15234 (SFD)I
P.O. BOX 1504
g 78-495 CALLE TAMPICO
Addrdess - -140 Bit, I. orn Tr LA OUINTA, CALIFORNIA 92253
Owner ; -110'a$G Iie_AA A.'eri
11
BUILDING: TYPE CONST: OCC: GRP. R3
A.P. Number 769-550-019
Legal Description lot .25 tract 25429
Project Descriptiofi S�
Painted Crave
No. 14234
Address p,,J.. - $®X 1804
.City Zip Tel
�
a oouint a, C. . 92253...
Contractor . .
Mandran Construction, CO.'
Addresgs/ g yg .
r.
COY • , . - Zip, .. Tel
51a Qu a,. CA 92253 X64-5 75
State Llc 5 f City]
& Classlf $% L-ic.
Arch:; Engr.;
Designer - fro �J
Address Tel.
CityZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm hatA am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Bu ine amend Professions Code, and my license: is in full force and
effect. .:�,f
DATE '
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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 fmproves4hereon and who does such work himself or through his own employees,
provided that suchimprovements 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, 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 contractors) jicensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec • B: & P.C. for this reason
DateOwner
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 '
.O Copy is filed with the city:. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE '
(This •section need"not be completed N the permit is for one hundred dollars ($100) valuation
or less.) '
I certify that in the performance of the 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: N,, 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. .
WARNING: FAILURE To SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES.UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE; INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when property 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
bovementioned property for inspection purposes.
Signature of applicant Date'
Mailing.Address
City, State, Zip
Sq. Ft. 3389 No.
Size. - Stories
New ❑ Add ❑ 1 ' Alter ❑
No. Dw.
Units
Repair ❑
Demolition ❑ 1�
1permit, includes '230 g. f. of 5' hicrh
len walk. and. 501 of 5 +F h
Pool petmit to he Gab
xately. .
ted Valuation $212,r135.00
PERMIT.,
Plan Chk. Dep.
Plan Chk. Bala
Const.
Mech.
Electrical
Plumbing .
S.M.I.
Grading
Driveway Enc.
Infrastructure
Arts • in -Prbl
TOTAL
REMARKS
00
AMOUNT
631.63:
1,035.60
HMO, ..
209. £32
7.4'x.50
21. 2l
20.00
.00.
4,475.67
2FIQ.34
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from.Rea Prop. Line
\ -
Side Street Setback om Center Line
Side Setbackr/m Propene:
FINAL DA
Issued by:
Validated by:
'J
3
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING; FEES
IST FL. SO. FT. ® $
_ UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2N0 FL. SO. FT.
FORMS
WER OR SEPTI
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO. 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
WASH ER(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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.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 PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
WER OR SEPTI
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOVICE: Indio, CA 92201
o_. Document Cannot Be Duplicated 619-775-3500
Date 6/26/95 1 Type of Permit I La Quinta
No. 113523 1 Permit #
Owner Name Pete W. Hendren Log
No. 79-140 Street Big Horn Tr.
City La Quinta Zip 92253 Study Area 125
APN # Tract # Lot # 0 Square Footage 1
Type of Development 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:
Under Mitigation Agreement
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Mitigation Agreement
in the amount of 628.00 x 0 or $ 628.00 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 Hendren Construction
Name on the check
By
Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Ma Lou
. c
Signature
i
Collector: Attaccopy of county or city
Embossed Original- Building Dept./Applic
564-5075
Telephone ,y
r5 +
ez
Payment Receieed l
Check No. 002525
Leek application form to district copy for all waivers.
Copy - Applicant/Receipt Copy - Accounting