04938 (AR)z
T,44- 4 ZP "
P.O. BOX 1504 No. U44*130
78-105 CALLE ESTADO "AN ADEQUATELY SIZED DEBRIS CONTAINER
LA QUINTA, CALIFORNIA 92253
IS REWIRED ON THE JOB -SITE DURING
BUILDING: TYPE" MSI SE" ONW:`C O
A.P. Number 617-330-017
Building
Address 78-230 San iir-etee
Mailing
Address
City
La Qi
Contractor
George -Jacobson
Same
Zip Tel.
into 1 92.253
8uyelt Construction
Address
64-060 Mobile Drive
City Zip Tel.'
Desert Hot S rings 9224 . 329-:6965..
State Lic. City
& Classif. 31 7 Lic. #
Arch., Engr.,
Designer
Address I Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under proyisions of Chapter 9 (commencing with Section
7(100) of D/i/visi)on 3 oflthe Business/and Prop/sarins Cade, nd my license is in full force and
effect. C3E
S1GNATUR DATE
OWN EWBUILOEIYDECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bushness and Professions Code: Any city or county which requires a
permit to construct, after, improve, demoffsh'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 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 exampt therefrom, and the basis
for the afteged 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).
❑ 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: •7he Contractors 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 safe. N, 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. fi 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 Ze ` ,
❑ Copy is filed with the city. ❑ Certified copy is he by furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
1 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: If, 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 pemmft shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
I=firm 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 180 days.
1 certify that I have read this application and 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
Legal Description
Project Description Addition
Sq. Ft. 892 No. No. Dw.
Size - Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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
12%6/£8
Issued by: Date Permit
Validated by:
Validation:
Estimated Valuation
$60,388
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$205.40
Const.
316.00
Mech.
38.00
Electrical
32.30
Plumbing
22.00
S.M.I.
4.24
Grading
Driveway Enc.
.Infrastructure
TOTAL
$617.94
REMARKS
l
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
12%6/£8
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIVG FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARb SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
MING /� / . $
(Jv
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
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.
SQ. FT. @ c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/e c
SEWAGE DISPOSAL
/
NSULAT 10NISOUNDLf
SQ.FT.GAR ® 3/ic
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
OUND 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./EQUIP.
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.
MING /� / . $
(Jv
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
ALL
t
LATHING
MES
/
NSULAT 10NISOUNDLf
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
N®T IC t: THIS D6CMcWq
BEDUPLICATED ct,u
TO: City of La Quinta DATE: I p - O —8b (M
Department of Community Development
78-105 Calle Estado
La Quinta, CA- 92253
I
This is to certif that
developer of 4rvkah -,which is
located at — ( within
this District, has paid school facility fees imposed pursuant to the
au or'ty enera ed by overnment Code Section 53080 in the a ount of
$ (
covering a total of ~]) square feet of ( ) residential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
-r6to-4 ou 0 = 70 146b. 4� �2�44�
for DESERT ANDS~U IFIED SCHOOL DISTRICT
(`-White Building Department 0 Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(1007
08/28/92 09:13 $503 234 3506 PACIFIC-HOE 2001..
HOE
PACIFK/
PACIFIC/HOE SAW AND KNIFE COMPANY 2700.S.E. Tacoma'St,; P•o• Box 82155
Portland, Oregon .97282-0955 U,S.A,
Telex 360712, 503/234-9509
Aug. 28, 1992
Building Dept.
La Quinta, CA
Attn: Ellie
Fax: 619-564-2246
Patrick Malone is authorized to sign for a Building Permit to
construct a facade at my residence at 78-230 San-Timoteo,-La
Quinta, CA. .
:%
George"H. v]a/Cohsen
. t ,
RE"CEIVED
AUG 3 y 1992
bUIIDING SAFETY DEPT,
JOB L r
A=1 SURVEYING CO. INC. of
73-400 Higway 111, Suite 1` SHEET NO. ry
PALM DESERT, CALIFORNIA 92260
(619) 346-0335 ta+.sabaxEp eY „' • ? �°• C DATE
CHECKED B/Y� � (^ DATE
SCALE Z " O -S'Z r It �
PRWM 7041ces IM., Gramm Mm. 01471. � '