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05722 (PLBG)4 4 " P.O. BOX 1504 Building 77_550 gam. 7&105 CALLE ESTADO Address LA OUINTA, CALIFORNIA 92253 Owner im S1 ITR Mailing , Address: City LA QUIMA Zip 92253 ITel- Contractor 11=4ER $ERE 1 Ct9i MUCTION �. Address 68-365 PERU RD. City Zip Tela CATHEDRAL CITY 92234 Sq. Ft. Size 619/321•-1854 State Lic. & Classif. CA 410275 New ❑ Add ❑ City Lic. # 1138 Arch., Engr., Designer Address Tel. City Zip State Estimated Valuation Lic. # LICENSED CONTRACTOR'S DECLARATION PERMIT I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Dt si�o�n 3 t, B 'sinedSs an�d''Professions Code, and m license is in full Force and y ,tAhe effect yl'l'� 4"`1 �� f A ✓ �•.p1"i i - i �! OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Busi7ess 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 appbrarnt for such permit to file a signed statement that he is licensed pursuant to the provisions o1 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 civilpenalty of not more than five hundred dollars ($500). D 1, 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 appy to an owner or 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. It, however, the building or Improvement is sold within one year of completion, the owner -budder 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 appy 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. ti: 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 Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company ❑ Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (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 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. late Owner NOTICE TO APPLICANT: lf, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith campy 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 Lenders Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 100 days. I certity that I have read this applicationand state that the above information is correct. 1 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. 05722 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 774-{'275-024 Legal Description Project Description SIC & PIT 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 INSPECTOR 5/11/89 Issued by: Date Permit Validated by: Validation: Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 1s�Q�.� PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 5.t7(i Mech. Electrical Plumbing S.M.I. .14 Grading Driveway Enc. Infrastructure TOTAL REMARKS 10i"SW IL�rFfffk. ` :t ii..; a. 2.4 iti 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 INSPECTOR 5/11/89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. a $ UNITS SLAB GRADE 2ND FL. Sp. FT. BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR. Sp. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEOUIP. DRAINAGE PIPING CAR P. SO. FT. ® TEMP. POLE WALL Sp. FT. Q GROUT DRINKING FOUNTAIN. SERVICE FINAL INSP. URINAL SQ FT ® 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 GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRY TRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING 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. 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 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 APPJEOUIP. 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 SIGNATURES/INITIALS GARDEN WALL FINAL 1. • �/- A) 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (61 9) 777-7000 FAX (619) 777-7101 October 22, 1993 Subject: Notice of Pending Administrative Proceeding To Whom It May Concern: The structure located at 77-550 Calle Potrero in La Quinta, California: APN# 774-275-024, Lot 12, Block 307 of Santa Carmelita at Vale La Quinta, Unit No. 25, is no longer the subject of proceedings by the City with regards to non-compliance. An inspection of the structure was conducted on February 11, 1986, by this department and it FORNIA ALL-PURPOSE ACKNOWLEDGMENT State of County of On l �aa q 3 before DATE NAME, TITLE OF OFFICER - E.G.; "JANE DOE, NOTARY PUBLIC" personally appeared { Ua -R) nQ , AME(S) OF SIGNER(S) personally known to me - OR - ❑ proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and ac- knowledged to me that he/she/they executed 'the same in his/her/their authorized OF'FICIALSEAL capacity(ies), and that by his/her/their DFRORAH S. DE RENARD signature(s) on the instrument the person(s), '+r)'%RYOUBLIC-CALIFORNIA or the entity upon behalf of which the r PSID C w rEo1�r: r: I '��., f,� I;;;,, � - person(s) acted, executed the instrument. THIS CERTIFICATE MUST BE ATTACHED TO THE DOCUMENT DESCRIBED AT RIGHT: Though the data requested here is not required by law, it could prevent fraudulent reattachment of this form. WITNESS my hand and official seal. No. 5193 OPTIONAL SECTION CAPACITY CLAIMED BY SIGNER Though statute does not require the Notary to fill in the data below, doing so may prove invaluable to persons relying on the document. ONDIVIDUAL CORPORATE OFFICER(S) TITLE(S) PARTNER(S) ❑ LIMITED .GENERAL E] ATTORNEY-IN-FACT TRUSTEE(S) GUARDIAN/CONSERVATOR OTHER: SIGNER IS REPRESENTING: NAME OF PERSON(S) OR ENTITY(IES) SIGNATURE OF NOTARY OPTIONAL SECTIO TITLE OR TYPE OF DOCUMENT ��71) NUMBER OF PAGES ! DATE OF DOCUMENT 10bal l SIGNER(S) OTHER THAN NAMED ABOVE ©1992 NATIONAL NOTARY ASSOCIATION - 8236 Remmet Ave., P.O. Box 7184 - Canoga Park, CA 91309-7184 C78-495 CALLE TAMPICO — LA 'OUINTA, CALIFORNIA ' 922 FAX (619) 777-7000 s J 2 .� I ( `�m+, ,October .22, 1993 ,Subject: t Notice of Pending Administrative Proceeding -To Whom It May Concern: A The structure located at 77-550 Calle Potrero in La Quinta, California: APN# 774-275-024,aLot , 12, Block 307 of Santa Carmelita at Vale La Quinta Unit No. 25 is no longer the subject of a r •' " proceedings by the City with regards to non-compliance. An inspection of the structure was conducted on February 11, 1986, by, this department and it � was found to be in substantial compliance. No subsequent inspections have been performed. Sincerely, '= BUILDING AND SAFETY DEPARTMENT Tom Hartung a ' r, Director. of Building and Safety kt MAILING ADDRESS -' P.O. BOX 1504 - •LA• QUINTA, CALIFORNIA- 92253 �`