11083 (SFD)r �
4
4
P.O. BOX 1504 N Q . 11083
Buildin78-105 CALLE ESTADO
Address 78-590 sSanAa Drive LA QUINTA, CALIFORNIA 92253 �q �
Owner C
La Quinta Vista. Pa•xtnershi
Mailing
Address P. 0. Box 227
City
La . Vii?) Uta
Zip
�2253
Tel.
Contractor
Same*
Address.
c;
City
Zip
Tel.:
State Lic.
& Classif. 50'0316
City
Lic. #
Arch.;-Engr.,
Designer
Address
Tel.
City
'
Zip
-
State
Lic. #
1646
I hereby affirm that I am licensed unpe vrovis n o Chapter 9 (commencing with Section
000) of Division 3 of tfie Business and Professi/offs Code, and my license is in full fo;ce and
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason_ (Sec. 7031.5,Busfness and Professions Code: Any city or county which requires a
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
the provisions or the Contractor's License 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 of not more than five hundred dollars ($500).
❑ 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 ofcompletion, 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 contractors) licensed pursuant to the Contractor's License Law.)
0 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. 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.
Date- Owner
NOTICE TO APPLICANT. ff, 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 Coder
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
ateMailing Address
City, State, Zip
11LDING: TYPE CONST. OCC: GRP.:
P. Number
Legal Description Plan 2 Tract 23265
Project Description SFD
Sq. Ft. 1688
Size
No:
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ -Demolition ❑
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:
Estimated Valuation
2 ,.4 % 7
PERMIT
AMOUNT
Plan Chk. Dep.
Plan.Chk. Bal.
510.41
Const.
608.00
Mech.
60.00
Electrical
104.26
Plumbing
138.50
S.M.I:
6.51 .
Grading
Driveway Enc.
Infrastructure
2080.73
TOTAL
M,
r.41
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. Ff.
WALL SQ. 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'
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM - FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
r
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER, B.T.U.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. Ff. RESID ® 1 Vi c
SEWAGE DISPOSAL
LUMBER GR.
SO.Ff.GAR ® Wic
HOUSE SEWER
FINAL INSP. ^7� O�
o� T
ROOFING
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 APPJEQUIP.
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. ^7� O�
o� T
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING Yj
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 6/23/92 1 Type of Permit I La Quinta
No. 111497 Permit #
Owner Name La Quinta Vista Partnership Log #
No.
city La Quinta zip 92253 Study Area 0
APN # Tract # 1232B5 J Lot # Square Footage 11688
Type of Development I Single Family Residence No. of units
Comments
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.58 I X 11.688 1 or $ 2,667.04 have been paid to D.S.0 S.D. for
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 By Swan Development Co.
Name on the check
gy James E. Lively
Assistant Superintendent, Business Services
Fee collected /exempted by Shelley D. Bennett
Telephone (
Paymena Received
Signature>Fieck. 1,40.00297
Collector: Attach a copy of county or city plan check application form to disirict copy fon-sill waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Ancour_64