12360 (AR)Z'
t
44.%,.
.�� P.O. BOX 1504 No. 12360
Building :y Northwood"-•- - :78-105 CALLE ESTADO
Address 79' •,,x;45 LA QUINTA, CALIFORNIA 92253
Owner Te Allan `
BUILDING: TYPE CONST.. -_ OCC: GRP.
Mailing :1 ,
Address $able
A.P. Number
City Zip Tel.
La Quinta ."CP 92253 Legal Description
ContractorAClditioIZ
Integrity Construction - Project Description
Add
rI455 Dela wart" .
Cit�alm Desert, C-:10 92260 Te1.345-7031 ' 5a<°
State Lic. City _ -
' v
& Classif. B 621,156 Lic. # 2968 Sq. Ft. 1043 No. No. Dw.
–Arch., Engr., _ ,• =,,i, - Size Stories Units' r
Designer,New 0Demolitionj0
Address Tel.
City Zip 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
effect.
SIGNATURE - - DATE _
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation $776;812.00
reason: (Sec. 7031.5,Businessand Professions Code:. Any city ort county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant /or such permit to file a signed statement that he is licensed pursuant to .PERMIT AMOUNT '
the provisions o/ 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 . Plan Chk. Dep. - - -
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 Plan Chk. Bal. 415.70
do the work, and the structure is not,intended or offered for sale. (Sec. 7044, Buisness and Const. 36 .�
Professions Code: The Contractor's' License Law does not apply to an owner o/ property who
builds or improves thereon and who does such work himself or through his own employees, 36.50
,
provided that such improvements are not Intended or offered /or sale. If, however, the building Mech.
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical ^rte C®®
of p oving that he did not build or improve /or the purpose of sale.) - 5 `= • 3 3
C I as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 45.00-, :
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 /or .S.M.I. - s 7.70
'
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - k
Grading
❑ 1 am exempt under S.C. B, & P.C. for this reason
Driveway Enc. -
Date Owner. Infrastructure t i
1
WORKERS' COMPENSATION DECLARATION s` ,
. I hereby affirm that I have a certificate of consent to self -insure, or a certificate of _ y,
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) F_y
Policy No. Company
❑ Copy is filed with the city. ' ❑ Certified copy is hereby furnished.
i TOTAL 1,089.23 "17
CERTIFICATE OF EXEMPTION FROM REMARKS A , 1f
WORKERS' COMPENSATION INSURANCE
(This section need not be' completed i/ 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: If, after making this Certificate of Exemption you should become ZONE:— BY:
subject to the Workers' Compensation 'provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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 - .
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from P
Lender's Name Q
Lender's Address FINAL' DATE INS OR
This is a building permit when properly filled out, signed and validated, and is subject to
OR—
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. Issued by: Date �rl 11
I agree to comply with all city and county ordinances and state laws relating to building 1
construction, and hereby authorize representatives -of this city to, enter the above-.'
mentioned property for inspection purposes. Validated by: t�
Signature of applicant Date �(( v
Mailing Address Validation: t By {_' ( f
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. p $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
Y
ARD SPKLR SYSTEM
2ND FL. SQ. FT. p
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
FOR. SQ. FT. p
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. p
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. p
GROUT
WATER HEATER
WALL SO. FT. p
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. p
=$
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.COOL HOOD
SIGN
WASH ER(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. p c
BATH TUB
SQ. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID p 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR p 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 619-775-3500
Date 10/11/93
No. 112474
Owner Name Terry Allan
No. 79745 Street Northwood
Type of Permit
La Quinta
Permit #
Log
city La Quinta Zip 92253 Study Area 106
APN. # I Tract # Lot # 0 Square Footage 11043
Type of Development Residential Addition No. of units 0
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 1.65 x 1043 or $ 1,720.95 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 Terrence A. Allen Telephone 619-771=0183
Name on the check
By
Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Vickie J. DurrettZL'
Payment-.Re,�eived {�
Signature _ r r` » C,h'?pk N61140
Collector: Attach a copy of county or city plan check application form to At;ict co�`py fo all wa ers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt CopyAccounting:
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