12235 (BLCK)_ __ T4.hf 4 4 a"
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-102 Avenida i3e=udas LA QUINTA, CALIFORNIA 92253
Mailing
Address
City
Legal Description
j Contractor
PADLDEN EVANS
Address
SME
City Zip Tela
State Lic. ' City
& Classif. 41 652188 Lic. # 2592
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) 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, 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 or 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 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.)
O 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
Date'•? Owner. m". .... �r—
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. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Project Description
1r1l
OCC. GRP._
22235
75' of 511 RETAINING WALL
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter p Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
451.00
Mech.
Electrical
c t
Plumbing
S.M.I.
RECTO
Grading
Driveway Enc.
Infrastructure
TOTAL
45.00
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
c t
_
FINAL DATE I
RECTO
Q
Issued by: Date
Validated by:
Validation:
i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
f
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. p
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE 3 Z-0
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
-$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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.
SO. FT. ® c
BATH TUB
LATHING
SO. 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
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
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. (Ji
_ 1
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE 3 Z-0
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM �� (—OJ'j ��
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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�NGINEER�S'DIV:
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Ddvo
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ER
WEATHER
TEMP,
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PRESENT
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Av
I FIELD TESTING ; REFEM
TEST TEST LOCATION LOT MO$TURE DRY MAXIMUM MAXIMUM
NO.
NUMBE�i ELEVATION I CONTENT DENSITY DAY DRY
X iEsJCu. it, 04N811Y DENBtTY
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REMARKS:
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�.j
m
V
m
m
m
i
4" CONC PANEL AS PER
OR WOOD STUD WALL
SLAB AS NOTED
ON PLANS W/ WELDED
WIRE FABRIC, ON
MOISTURE VAPOR
BARRIER AND COMPACTED
SAND
a ..
(N) 05 m 32" O.C. TYPICAL
EXTEND 32" INTO SLAB
(N) 04 HORIZONTAL - CONTINUOUS
3 REQUIRED 3" FROM'EARTH
STEP-DONN FOUNDATION DETAIL
LOT 8 - BERMUDAS - LE\IESQUE RES.
PAULDEN EVANS DESION
DWG. T ITLE: STEP DOWN FNDT DETAIL
DWG. No.:
DR. BY: D5W DATE: gl5Olg5 SIZE
CHKD . BY: D5W APPD . BY: D`-' W A
SCALE: I"=1' -O" SHT .: I OF: - I
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 9/28/93 1 Type of Permit I La Quinta
No. 112453 Permit #
Owner Name Paulden Evans Log
No. 54102 Street Avenida Bermudas
City La Quinta Zip 92253 Study Area 110
APN # 774225-008 Tract # Lot # 0 Square Footage 2400
Type of Development I 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 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 1.65 x 2 400 or $ 3,960.00 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 Paulden Evans Telephone
Name on the check
By Dolores A. Ballesteros
Superintendent
Al
Fee collected /exempted by Vickie J. Durrett -. =
Payment Re�eived P'
Signature_ff!,Chpck� No. 29726
Collector. Attach a copy of county or city plan check application form to district copy for;all-wiivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/ Receipt Copy - Accounting