14713 (SFD)Tit
4 QUA
P.O. BOX 1504
Buildi g 3 1 0 -Ave. Juarez 78-495 CALLE TAMPICO
Addres6•-•, LA QUINTA, CALIFORNIA 92253
Owner
avid Ross Miller
Mailing
Address
'.. City lZip
Tel.
. (.
Contractor._
Sika..... .
Address
City IZip . ITO.: .- -"'
No. 14713
BUILDING:' TYPE CONST.-` OCC: GRP. R3
A.P. Number 774--041- R09
Legal Description Lot = 16.Block 178
Project Description `'
ft
State Llc City
8 Classlf..
42538.1.: 19.55. Sq. Ft. No No. Dw.
Lic. #
Size. 159 Stories Units
Designer, ' New ❑ Add ff Alter ❑ '. Repair ❑ Demolition.0 .
Address Tel...T11+� Y:RDt 'Li��.4f�E.' bltack C3a1 C_,
City . Zip State 1 ,
Lic. #' s
LICENSED CONTRACTOR'S DECLARATION ^
0Zho reby affirm that I am licensed under provisions of Chapter 9{commencingwith Section
of DvSign3 of the Business and Professions Code, and my license is in, ull force and
ct
P
"SIGNATURE' DATE
OWNER -BUILDER DECLARATION Estimated Valuationtf �f 9
I- hereby affirm that I aim exempt from the Contractors License Law for the following : V'/.b%/€i
reason:. (Sec. 7031:5,Business 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:.
provisions of the- Contractor's License Law, Chapter 9 (commencing with Section, 7000) of
Divislon 3 of the' Business and Professions Code, or that. he is exempt therefrom, and. the basis • . -.r
for the alleged' exemption. Any violation of •Section 7031:5 by 'any • applicant for a : permit ' -
'subjects the applicant to a civ8 penally of not more than five hundred dollars ($500). - - . •,-
❑ I, as owner,of the,property, or my employees with wages as their.sole cbmpensation,"will
do the work, and the stricture Isnot intended or offered for sale. (Sec. 7044, -Buisness and
Proressions.Code: The Contractor's License Law does not apply to•an owner of property' who '
builds or improves. thereonandwho does such work himself or through his own .employees, .'
provided. that such. improvements are not Intended or offered for sale. If, however, �.the .building. a�.-�
or Improvement is sold within one .year of completion, the owner -builder will have the burdem . -
of proving.tbat he did not build or Improve for the purpose of sale.).
-
PERMIT
-
•,^
Plan Chk: Dep?- •
Plan Chk. 631.
ICOnst-. " •` _ '
�.t-��-�,�
.• McCh.' -'• .,
Electrical'
Plumbing
O'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 -
S:M.I. - -
.does not apply Loan owner of property -who builds or improves thereon, and.who�contracts for'
'. such projects with'a contrsctor(a licensed pursuant to the Contractor's - License 'Law.).
• ❑ 1 am exempt under Sec •B. & P:C. for this reason "
Grading
Driveway Enc.'
Date Owner
Infrastructure
r"
Precise Play -
.
)0
AMOUNT
WORKERS' COMPENSATION DECLARATION
I he eby affirm that I have'a certificate of,'consent .to self -insure; or a certificate of
Worker CO`?npensation Insurance, or a certified copy thereof. (Sec: 3800., Labor Code.) - "•'
Policy No.' Company.
LIQ CoPy'I. filed•with the city, ❑. Certified.copy is hereby furnished.'
TOTAL 3 e 725.. -SO
'CERTIF C '
caaFv+
144.00
9.82
. ��••gg '.. 40
qq.
25.00
3,475.50
1 ATE OF EXEMPTION FROM .I
WORKERS' COMPENSATION INSURANCE '
..REMARKS .� .. ;.
(This section need not. be completed B. the permit Is for one 'hundred dollars ($100)
.. . or less.) - - .valuation
I certify that in the performance of thg,work for which this permit.is issued;.l•shall not .
person in any.manner so as to become 'subject'to'the Workers'' Compensation.
