07570 (SFD)Building
Owner
Reams Haste
Address PO Box 415 '
City Zip Tel.
Contractor
tyIZip I Tel.
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
• 0�
f 4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
CityI Zip I
State
n Lic. #
` LICENSED CONTRACTOR'S DECLARAT16N
I hereby affirralitlhat I am licensedunder provisions of ChapteA (commencing with Section
7000) of Oivi i66 3 of the Business a �j Professibs Code, and my license is in full force and
effect./ tc
S1GNA.Sr1RE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 or the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
Division 3 or the Business and Professions Code, or thathe 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.) -
❑ 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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. It, 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
Ihereby 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 Address
City, State, Zip
No. 07570,
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number 617-381_10"
Legal Description
Project Description C9tlmie Emily 91► Hing
Sq. Ft. No. No. Dw.
Size 1695 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation –__ ---
PERMIT
AMOUNT
Plan Chk. Dep.JFi.
Plan Chk. Bal. ,
269.09
Const.
603.50
Mech.
55.50
Electrical
116.23
Plumbing
178.50
S.M.I.
6.44
Grading
23.00
Driveway Enc.
20.00
Infrastructure
2,024.46
FrinWf
rag 75.78
TOTAL
$3.619.50 13,369.50
:REMARKS
_ 1y �7 o
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
Issued by:—
Validated by:
Validation:
INSPECTOR
4/19/90
Date Permit
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
SEWER OR SE
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROCK STORAGE
FOUND. REINF.
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CAR P. SQ. FT.
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN
SO. FT. ®
SERVICE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
_$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
tit
0
O SeipAc—
(CGAR.
0
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
MESH
SO.FT.GAR ® 3/ic
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 O
LUMB
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
FORMS
ROUGH PLUMB.
SEWER OR SE
BONDING
ROUGH WIRING
HEATING (ROUGH)
STORAGE TANK
DUCT WORK
ROCK STORAGE
FOUND. REINF.
/T
GAS (ROUGH) /c; �d (P
l
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
't;L_cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. a/
FRAMING
J0
FINAL INSP.
^^616
ROOFING //��i- !'
tit
0
O SeipAc—
(CGAR.
0
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING'f OW4/ 7 9 PO
MESH
INSULATION/SOUND QIf
FINISH GRADING
FINAL INSPECTION (d
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
f
COACHELLA VALLEY FRINGE -TOED LIZARD
SECTION 10A MITIGATION FORM
FROM:
APPLICATION
DATE:
APPLICATION.FOR
GRADING OR BUILDING
PERMIT NUMBER
CITY OF LA QUINTA
Q
ASSESSOR'S PARCEL NO (S) .
ADDRESS '-�"S o 2!%TT "4arN
l?�-I✓s •yAsr* (Name of Developer) has applied for a
building/grading permit affecting ��2 L3 acres.
This proposal will require the payment of $ S• ��
( $600.00 X . 7Z&_3 acres) .
/-ass x. �•�2
Title
We have received mitigation in the amount of $
($600.00 X acres) in the form of cash on
from
Name of Developer
BJ/FORM.006
By:
Title
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
TO: City of La Quinta
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253 NOTICE:
DATE:
LA
to
4-1
f J&Fhn
-THISt)0WU TEfl� C
BE I)uPLICA
This is to certify that
developer of which is
located at j' ithin
this District, has paid school facility fees imposed pursuant to the
authorit Aener{ted by Government od sec ioli 5 080 in the mount ofelm
(�
covering a total of Q square feet of ( resi ent' 1 or
( ) industrial/commercial development and that buil ing permits for
this foots e n this development may now be issued by your jurisdiction.
" 1e /LA—
S�'
L( 9:5 r_4:q .
for DESERT SANDS UNIFIED SCHOOL DISTRICT
White - Building Department a Yellow - Facilities Planning ■ Pink - Accounting ■ Gold - Developer
(1007