003116 (BLCK)Building
Address
Owner
Mailing
Address
City
3.A 0*14
Contractor
.Address.
i
I
78-555 Bottlebrush
. I ZIp
Owner/Builder
P.O. BOX 1504 111 O .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC. GRF
A.P. Number 637-382-005
Legal Description
0031.6
Project Description 180 f t • - of ` ood - f encs
City
Zip
Tel.'
Front.Setback from Center.Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
State Lic.
City
FINAL DATE
INSPECTOR
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Validation:
Size -ti
Stories Units
Arch., Engr.,
Designer
New ❑ Add D
Alter ❑ Repair ❑ Demolition ❑
Address
I
Tel.
}
_
City
Zip
State
I
Lic. #
LICENSED CONTRACTOR'S DECLARATION .
I hereby 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.
j SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
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
s
permit to construct, atter, 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
PERMIT
- AMOUNT
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
Any Section 7031.5 'any fora
Plan Chk. Dep.
alleged exemption. violation of by applicant permit
subjects the applicant to's civil penalty of not more than rive hundred dollars ($500).
Plan ChkBal
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
COr1St...
Ya Biu
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,
Mech.
.
provided that such improvements are not intended.or offered for sale. If, however, the building
• or improvement is sold within one year or completion, the owner -builder will have the burden
Electrical
of proving that he did not build or Improve for the purpose of sale.)
0 I, as owner of the property, am exclusively. contracting with licensed contractors to con-
Plumbing
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
S.M;I.
such -projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C.-for this reason
Driveway Enc.
Date Owner
Infrastructure
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
WO R KERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
or less.) ^-
I certify that in the performance of lhg 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
sublect 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 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 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 property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
TOTAL
REMARKS a V
ZONE:
BY:
Minimurri 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
INSPECTOR
Issued by:
Date 5/20/8 ?Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING'FEES a
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
IPOWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALLSO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®URINAL
WATER SYSTEM
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
VENTILATION
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,TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
a
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @'111/4 c
SEWAGE DISPOSAL
SO.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
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.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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.:'—
INSULAT16NISOUN D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL -
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^na Engineers, Inc. NUCLEAR GAGE RELATIVE COMPACTION FIELD DATA SHEET 1731•A Walter Street
Ventura, California 9300,
PROJECT: �I%J`<� Cr,-� % JOB NO.:
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OWNER OR
DEVELOPER: GRADING CONTRACTOR: SAMPLED BY:�
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Signature
MPACTION FIELD 'DATA .SMEET?
'Ventura Catffo7nia 9.3003
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x = Desert Sands Unified School District
H BERMUDA DUNES r
RANCHO MIRAGE 82-879 HIGHWAY 111 ® INDIO. CALIFORNIA 92201.5678 a 1619) 347.8631
INDIAN WELLS H
PALM DESERT
J` LA QUINTA
''IQ INDIO
e
City of La Quinta
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
Re: Lot 55, La Quinta, CA (DCM #1)
Gentlemen:
The developer of the above referenced
has mitigated i:ts impacts on our overcrowded schools by payment
of the amount of $628 per unit to be applied to the cost of
district educational faci-lities made necessary by such new
development.
Sincerely,
-,L i.
John D. Brooks
Assistant SuperintendentBusiness Services
JDB/crm
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
T0: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253 NOTICE-. Tt�IB ®�C1���6�iT CANNOT
BE DUPLICATED,
This is to certify that
developer of , w ich is
located at — — r1 /� ithin
this District, has paid school facility fees imposed pursuant to the
authorit enerated by Government od Sec iott 5 080 in the mount of
$ (��
covering a total ofAlle-AIVO square feet of ( resi ent' 1 or
( ) industrial/commercial development and that buil ing permits for
this e foots n this development may now be issued by your jurisdiction.
�#" iP i
2 ��95
for DESERT SANDS UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37