9620 (SFD)T a . 0 -
iiv� 4
Building
Address 78-640 Carnes Circle
Owner
Acacia
Mailing
Address 1021 Bastanchury Rca
City I Zip Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
r3d1iex"r—oT1 I :YA / L5l/Si L"t)iSi31►
Contractor
Acacia Construction
Address '
p
State Lic. City
& Classif. B 2923954 Lic. # 1612
Arch., Engr.,
Designer
Address
CityI Zip I State
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. r
SIGNATl1RE'' 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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's Lfcense.Law, Chapter 9 (commencing with Section 7000) or
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 or not more than rive hundred dollars.($500). '
O 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 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 or 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' COMPENSATIONINSURANCE
(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 thq 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. rrjf;
Date L" 'V s: 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 torthwfth
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 of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 9620
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number
Legal Description Bot 58
Project Description Plan B2
Sq. It -No.
Size.
No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
33558
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
507.35
Const.
612.50
Mech.
53.50
Electrical , * .
103.66
Plumbing
120.58
S.M.L.
6.58
Grading
Driveway Enc., ,
Infrastrtictu�e
2105.06
1
t .
TOTAL
3509.16
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,
. }
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by: .
Validation:
4
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
ROUGH PLUMB. BONDING
2ND FL. SO. FT.
STORAGE TANK
YARD SPKLR SYSTEM
POR. SD. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. Q. FT.
REINF. STEEL
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN.
SO FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
LUMBER GR.
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Yic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING WVot(40 UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE /
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
L EWER OR SEPTIC TANK ct ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REIN . -'7y
ROUGH) O K vi METER LOOP
GAS (ROUGH),/(5/f'?(
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP/4 p Ilcu.
I
FRAMING �lC�
FINAL INSP.
ROOFING �(( C�(
o l K(
�u I L�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING �Pfjt 4.1-12
MESH
INSUILATIONISOUND O,fq(
04 to
FINISH GRADING
FINAL INSPECTION
. h
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL
Notice:
Document Cannot Be Duplicated
Date 4/29/98
No. 16965
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
APN # 604-223-015
Jurisdiction La Quinta
Owner NameKurt E. & Lexa S. Schoppe Permit #
No. 78-640 Street Carnes Cir. Log #
City La Quints
Tract #
Lot #
Type of Development Residential Addition
Comments
Zip 92253 Study Area
Square Footage 200
.,onvert 3rd bay of garage to 200 sq. ft. tor home o ice.
No. of Units 1
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:
Residential Addition 500 Sq Feet or Less
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 200 , or $ 0.00 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 B Lexa S. Scho e
Y pP Teleph0aetj�
Name on the check.''' 7,
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Exempt
Check No. N/A
Signature
NOTICE: Pursuant of Asseryfbly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run fronj the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting