14274 (SFD)C a
` 1 r 11 - • r ����
P.O. BOX 1504
Building 52-394 Ave.Juarez 78-495 CALLE TAMPICO
Address LA OUINTA, CALIFORNIA 92253
Owner
David Rasa Miller
Mailing
City Zip Tel,
Contractor
PaCifiC 'grades
Address
Same
City Zip Tela
N0. 142?
BUILDING: TYPE CONST. VNOCC. GRP
773-251-009
A.P. Number
Let 14 Black 8
Legal Description
SFD
Project Description
R3.
State Lic.
City
& Classif. B 425381
Lic. # 1955
Sq- Ft- 1600
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition
Address
Tel.
Permit does
not include block wall or
pool.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
k __I hereby affirm that I am licensed under Drovisions of Chapter 9 (commencing with Section
1
70). of Division 3 of the Business and Professions Code, and my license is in full force and
Ifect.:
"SIGNATURE DATE
OWNER -BUILDER DECLARATION 1
leraffirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
$98j145.00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires .a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance alsoth
requires e applicant for such permit to file a signed statement that he is licensed pursuant to
PERMIT
AMOUNT
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 Section 7031.5 'any for
Plan Chk. Dep.
U •Uri
violation of by applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
Plan Chk. Bal.
2 r J 7
r- 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. 704,4, Buisness and
Professions Code: The Contractor's License Law, does not apply to an owner of property who
Const.
i1C1 • au
builds or improves thereon and who does such work himself or through his own employees,Mech.
55 • 50 -
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
Electrical -
9 • Gn
of proving that he did not build or improve lot the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
_
Plumbing
4 • 0
r'
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
9 a A
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.)-
- S.M.I.-
•
-Grading
•
-i^
C I am exempt under Sec. B. 8 P.C. for this reason
.
Driveway Enc.
• �%
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
G .:prfis filed with the city. O 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 ($100) valuation
or less.)
I certify that in the performance of thg 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND.
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant -Date-
Mailing
ateMailing Address
City, State, Zip
Infrastructure
rr ti a. sv r: A. ai 2 5. 102110
TOTAL 2r 1•G a,4 5 a. 6 a
REMARKS
ZONE: BY:
Minimum°Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Z11-1
Side`Setback from ProDe y Lin
FINAL DATE INSPEC'
Issued by: Date r
Validated by: a 1t 1
Validation:
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO.
iST FL. S0. FT. ® S
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION Y
UNITS
MOBILEHOME SVC.
POWER OUTLET
I
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
COLL, AREA
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.0OOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
(ROUG
/
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APPJEQUIP.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
-EMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
GRADING
cu. yd.
a plus x$
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® t1/. c
SEWAGE DISPOSAL
FINAL INSP.
SO.FT.GAR ® 3hc
HOUSE SEWER
d/1—
REMARKS:
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
i UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE _cq2`l
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
r�
FOUND. REINF.GAS
!�
(ROUG
/
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.
a plus x$
-S
LUMBER GR.
FINAL INSP, !�s
/
FRAMING �Qs,//
7
FINAL INSP.
ROOFING /
l
d/1—
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISHG DING
FINAL INSPECTION
CERT: -OCC.
FENCE FINAL
insrtc i un a a�unw � untanm i Www
GARDEN WALL FINAL
Building
Address
Mailing
A.P. Number 1 Z- zS) - 0 09
(<
ZIP � Tel. ) Legal Description La -c
Project Description
C
Zip
State Lic. I City
& Classif. SC( 2 Sag Lic. # �G S
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
,/�\ LICENSED CONTRACTOR'S DECLARATION
I hereby ffirm hat ram licensed under provisions of Chaap e79 (commencing with Section
7000) of(Div sio of `he`9usiness and Professiii'ns Code, and mJ license is in full force and
effect. i l� �lti—c- c Ln m)
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, alter, 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 five hundred dollars ($500). -
17 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.)
1-1 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.)
17 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 ($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: 9, 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.
r
- 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 stale 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
BUILDING DIVISION
Sq. Ft.
Size
New ❑
No.
600. Stories
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑ .
IEstimated Valuation ?9 (q 3" O D
7
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure .
