07411 (SFD)Building $2-'770 Ave. Cortez
Address
Owner
Bruce Shit
' u
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 78-725 LA Fonda #1
CityZip Tel.
Ls ouinta 9Z2b3 1
Contractor
Address
` City Zip Tela
rl1
State Lia 6 Lilo # ��
& Classif. rJ{3s$12 _
Designer
Address Tel.
City_ ' I Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby, affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 3 of Business and Proons Code, and my license is in full force and
efffegai
ect. /Y.
SIGNATURE DATE
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 live hundred dollars ($500).
i ❑ 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 or property who
i 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 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.) '
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
j 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' 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 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
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
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 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 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. 07411
BUILDING: TYPE CONST. to OCC: GRP.
A.P. Number 773-153-001
Legal Description
Project Description Single Fwdl-y DwZl#iii
• wd
Sq. Ft. 1627
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
imictaff % s
umn And yad fent►.
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
M.06
Const.
612;50
Mech.
63.60
Electrical
113,N
'Plumbing
257•510
S.M.I.
6.68
Grading
20.00
Driveway Enc.
20.00
Infrastructure
072.03
TOTAL
REMARKS
b
Nva' i10W-'f" Ite. #41
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 INSPECTORS
Issued by: —Date_Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE tJO ,j 4v
ROUGH PL B. BONDING
YARD SPKLR SYSTEM
2ND FL. S0. FT.
FORMS
SEPTIC TANK ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH) METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) TEMP. POLE- y a
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER SERVICE
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING a�
FLOOR DRAIN
MECHANICAL FEES
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WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SPARK ARRESTOR
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
MESH
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSPECTION 3
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
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% c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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 f /0
AgmBING/4�/J UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE tJO ,j 4v
ROUGH PL B. BONDING
HEATING (ROUGH)
STORAGE TANK +
FORMS
SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. 7�
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPIEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE- y a
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
-plus-x$-=$
LUMBER GR.
FINAL INSP. / 3
FRAMING a�
FINAL INSP Gam/
/G1
ROOFING&4f Wme
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EMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING ��— ?0
MESH
INSULATION/SOUND T 2I LLL
FINISH GRADING
FINAL INSPECTION 3
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
h
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RECORDING REQUESTED BY
UNION LAND. JITLE COMPANY,
` + AND WHEN RECORDED MAIL TO
r -t
Name Bruce K. Swan
Street 78-725 La Fonda #1
Address
City a La Quinta, CA 92253
state L J
MAIL TAX STATEMENTS TO
F- 7
Name
Street SAME AS ABOVE
Address
City a
sat J
state L
CAT. NO. NNO0582
TO 1923 CA (2-83)
SPACE ABOVE THIS LINE FOR RECORDER'S USE
Individual Grant Deed
THIS FORM FURNISHED BY TICOR TITLE INSURERS
The undersigned grantor(s) declare(s):
J z Documentary transfer tax is $ A - Qn
a a (XX ) computed on full value of property conveyed, or
( ) computed on full value less value of liens and encumbrances remaining at time of sale.
S ) Unincorporated area: ( XX) City of r.a Q,, in f -a , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
DUSTA-LYN WEAVER JORDAN, a married woman as her sole and separate property,
(who acquired title as DUSTA-LYN WEAVER, a widow)
hereby GRANT(S) to
BRUCE K. SWAN
the following described real property in the City of La Quinta
County of - Riverside , State of California.
Lot 24 in Block 30, Unit No. 2 of Santa Carmelita at Vale La Quinta, as per
Map recorded in Book 18, Pages 55 and 56 of Maps, records of said county;
Dated: NAVPmhoar 7AF 7QRR
STATE OF CALIF NIA _ �Ss. COUNTY OF 1 aOitdl�GCi
On before
me, the undersigned, Notary2Pun an for said State,
rsonallDre c i= -
rsonally known to me or proved to me on the basis of sat-
sfactory evidence to be the person_whose.name �CdJ
subscribe to the within instrument and acknowledged
that executed.the same.
WITNESS d and official seal.
Signatur
Title Order No.
Dusta—Lyn Wea er Jordan
OFFICIAL SM
JUDITH J. M10111011 1
NOTARY PUBLIC- CALIFORINA
RNERSIDE COINITY
MY COMMISSION EXP. DEC. 9.1991
(This area for official notarial seal)
Escrow or Loan No.
MAIL TAX STATEMENTS AS DIRECTED ABOVE
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SPACE ABOVE THIS LINE FOR RECORDER'S USE
Individual Grant Deed
THIS FORM FURNISHED BY TICOR TITLE INSURERS
The undersigned grantor(s) declare(s):
J z Documentary transfer tax is $ A - Qn
a a (XX ) computed on full value of property conveyed, or
( ) computed on full value less value of liens and encumbrances remaining at time of sale.
S ) Unincorporated area: ( XX) City of r.a Q,, in f -a , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
DUSTA-LYN WEAVER JORDAN, a married woman as her sole and separate property,
(who acquired title as DUSTA-LYN WEAVER, a widow)
hereby GRANT(S) to
BRUCE K. SWAN
the following described real property in the City of La Quinta
County of - Riverside , State of California.
Lot 24 in Block 30, Unit No. 2 of Santa Carmelita at Vale La Quinta, as per
Map recorded in Book 18, Pages 55 and 56 of Maps, records of said county;
Dated: NAVPmhoar 7AF 7QRR
STATE OF CALIF NIA _ �Ss. COUNTY OF 1 aOitdl�GCi
On before
me, the undersigned, Notary2Pun an for said State,
rsonallDre c i= -
rsonally known to me or proved to me on the basis of sat-
sfactory evidence to be the person_whose.name �CdJ
subscribe to the within instrument and acknowledged
that executed.the same.
WITNESS d and official seal.
Signatur
Title Order No.
Dusta—Lyn Wea er Jordan
OFFICIAL SM
JUDITH J. M10111011 1
NOTARY PUBLIC- CALIFORINA
RNERSIDE COINITY
MY COMMISSION EXP. DEC. 9.1991
(This area for official notarial seal)
Escrow or Loan No.
MAIL TAX STATEMENTS AS DIRECTED ABOVE
DAILY WORK SHEET
LJOBBN-AME JOB N0. DATE
CLIENT
COMMENTS
TE
TEST ELEVATION
DENS Y PERCENT I MOISTURE DENSITY C RELATIVE
)CATION OR
l
SOIL TESTING, INC.
Phone (619) 340-9492