13707 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 52-020 Ave. Ramirez LA QUINTA, CALIFORNIA 92253
David Ross Killer
Mailing
Address P.O. Box 722
Cita Qu4nta, CA zip 92253 Tel. 564-0273
CoMractor
acific Trades
Saalte
City lZip —FTel.
State Lic. City
& Classif. B 425381 1 Lic. # 1955
. -'I — — -1
Designer
Address Tel.
City JZip State
I Lic. #
.9 (commencing with Section
my licen se 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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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).
0 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.)
0 1, 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.)
0 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.)
PolicA�N�,!!_' Company
0 opy is tiled with the city. 0 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 th� work for which this permit is issued, I shall not
employ any person in any manner so as 0 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. 309 7, 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.
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 properly for inspection purposes.
Signature of applicant -Date-
Mailing Address
City, State, Zip
No. 13707
BUILDING: TYPE CONST.— MR OCC GRP.- R3
A.P. Number 773-222-001
Legal Description Lot 2 2 Block 77
SFD
Project Description
Sq. Ft. No. No. Dw.
Size 1393 Stories Units
New 0 Add 0 Alter 0 Repair 0 Demolition El
Permit includes masonry wall return
to house. Additional block work
and/or pool permits to be obtAined
separately.
Estimated Valuation $89,495.00
PERMIT
AMOUNT
Plan Chk. Dep.
1%5^ 0^
Plan Chk. Bal.
258.67
Const.
599.00.
Mech.
55.50
Electrical
122.02
Plumbing
144.00
.S.M.I.
8.95
Grading
20.00
Driveway Eric.
.00
Infrastructure
Validation:
vx—,ecise
25.00
TOTAL
3,400.25, /JJ, 159-� 25 1
M-1 :
REMARKS
U
JUI 1 9 1994 11116
V I
ZONE:
—BY:
Minimum Setback Distances:
Front Setback frorb-Cente'r Line VA
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. -PLUMBINGFEES
IST FL. SO. FT. a $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. @
DUCT WORK
ROCK STORAGE
FOUND. REIN51
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. @
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. @
WALL SO. Fr. @
WATER HEATER
DRINKING FOUNTAIN.
.
FINAL INSP.
URINAL
SQ. FT. @
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADIN
—cu. yd.
—plus—x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
ROOFING 8'-?LIY ZR
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. Fr. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
INSULATIONISOUND,?—/2-1,01/,gi
SO.FT.GAR @ V4c
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT.FEE
SMIFEE PLUMB. FEE
STRUCTURE I 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. REIN51
GAS(ROUGH) A0 --7
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADIN
—cu. yd.
—plus—x$
$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING 8'-?LIY ZR
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREw�2/z,
LATHING -00'
MESH'
INSULATIONISOUND,?—/2-1,01/,gi
FINISH GRADING
(::]LFI11NAL IN N
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED -SCli(jOL, DISTRICT'
hw
82-879.Hik ay 111
NOTICE: Indio, CA'.92201:
Document Cannot Be Duplicated -6i0-77'5-3'5 , 00 -
Date 7/11/94 Type of Permit rLd Quinta
No. 12946, Permit #1
Owner Name
APN #
Log Jq __j
David-'Ro8s Miller
,Streev.Avenida.�Ramirez'
N o. �202_0
Cit L�a-Quinta
Zip -92251.1" "Study Area
Tracffk.�. 7j. Lot* S quAre FoDUge, 1393
Type of Development 'I Single TArnily -Residence'-�.-.' No. ofunits
Comments
At the present time, the, Desert Sands-Unifibd Sch661 District does not, collect fees on
garages /carpofts, covere'd "�tios/wa.lk*way"s,.residenti�I addit',ion*S'unde�i500 square feet,
p
-lace -ent mobilehomes., It ha*s-�been determined
detached accessory structures.lor rep., . M,
the above-named'owner is exempf tfrom paying-., school -fees'.at ihis tim e due to the
following reason:
EXEMPTION NOT APPLICABLE
This certifies that schoob,facility fees inilposed-pursuiant to Gove'rnment..-Code. 53080
in the amo lunt of I x 14,503 6r;$ �,298.45 "have;been paid.tb D.S.U.S.D. for
thepro ertylistedabove " d'ih -"_g�.p rmx'i;. rt . i - ficatgs.', of :Occupancy for
.p An af buildin e ts,4nd/or Ce
this square footage in this proposed- projpct may. now-, bi�"isi8iuied'.'
Fees Paid By David Ross Miller�� .Jej.ephone. 564-0273
harne"o'n the check'
By Dolores A. Hallesterbs
Superintendent
Fee collected /exempted by Vickie, J. Durrett
-Payment-Re C*eiived
Signature Check No
.4207
Collector: Attach a copy of county or kt�
c ,plan check application form to.dr�trict copy for all waivers.
Embossed Original- Building Dept.i/Applicant C&py--'Applicant/Receipt_. Copy -Accounting
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From: InI t -t -F ra, Zivct>
a J-441-
7z
—Datei ;r -
57-3-430 A V C A tZ R A
ZA I &
U 1 rA
'7_F17-
Address:
Al -A
/4
AccountNo. Lot(,)
_Z LV_
-7 Tract
SA t I _TA A L f
Service Address 5-2- 0 Z 0
G.A. Code
16101 reter(s)
$
*1el-Ice(s)
K5 0
• Backflow(s)
• HouseLateral(s)
• Detector Check(s)
�0 Me Surcharge
�Saltatlon
41
Capacity Charge
• W.S.B.F.C.
• Temporary Construction Meter
0. Turn on Charge
• Uncollected Account - Name
• Inspection Fee - Tract -
Fee -
0" Plan Check Fees Water Sewer -
Tract -
• Bond Payment - A.D. --Bond
Assmt.
• CustomerDeposit
• Other
TOTA
Remarks:
0 COPY to:
Cash
WaterService
Check 0 11
Money
Cashier
Order
0
U
CVWD-438 (11/89)
Al
�Lf ofta_.�;i
Tit�t of 149a (0-11,thitc-1
C * 11 hi
i t b i b -So C-1 f V. t
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 52-020 Avenida.Ramirez
Use Classification Single Family Dwelling Bldg. Permit No. 1,3707
Group R3 Type Construction YN Fire Zone Use Zang SR
Owner of Building David Ross Miller Address P.O. Box 722
city. La Quinta, CA, 92253 By; Mark Harold
January 3, 1994
.tsuooing Offici 07 POST IN A CONSVICUOUS PLACE
-a*
IF