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05309 (SFD)Buil Add. in , 51-325 JUARB2 Owner Address . City lZip Tel. Address State Lic.I City & Classif. Lic. # Arch:, Engr., Designer Address Tel. City IZip IState Lic. # �F .fwQur«rw P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7(100) of Division 3 of the Business and Professions Code, and my license is in full force and effect - SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,13usinass 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 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 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). ❑ 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 iriproves 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.) ❑ 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 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.) r ) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date..{'€� Owner :...,-,^,Ci ,�•r, 7,� �.;•1WJ11„f. 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.. ❑ 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 thp: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. i 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 wtlh such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby 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. 1 certify that 1 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. LDING: TYPE CONST. OCC: GRP. P. Number 773-042-004— 005 .egal Description Tnlii9 5. R A Iroject Description Sq. Ft. Size 273 New ❑ No. 05309 No. Dw. Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estlmateo valuation PERMIT Plan Chk. Dep Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL IfAms AMOUNT 250.00 r 54.60 REMARKS AV t.71..>r's .Y A6Y(Ail. i 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 2/1/69 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS T SLAB GRADE ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SQ. FT. HEATING (ROUGH) STORAGE TANK POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. SO. FT. ® HEATING (FINAL) OTHER APPJEQUIP. WALL SQ. FT. GAS (FINAL) DRINKING FOUNTAIN SO FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER HEATER WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GROOFING -- LAUNDRY TRAY AIR HANDLING UNIT CFM /ZCz;' 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Vi c SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® 3/ic HOUSE SEWER LATHING 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 PLUMBIN UNDERGROUNDA.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS06WER OR SEPTIC / ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) T P. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. GROOFING -- +O+ 1 %1 /ZCz;' REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUNDS? 9 FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL 1 O S SIGNATURESIINITIALS GARDEN WALL FINAL 1 Desert Sands Unified School District CERTIFICATION OF PAYMENT JN� r 0 F -® Y ICE.- THIS SCHOOL FACILITY FEES � CUMENTCANNOT -9,F'QVP.LICA Epi DATE: �-��/ (1 TO: City of La Quinta Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is to certify that anc �Q. /tel developer ofsedy which 's located at / , within this District, has paid chool fl&6ility fees imposed pursuant to the aut or't ge erat d by Government Code Se tion 530 0 in the amount of'z $ ( � C �� covering a total of square feet of (P) re idential or ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction. u� ) 919 - ':2qu!" j), 7 J. -J - for DESERT S S•UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 LE T, 1Xy Smil Buena Engineers, Inc. 79-811 Country Club Drive, Suite 4 Bermuda Dunes, CA 92201 • (619) 345-1588 / 328-9131 Client Client Address F � J Client Phone DATE 2/3/��i J JOB NO. (3'�113s--PZ PROJECT' �'!S � �' S� �vP✓l�t�G JtJGtvP LOCATION �- Q. REFERENCE CURVE CONTRACTOR DRY OWNER t WEATHER E TEMP. 0 at AM ° at PM PRESENT AT SITE LOT NUMBER `m gYtSi i� 4 CLIENT REPRESENTATIVE SIGNATURE FIELD REPORT TECHNICIANS SIGNATURE ti —'y FIELD TESTING REFERENCE CURVE MOISTURE DRY MAXIMUM MAXIMUM OPTIMUM TEST TEST LOCATION LOT NUMBER NO. ELEVATION CONTENT DENSITY DRY DRY MOISTURE _ % IbslCu. ft. DENSITY DENSITY CONTENT 0,3--.0- a — "- % IbsJcu.ft. t0, IU(6,(,. ::rG50^3t�•„' :�"7L":�.t`,@lt'�k�.�'d:'�'.."}9�.,sc'�...T`.�^�'FEX:�Ci.l*�:Ki's:^.i!C.,:�,t�.`'p.S2..sr�4:Gl his%1u.'pfd'Y.'9''�9P'i4>S4..A�!ti"d�t'tt_i` ' t^!:'►:3'IC'y'p-.`�"�'..G'hT�x F3,i`kia`.i.SiY'y?µ A'.•t,"�`+"+x=t^�'+ ."�i'<.2_„� •i. it `.:li'Nri.•”. .. h.a�.iti +ty_ .e+1�YIv`.�'rba..JMy'tt; ♦'+n`+_w., •y,• w,ry wi.,7 �i-a 1 REMARKS: s r wrk AA I C VvL'"� r V4unt4 IiJI {{ �' �-4 �! �'Pcr .�►I �s�s �� t ac-ooe 40J1p. gYtSi i� 4 CLIENT REPRESENTATIVE SIGNATURE FIELD REPORT TECHNICIANS SIGNATURE ti —'y