9512 (SFD)Twit
44a
t�G+h`trGt/
P.O. BOX 1504
Building53-660 Navarro 7&105 CALLE ESTADO
AddresLA QUINTA, CALIFORNIA 92253
Charjack, Inc.
Mailing
Address P. 0. Box 59
City Zip Tel.
La Quinta 92253 564-'1486
Contractor
Gene:ail Contract Migm :.
P. U. Box 59
City Zip Tel.:
La Quinta 92253 564-1485
State Lic. City
& Classif. B 524325 Lic. # 1235
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
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
OWNER -BUILDER DECLARATION 1
I hereby affirin that 1 am exempt froni'the=Contractor's License Law for the following
reason: (Sec. 7031.5,Bustness 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) 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 rive hundred dollars ($500).
❑ 1, 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.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Business and Professions Code: The Contractors 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 pursuantto the Contractor's License Law.)
❑ I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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
r'
gyCopy is filed with the city. O Certified copy is hereby furnished
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed i1 the permit is for one hundred dollars (5100) 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: M, alter 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
1hereby 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.
1 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
No. 9512
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 774-135--009
Legal Description Lot 16 bloc' 240
Project Description
SPI)
Sq. Ft. 1483 No. 1 No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Permit does not include block galls or
pool
Estimated Valuation x157 . 60
PERMIT
AMOUNT
Plan Chk. Dep.
2S0 •00
Plan Chk. Bal.
230.35
Const.
558.50
Mech.
42.50
Electrical
124.09
Plumbing
157.50
S.M.I.
5.74
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1797.27
TOTAL
3205.95
1 2955.95
REMARKS05
q�
�{14
tSri '..-t•tlk11 .t
fv4 .rvi_ A r_r__rs✓.o
ZONE: BY:
Minimum Setback Distances:
Front Setback iron Center Line
Rear Setback frorr Rear Prop. Line
Side Street Setback from Center Line
Side Setback from, Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SO. FT. ®
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SO. FT. ®
WALL SQ. FT. ®
SQ. 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
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FOUND. REINF. /
LAUNDRY TRAY
AIR HANDLING UNIT CFM
METER LOOP
IKITCHEN 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
SERVICE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
WATER SYSTEM
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GRADING
cu. yd.
$ plus x$
_$
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEESMI
FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK 9�
ND PLUMBING —
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE S 9r
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 `6/lj�
FINAL INSP.
ROOFING � .-3
/
� ('
//!
/O ✓� /
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING J�t)fVrA'
a
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Building
Address
Owner
Mailing
Address P�0, a1w S�
City Zip
Contractor—
Addess -
&-,�, F%
MMM
State Lic •—
& Classif. -�
,Arch., Engr.,
Designer '
Address
P-1
P.O. BOX<1504 ( APPLICATION�ONLY
78-105 CALLE ESTADO (l
J LA QUINTA, CALIFORNIA 92253
R
BUILDING: TYPE CONST. =~ OCC..GRP. _
A.P. Number r9�sjw ,
Tel. `` .
Legal Description 7: /G . >3i. k -2- V6
Project Description
City____._- -
Lic. # Sq. Ft. / No. No. Dw
Size Jzj Stories - Units
New ❑ Add O Alter ❑ Repair ❑
Tel.
City Zip State
i Lic. #
" LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
effect
of bnnsion 3 of the Business and Professions Code, and my license is in full force and.
Demolition ❑-
- t
i
�� •a.
x
1
1 SIGNATURE - DATES
_a._ — _ _ ..I _ , f�E_R•BUILDER DECLARATION• _ - .— •
- I hereby affirm that I am exempt from the Contractor s`License-Law• for_the-following
reason: (Sec. 7031.5,8nsiness and Professions Code: Any -city - or county which -requires a -
EstimatedValuation
'
_ __ . _ _
_ - _
1 PERMIT-- - - -- -- AMOUNT
pert to constrict, ager, improve ,•demorsh, or repair any structure, prior to its -issuance also.
provisions o appficant mContractor'sctl�icenose�iawgChhappter....s (commencing�witrh Secronu 0o) of
—Plan-Chk:•Dep. - -
-
- _-. .- p --- .L '- -- -• _ _ -
Otvision 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).
- ❑ 1, as owner of the property, or my employees with wages as their sole. compensation, will .
d' the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
* Professions Code: The Contractors License Law does not apply to an owner of property who
• bulk, or improves thereon and who does such work himself or through his own employees,
ProvMed that such krpmvements are -not intended or offered -for sale: If, however, the building .
or iriprovement is sold within one year of completion, the owner -builder wig have the burden •
- • of proving that he did not build or improvefor the purpose of sale.) -_z:...
_ Plan Chk. Bal.
Const.
Mech.-
Electrical
Plumbing
-
❑ 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 appy to an owner of property • who builds or improves thereon, 'and who iontracts�-foi
` S-. M.1. - "T'
such projects wgh a contractor(s) licensed pursuant to the Contractor's License Law.)-
❑ 1 am exempt under Sec' R, & p.C. fol this reason - _- ----
—Gfadlpg _
Driveway Enc.
' ` �,•
Date Owner -
Infrastructure
WORKERS' COMPENSATION DECLARATION
- •I hereby affirn-that-1 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. - El Certified copy is hereby. furnished.--- • -
- - -
- -
TOTAL.
f REMARKS
` CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
- --- 6;
: --
,y n +-
-_64
'(This`section need not be completed if the permit is for one"hundred dogais (S 100) 'valuation -
or less.)
