALL 23 f S
r
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK.FEEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE / PLUMBING ' ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING f4t&?' // UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER CiR-6ERIlG79DU4!� t ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) ) 'METER LOOP'
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL 7
GAS (FINAL) TEMP. POLE
7t,?,G
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
yd.
$ plus x$
_ $
LUMBER GR.
FINAL INSP.cu.
FRAMING (.0FINAL
INSP. / (��/��L
ROOFING %,...�j.�
�/_^�
12
/
t` 3
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL 23 f S
r
LATHING _? r
MESH
INSULATIONISOUNY2. 14
FINISH GRADING
FINAL INSPECTION I�-Cr-� LQ
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
•'FI''7
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 3/31/93
No. 112122
Owner Name
Type of Permit
Roger L. Kringen
No. 54-880 Street Rubio
City La Quinta Zip 92253
La Quinta
Permit #
Log
Study Area 110
APN # I Tract # Lot # 0 Square Footage 11849
Type of Development Single Family Residence I 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 53080
in the amount of 1.58 x 1849 or $ 2,921.42 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 __ Roger L. Kringen Telephone
Name on the check
By
Assistant Superintendent, Business Services
Fee collected /exempted by L94-
a e Arthur r v�
r ;
Payment Receivecl�'
Signature
.1 x
g CHeck
Collector: Attach a copy of county or city plan check application form to district copy fa Zallwaivers.; %
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy- Accountinv C J
ti, t
Titof 1a utnta.
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building!
Code certifying that at the time of issuance this structure was in compliance with the various.
ordinances of the City regulating building construction or use.. For the following:
BUILDING ADDRESS 54-880 Avenida Rubio
Use Classification -.Single Family Dwelling Bldg. Permit No. 119*56
Group R3 -Type Construction VN Fire Zone Use Zone SR
Owner of Buin Address
Roger L. Kringen 75-641 Camino De,Paco
Indian Wells, SA 92210
Bye
Lonni.e. Dgy
Date; November 4, 1993,
Building Official POST IN A CONSPICUOUS PLACE
� I