11810 (SFD)Building
54-620 Ramirez
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 118.0
Owner
York Bourgeois
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 91HIZWKIMM33 P.O. BOX 477
A.P. Number 774-281-807
Legal Description At 18 Block 306
Description $FD
City
raradise,
Zip
95967
Tel.
ContractorProject
DEDcO Construction Services
Address
P.O. Box 1012
CityTel.'
La Quinta, CA
l'ip92253
5€4-6478
State Lic.
& Classif. -. 397830
City
Lic. # 1375
Sq. Ft No. No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
Permit does not include block wall or
pool.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
Lhereby affirm that 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, alter, improve, demolish, or repair any structure,tpifor'.to its Issuance also
requires the applicant for such permit to rile a signed statement that he is�icensed pursuant to
the provisions of the .Contractor's License Law, Chapter 9 (commencing with Section, 7000) of
Division 3or 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 of sale.)
❑ 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
$103,073.00
PERMIT AMOUNT
'r a250.00
Plan Chk: Dep.
Plan Chk. Bal. - 02.10
Const. So
Mech. �� • UU
Electrical 136. 35
Plumbing 2 . �v
.S.M.I. iO • 4%
Grading 2tD.00
Driveway Enc.
Date owner
Infrastructure 2, 31 9. 1
Arts .i:$ rub! C.
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.
-
TOTAL J,%W0.DU
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars $100 valuation
( 1%
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.
REMARKS
�
y,� 2" � ;3 ! f ` -
lcra�r3ld.TYFT 9 kl��rzd:r cfl
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.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Side Setback from Property Line
Lender's Name
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
-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
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
STORAGE TANK
FORMS jf437
14
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. SQ. FT. ®
WALL SQ. FT.
DRINKING FOUNTAIN.
SERVICE
FINAL INSP.
URINAL
SQ. FT. ®
WATER SYSTEM
FINAL INSsP-7—�'3G 1.
ESTIMATED CONSTRUCTION VALUATION $
GRADING
cu. yd.
$ plus x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING r iy(
FLOOR DRAIN
MECHANICAL FEES
3 `Cjn
b 1�wf1J ,Jjq 13 i
'
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
INSULATION/SOUND �3
SQ.FT.GAR ® 3/4c
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
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK3/ Ln
r
GROUND PLUMBING �1NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS jf437
14
SEWER 6-**?"(# 4�3ROUGH
WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSsP-7—�'3G 1.
FINAL INSP. 2Z
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING r iy(
ROOFING�/�
r
3 `Cjn
b 1�wf1J ,Jjq 13 i
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 1*5 9 3 L*
MESH
INSULATION/SOUND �3
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S
SIGNATURESIINITIALS
GARDEN WALL FINAL
DESERT- SANDS UNIFIED',SCHOOL DISTRICT
§2-879 MgMkay 111-
NOTICE:g. Indio, CAw,.k 01
Document Cannot Be Duplicated) (619) 347-8631
w _-
Date 1/4193 Type'ofPermit La Quinta
No. 11938 Permit #1 11644
Log
Owner Name, York, E...Zourgeois
No. 54620, „ Street Ramirez`
Cityy, La Quetta `Zip '92253.Study Area 1110
APN # Tract # ' Lot # 0 Square Footage 11788
Type of Development 1pingle Family Resi'denc'e , n No. of units 0
Comments w '�
At the present time, the Desert Sands. Unified School District• does `not collect fees on
garages/carports,. covered patios/ valkways,5residential additions,under 500 square feet,
detached accessory structures-or;replacement mobilehoines: 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;fee
in the amount of 158 x l 788
the property listed above and that b
this square footage in ,this,proposed
imposed pursuant to ;Government Code 53080:.
I or $' 2;825 04`, have been paid to D.S.U.S.D. for
ilding permits and/or Certificates .of Occupancy for
Fees Paid By York .E. BourgeoisTelephone 564-5545
Nameon,.the check,
By lames E. Oji zely
Assistant Superintendent, Business Services ,a -
Fee collected /exem d by ,,haXU Arthur ma
Payment Received -7 Ly
Signature r dhbck'-NA 541 'R=
„ -
Collector: Attach,a copy of county.or city plan check,applicahon`form'.to distncEcopy for all waiver:'
Embossed Original- Biuilding-Dept./Applicant. Copy. ---A
pplicarit/ Receipt Copy -Accounting
M t °
}
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CORDINGAEOUESTeD E
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u,MMO,NVVEAL.T:H,,LAND -*,-TITLE'Uui,
",RECORDED MAIL i,"IibEtDAND UNLESS :OTHERWISE ,SHOWN BELOW �*:-A
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TMLEORDERN( �C3 00 3 7 90-2a 2-13395
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ROW NO.
SPACE ABOVE THIS LINE FOR. RECORDER'S USE
IN
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�y
GRANTORS) DECLARES) n
,31HIEUNDERSIGNED
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D CUME TARYTRANSFERITAXAS$`
2,7. 50
gampUted ,on fu
11 valu6 dfor6pbrtyconveyed; o
c
'..computed on full Value. 4ii�-value offiens br,e'ricumbranclis -reTaining. at time of sale.
Uni -c6r'po�ated arei'
kcxy-,�Q
t',-' - La'
Quilnta AND
FOR.A.VALUABLE CONSIDERATION, receipt of.which'iglhereby acknowledged,
!JOHNHANCOCK ANDIOUISE A. HANCOC,1
htsband :and d wife as joint tenants+.
hereby. GRANT(s) to
YOR'K-�BOURGEOIS, -,.,,an,,unmarried
man
Djollowing described real property in the
".4 . 'City of La, Quinta.
Ri
iunty of ,State ate of California:
6;f,1&,- of
Block 306', -Santa Cirm"ei*ta ,aa ;;Vale 1a. :Quinta, Unit No. 28, as
er„'map ' recorded in Book -19 Tag6s!,."5`%--'
an'd .6 0.- of 1. t,.,Maps in the office of t
Aunty <Recorder of Rivers ide.'-.
_.0 1-P, y .California;
z
O.
7- -7
tise H
Oancock
7 -
0.
personally -known to me
(or-'rproved to me on the basis of satisfactory evidence) to be*1ther
:Persons, whose name -1 subscribed to the:within
iN
STATE OF4FqR”
COUNTY O9AEF
nstrument, and acknowledged to me. that —.:Me � executed it.
ISS
:t is / 77
0 Ih day -.-�q4lo-C'2
in the year 19 VZ,
un ersl n
before me, theundersigned, -a._Nbia�y Public in and for said 'State,
personally appeared: X.,
.tiff 'A1AA1e
I'lotor Public
y ,
7- -7
tise H
Oancock
7 -
personally -known to me
(or-'rproved to me on the basis of satisfactory evidence) to be*1ther
:Persons, whose name -1 subscribed to the:within
iN
nstrument, and acknowledged to me. that —.:Me � executed it.
WITNESS my hand and official seal.
V
"ktAMW_0CGUJTV
I'lotor Public
y ,
STATE OF TUA_ gnk/
..My COW F,p
Signature
NOTARY PUBI; IN AND FOR SAID
(This area for official notarial seal)
CO-441,(REV 4/85) MAIL Milt ATATEMENTS. AS. DIRECTED ABOVE.
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