9540 (AR)T 0 0
ihf 4 4 a"
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 78-435 Band Plower P1 LA QUINTA, CALIFORNIA 92253
Mailing
Address P. o. Box 3361
City Zip
Huntington Pk 90255
Contractor
ress
Zip
No.
BUILDING: TYPE CONST. OCC: GRP.;
A.P. Number 617-051-008-4
9540
Legal Description
. JProject Description Room & Garage Addition
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
Sq. Ft. 902 Dwelli og
Size 220 Gar. Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
City
Zip
State
Lic. #
4
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
of fact. i
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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 rile 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 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 rive hundred dollars ($500).
❑%l, 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,
Estimated Valuation
47,823.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.260.00
Const.
Y
401.0 Vry
Mech.
15.00
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
orimprovement 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.)
Electrical
27, 00
Plumbing
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
slruct 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.)
O 1 am exempt under Sec. B. 8 P11 . for this reason a f
�, ,,•� J ,�' ,t'
S.M.I.
t� �i
4.90
Grading
Driveway Enc.
/ �j�f� //,.�,
Date t + downer �""(' :
Infrastructure
WORKERS' COMPENSATION DECLARATIrOP%_,—
I hereby affirm that I have a certificate of consent"to se nsure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. .Company
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
%' 07.9 0
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit Is,ror'one'hundred dbllars ($100) valuation
or less.) - ,r
I certify that In the performance of thq work for which this permit is issued�l shall not
employ any person in any man er so to becometsutije ' torthe o ars' Compensation
Laws of,Cali(ornia.. e `
Date +�i' p%` 'i'Owner %l ! A % �!�'����
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 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 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
REMARKS.
005M.tt'i. it9 . 01_09_91_ 10
IV LH,11`1 3 t1:1ii Y ivoi :I?V
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:
T4ht
"
�! P.O. BOX 1504 APPLICATION ONLY
Building w YES �"' f]y.� r� G �A OUINTA CALIFORNIA 92253
Address Gil.. ! �r.
fK^*`t.1 i If
Mailing
Address v p, 13 3 3 6
City Zip Tel. ij—slIfy - /6
��. T aZ ems- `z 3 - 5 -34
City IZIP I Tel.
State Lic. City
& Classif. I Lic. #
Arch., Engr.,
Designer
Address Tel,
City I Zip I State
J Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)
t.of Division 3 of the Business and Professions Code, and my license Is In full force and
effec
SIG
NAt Alf
OWNER -BUILDER DECLARATION
I hereby affirm that l am exempt from the Contractor's License Law for the following
reason: (Soc. 703 t.5,Bminess and Professions Code: Any etty or County which requles a
PamHl to conslrucf, oiler, improve, damoNsh, or repair any slfacture, prior to Its issuance ad8o
requires the applicant for such Parma to Hla a S.Ipryea sf8fament that ha Is acensed pursue"( ro
rho ProvWbrisr of the CoryfraclorY License Law, C6WQr 8 fcommerrckrg with Section 7000J of
Odvislon 3 of the Buslaoss and Prolesslons Code, or that -he is exempt therefrom, and rho basis
for the alleged exaMlka. Any vlotelion of SoCrion 7031.5 by any applicant for a permit
subjects Me applicant to it civU penalty of not more than live hundred donors ($500),
>�„aa owner of the properly, or my employees with wages as ,their sole Compensation, will
do the work, and the s4tictura is not intentled of offered for seta. fSec. 7044. Buisnass aril
Professions Code: 'the Coanachurs License Law does not apply ro an owner of property who
buM73 or Reproves thereon and who does Such work hlmsall or through his own 0mPMyae$,
provided that such improvements are nor Intended or offered tot sera. If, however, the btdfdfrtg
or Improvement is sold within one year at completion. the owner•buildor win have file burden
el proving that he d/d not bod or Iniprovo for iho purposo 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, who contracts for
such projects with a contractor(s) licensed pursuant to the contractor's Lic La 1
❑ I am exempt under Sec., B. P.C. fo
`Data Owttar
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 if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance ofnhorkfor wh this t is issuemploy any porson iany annarme a lec a Wor }
Laws of cif r '
Date na
fvarr TO AP /Y7. Ir, It m k rim to . Ex piiW you should ecem
subject to the Workers' Comp sation provisions of the Labor Code, you must forthwith
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-
monflotred property for Inspection purposes.
Signature of applicant Date
Mailing Address -
City, State, Zip
BUILDING: TYPE CONST. �r OCC. GRP.
A.P. Number .7
legal Description
Description
II�
v
Sq. Ft.
Size
New ❑ Add ❑
No. No. Dw.
Stories Units
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuatia
7, FA3
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
222
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Lane
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Perrnit
Validated by:
Validation:
FINANCE
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL, SQ. FT. @
2ND FL SQ, FL @,
POR, SO. FT, @
GAR. SQ. FT, @
CARP. � SQ. FT. @
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
IMOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
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
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
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4C
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 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
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
IN S P ECTOR'S S IG NAT U R MIN I T IA LS
—
GARDEN WALL FINAL
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
FOR. SO. FT. ®
GAR. SO, FT. ®
CAR P. I SO. FT.
WALL SO. FT.
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
HEATING (ROUGH)
FLOOR DRAIN
MECHANICAL FEES
SEWER OR SEPTIC TANK ROUGH WIRING.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
OTHER APPJEOUIP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER HEATER SERVICE
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
REMARKS:
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
FIREPLACE
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 UNDERGROUNDS Ci t
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 10
[0,VVI
FINAL INSP.
ROOFING �(j(q 1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH \ .
INSULATIONISOUND L
FINISH GRADING
FINAL INSPECTION3._(s-�-jq
l
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINRIALS
GARDEN WALL FINAL
4
MEMORANDUM
TO_: Ron Kiedrowsk
FROM: Tom Hartung
RE: Addition at 78-435 Sand Flower
DATE: June 5,, 1991
The room and garage additions at the above address have been
permitted by the Building and Safety Department. I visited the
site personally on June 4, 1991 to verify the setback and height
requirements.
The garage addition maintains the required 5' side setback. The
exact property line is difficult to establish because of the
large oleanders at the site, but at its closest point the new
garage addition is 9' from the Vossler's block wall. Their block
wall appears to be several feet inside the.property`line at that
point.
The allowed height for that area is a maximum of 351. The
highest point of the addition will be approximately 18' high.
Please notify me if there are any other concerns with the
project..
TH/lc
t,