TOTAL
REMARKS
AMOUNT
z 76.
6 2i . S'rt
i yppy• quo
!i 8/
2e�•vo
�9-
0/,65 v1 345/ o 5-
ZONE:
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line—
Rear Setback from Rear Prop. Line.
Side Street Setback from Center Li
Side Setback from Property Line_
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated bv:
Validation:
CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO.
ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ g
7
b
BONDING
UNITS
STORAGE TANK
FORMS
2ND FL. SO. FT, `y
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
YARD SPKLR SYSTEM
POR. S0. FT. <U
HEATING (FINAL)
OTHER APPJEOUIP.
MOBILEHOME SVC.
GAS (FINAL)
BAR SINK
GAR. S0. FT. @
8
GROUT
POWER OUTLET
SERVICE
ROOF DRAINS
CARP. SO. FT.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
g plus xg
DRAINAGE PIPING
WALL SO. FT. @
rZD 0
FINAL INSP.
FRAMING
FINAL INSP.'
DRINKING FOUNTAIN
SO. FT, @
REMARKS:
URINAL
ESTIMATED CONSTRUCTION VALUATION S
WATER PIPING
NOTE: Not to be used as property tax valuation
FIREPLACE
FLOOR DRAIN
MECHANICAL FEES
GAR. FIREWALL
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
LATHING
SIGN
MESH
WASHER(AUTO)(DISH)
APPLIANCE DRYER
INSULATIONISOUND
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSPECTION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
CERT. OCC.
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
INSPECTOR'S SIGNATURESIINITIALS
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.
S0. FT. RESID @ 11A c
/
SEWAGE DISPOSAL
SO.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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
g plus xg
=g
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
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 111/17/941 Type of Permit I La Quinta
No. 113191 1 Permit #
Owner Name David Ross Miller Log
No. 52-394 Street Ave. Juarez
City La Quinta Zip 92253 Study Area 113
APN # Tract # Lot # 0 Square Footage 11600
Type of Development 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 1.72 x 1600 or $ 2,752.00 have been paid to D.S.U.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
David Ross Miller
Name on the check
Telephone
By Dolores A. Ballesteros
Superintendent w ' a z1 4
Fee collected /exempted by Mary Lou Lopez2ZL
Payment Received
Signature / �� 7
4307=
,C11eck,No:
Collector: Att ch a copy of county or city plan (14 application form to district copy for all'waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
Received From:
....... ..... .. �
Address:
Account No.
Service Address
Meter(s)
Service(s)--
• Backflow(s)
• House Lateral(s)
• Detector Check(s)
• Meter Surcharge
A. Sanitation Capacity Charge
0 W.S.B.F.C.
0 Temporary Construction Meter
0 Turn on Charge
0 Uncollected Account - Name
0 Inspection Fee - Tract -
Fee -
0 Plan Check Fees Water I Sewer -
Tract -
• Bond Payment - A.D. -- Bond
—
Assmt.
• Customer Deposit
0 Other
Remarks:
0 COPY to:
Cash
Check
Money
Order
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
C4
4
Mr
N2 5RRf-.s
Date:
- -11-
Tract — -
G.A. Code
$
TOTAL $
Water Service
Cashier
CVWD-438 (11189)
oF
I�
II
1 i
I
41 i
I
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♦
u 1a Quiuta
I
This Certificate issued pursuant to the re uirements of Section 306 of the Uniform Building
i'
Code certifying that at the time of issuance this structure was in compliance with the various
Y 9 P
ordinances of the City regulating building construction or use. For the following:
BUILDING ADDRESS 52-394 Ave Juarez
;
!'
Single Family Dwelling 14274
Use Classification Bldg. Permit No.
iI
i
Group R3 Type Construction VlV Fre Zone Use Zone SR
I
I 4
!, j
ilj
l li!li
l�`
Owner of Building David Ross Miller ,address 52-394 Ave Juarez
E i
i
i I I
!I
City La Quinta , CA. , 92253 By; Daniel P. Crawford Jr.
Dote; July 14., 1995
Building Official
POST IN A CONSPICUOUS PLACE
--
—
NAN/N6