- I certify that in the performance of thg work for which this permit is issued, I shall not
employ anyperson in any manner so as to become subject to the' Workers' Compensation
Laws of California
V -Y- t
V 5 b S L 1 V +
i n (''CCM f TIITQI f 775 , 00
- -
_
Date Owner
M077CE TO APPLICANT: n, after ;making this • Certificate of Exemption you should become
subject to the Workers' Conpen aban provisions of the Labor Code, you must forthwith
comply with Such provslors Or this pemrit shag be deemedrevoked: - ..
+ ZONE:
Set k-Di
Minimum S.
�
g
_
BY: - '^
-
stances: ,
Front Setback from Center'Line
Rear Setback from Rear Prop. Line- -
CONSTRUCTION LENDING AGENcy
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
T•work for which this permit is issued. (Sec. 3097, C40 Code.) ..
-
-.
Side. Setback from Property Line .
Lender's 'Name
Lender's Address
is a building permit when pioperly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
expiration if work thereunder is suspended for 180 days.
certify that 1 have read this application and state that the above information is correct. rr
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.
Issued by:
Validated by:
Date Permit,
`
Signature of applicantDate
Mailing Address— -
Validation:
City, State, . Zip
BUILDING DIVISION
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SQ. FT. ®
_$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
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/ac
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 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.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
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 4/29/91 Type of Permit La Quinta
No. 110565 Permit #
Log #
Owner Name General Contract Management
No. 53660 street Avenida Navarro
city La Quinta zip 92253 Study Area 111
APN # 774-135-009 Tract # I Lot # 16 Square Footage 11483
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 1.58 X 11.483 or$ 2,343.14 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 General Contract Management
Name on the check
By Richard M. Beck
Telephone X64-1486
Director, Facilities Planning & Development
1{
Fee collected /exempted by Shelley D. Bennett ZI
Payment Received y,
gn ���.
f
Si store � Check ho 0:1 6887
N
Collector: Attach a copy of county or city Plan check aPP Lcation form to districiri'coPYfor aill waieL e`r_..,s
.
Embossed
Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting,,
f
Of R�
CALVIN C. KAMINSKAS +s DAN RILEY
o n Sealer. Weights & Measures
Assistant Commissloner „ c
(714) 275-3000 (714) 275.3030
OFFICE OF
AGRICULTURAL COMMISSIONER
JAMES O. WAL'LACE. Commissioner
83-612 Avenue,45 Suite 7
Indio, CA 92201
(619) 342-829I
DATE / �Z� •CASE NO.
DEVELOPER'S NAME: (;-e6Lc
ADDRESS: -Po
U S
/ r 9 Z z Ss
TELEPHONE:
53 0
Dear Developers
After reviewing your-landscaping plans, all plant'material listed is not in
violation of- 'quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ from plant material,listed, this office mast be notified.
immediately.
Thank you for protecting and preserving the Coachella Valley's pest-free environment.
Agricultural Cormtiss oner's Office
cc: Indio and Riverside
.4080 LEMON STREET, ROOM 19; RIVERSIDE, CALIFORNIA 92501 — FAX (714) 275-3012
'n
.111.
0
Cott f
04 44
�1 7, t ��41-
fe
t t n,
"This Certificate issued pursuant to the requiremIeptspfl,*Sq; the Uniform Building'
Code ,�Y
-certifying that at the time of issuance �p��.$�tryipture'.wasin!cotnplionce with the various
ordinances of the City regulating buildingconstruction oiLis-p1l,, For,;,- the following:
const q.q
53--�660 AVENIDA NAVARI�0-.,
BUILDING ADDRESS
Use Classification SINGLE FAMILY DWELLING Bldg. Form It No. 9512
R3 VN- re Zone SINGLE RESIDE
Group Type Construction F1 Use Zone
Owner of Buildihd CHARJACK Address 53660'.AVENIDA NAVARRO
LA� QUINTA, CA
city . .... ....... . MARX HAROLD
ay i -
'
Date; SEPTEMBER 9 1991 _
774P
Building Official
4.1Pr_ POST IN A CONtIPICUOU13 PLACE
j !Si�
4
tie
q
'n
.111.
0
Cott f
04 44
�1 7, t ��41-
fe
t t n,
"This Certificate issued pursuant to the requiremIeptspfl,*Sq; the Uniform Building'
Code ,�Y
-certifying that at the time of issuance �p��.$�tryipture'.wasin!cotnplionce with the various
ordinances of the City regulating buildingconstruction oiLis-p1l,, For,;,- the following:
const q.q
53--�660 AVENIDA NAVARI�0-.,
BUILDING ADDRESS
Use Classification SINGLE FAMILY DWELLING Bldg. Form It No. 9512
R3 VN- re Zone SINGLE RESIDE
Group Type Construction F1 Use Zone
Owner of Buildihd CHARJACK Address 53660'.AVENIDA NAVARRO
LA� QUINTA, CA
city . .... ....... . MARX HAROLD
ay i -
'
Date; SEPTEMBER 9 1991 _
774P
Building Official
4.1Pr_ POST IN A CONtIPICUOU13 PLACE
j !Si