=Cal
Laws of California
.
-- in
bite.
Owne
NOTICE, TO APPLICANT:rIf,' after making this, Certificate of Exemption'.you should become'
'ZONE: .'' BY: In' - ' �
subJett' to the Workers' Compensation provisions of the Labor Code,, you . must forthwith •
comply with such provisions orthis,petmifshall bedeemed revoked.
. •- • '
Minimum Setback Distances:.•. •�.Itll.
Front Setback'from Cenfteik Lin 10.OG ' ••
-
�I)
Rear Setback from Rear Prop. Line v '
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND"
Side Street Setback from Center Line
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; ..'
Side Setback. fror;, Property, Line -
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE -LABOR CODE, INTEREST, AND '
ATTORNEY'S FEES.
This is a building pePrnit when property filled out; signed and validated, and.is subject to
FINAL DATE INSPECTOR
expiration if work thereunder is suspended for180•days. .
I certify that I have read this application' and state that, the above information Is correct::
Issued by: Date- Pefmit
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.'
Validated by:
Signature of applicant Date
Mailing Address
-Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO., Ir ELECTRICAL FEES a+
z
N0. PLU1,101ti FE�I S
1& $
FL. SO. FT. ®
UNITS
'
COLL. AREA
SLAB GRADE •
ROUGH PLUMB.
24D FL. SO. FT.
YARD SPKLR SYSTEM, --
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
DRAINAGE PIPING
WALL SO. FT.
AS (ROUG
DRINKING FOUNTAIN.
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REIN F. STEEL ;_
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
WATER SYSTEM
LAUNDRY TRAY
AIR HANDLING UNIT CFM
4RADING
cu. yd.
—plus—x$
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
SQ: FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
I 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 /y t!
v ✓
GROUND PLUMB �
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE •
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
'SEWE OR 1
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS (ROUG
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REIN F. STEEL ;_
GAS (FINAL)
TEMP. POLE 171/x 1�
GROUT
WATER HEATER
SERVICE
flNAL INSP.
/
BOND BEAM �K/ �A`
/ o
WATER SYSTEM
$
4RADING
cu. yd.
—plus—x$
_$
LUMBER GR.
FINAL INSP. �6 �
FRAMING / Q
FINAL INSP.
ROOFING 3 � �
- �` �
(/GL►/l
.
l/%N
REMARKS: '
VENTILATION
/
FIRE ZONE ROOFINGAlAlly
u� ,
S —a
FIREPLACE
, SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION / /s
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 2/10/95 1 Type of Permit I La Quinta
No. 113299 Permit #
Owner Name David Ross Miller Log
No. 53180 Street Ave. Juarez
City La Quinta Zip 92253 Study Area 112
APN # Tract # Lot # 0 Square Footage 11590
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 1.72 X 1 590 or $ 2,734.80 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 Telephone
Name on the check
By Dolores A. Ballesteros
Superintendent
.4.
V.-
4
.
Fee collected /exempted by Pauline Pearson
(� Payment Received
Signature Check u�,,,, p jl' D (It�J� 4 v t
—s Check . No. 4454..
..
Collector: Attach a copy of county or city plan check application form to district copy foiAl waivers. S
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounfina
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From: 4!:1: .2 0--e 2 —0,
Address: sa
Account No. Lot(s)
Service Address
674,
AM eter(s)
Nservice(s)
0 Backflow(s)
0 House Lateral(s)
• Detector Check (s)
• MeterSurcharge
5XSanitation Capacity Charge
0 W.S.B.F.C.
• Temporary Construction Meter
• Turn on Charge
0 Uncollected Account - Name
0 Inspection Fee - Tract -
Fee -
0 Plan Check' Fees Water / Sewer -
Tract -
0 Bond Payment - A.D. - Bond
Assm t.
• Customer Deposit
• Other
-
N! 51725
G.'A. Code
11 — 3 4 f $ e7-,!!!1 - -y c-,/
Z__
-Remarks:
TOTAL $
0 COPY to:
Cash
Water Service
Check
Money
Order
CVWD - 4/38 (11189)