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10455 (SFD)TdY ' 414 P.O. BOX 1504 No. 10455 Building , 78-105 CALLE ESTADO t Address 5s -'$'S5 Velasco LA QUINTA, CALIFORNIA 92253 Owner Expectation Construction Mailing Address 54--295 -Diaz City Zip Tel. La Qdinta.. 92253 564-0793 Contractor Same Address JILDING: TYPE CONST. OCC: GRP. P. Number 7731-085--!-E323.' gal Description Lot I1 Block 64 oject Description ' SFA City Zip Tel:f State Lic. City & Classif. .3 ��>5' Lic.#N4& Sq _Ft. 1611 + Arch:, Engr., ' Designer Address I City LICENSED Thereby affirrn that_I am licensed 7000) of Dsion�3 of the,Business. effect- ! . ivi- l� Tel. Zip IState Lic. # CONTRACTOR'S DECLARATION t - under provisions'oVC' hap`ter9 (commencing with ; and Professions Code, -and my'li6ense is in full for `� 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 orcounty 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 703 1: 5 - by 'any applicant. for a' permit subjects the applicant to a civil penally of not more than five hundred. dollars.($500). ' . 1. " . d 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. W, 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.) _ t ❑ 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 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 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 cart ified.copy,thereof. (Sec. 3800, Labor..Code.). Policy No. - company SSI Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ifthe 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. 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 it 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 Address City, State, Zip New ❑ Add ❑ ermit doe F ,all or 0003. PERMIT Plan Chk. Dep. Plan Chk. Bal. . Const. Mech. Electrical Plumbing S.M.I. ' Grading Driveway Enc. Infrastructure No. Sto No. Dw. Units Alter ❑ Repair ❑ Demolition ❑ t incl .. 98;<5S5.tlfl - Com'► "'�,r TOTAL blocs REMARKS AMOUNT 2� ; ¢� 28th.. - Minimum Setback Distances: Front Setback from Center Line Rear. Setback from Rear Prop. Line Side Street Setback from Center Line e s. S 7 _51114 FINAL DATE INSPECTOR -Issued by: Date Permit' 20 Aa-.. 20b6.39 REMARKS 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 INSPECTOR -Issued by: Date Permit' Validated,by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. ?LUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. GAS (ROUGH) METER LOOP DRAINAGE PIPING WALL SQ. FT. OTHER APPJEQUIP. DRINKING FOUNTAIN. SQ FT @ URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER / FRAMING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED �Or I �f ((%" Arlo ///� Y LAUNDRY TRAY AIR HANDLING UNIT CFM 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 ® 1% c SEWAGE DISPOSAL THING 3o ?,2t.0 SQ.FT.GAR ® 3/ac HOUSE SEWER MESH GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE %IECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR' SETBACK GROUND PLUMBING,e/y4V alll1NDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS $ipA.6Ef�19! !t16 OUGH WIRING. ` DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. plus x$ _$ LUMBER GR. FINAL INSP. / FRAMING FINAL INSP. 7vL tI ROOFING/2(jx���LO �Or I �f ((%" Arlo ///� Y REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL THING 3o ?,2t.0 MESH INSULATIONISOUND FINISH GRADING INSPECTION CERT.FINAL CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL P.O. BOX 1504 APPLICATION ONLY Building/ 7&105 CALLE ESTADO Address S LA QUINTA, CALIFORNIA 92253 Owner _ Mailing Address S qs 0147- City 4 City Zip Tel. GA Q0fX)rp *' 5WS1 I S1Cy--d Contractor Address City State Lic. City & Classif. / jj Lic. # n 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 effect. 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 Secfion 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500). 1'2' 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'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.) i ] I 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 r] Copy is filed with the city. ri 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 i or less.) i 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: 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 affirnPthat 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 . I 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. i Signature of applicant -Date- Mailing ateMailing Address City, State, Zip FINANCE BUILDING: TYPE CJONST. QQ OCC. GRP. EC A.P. Number _713 ��O D/� Legal Description 69 L� A9 �-� Project Description J �� Ft. ' -7 No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. frastructu TOTAL REMARKS 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 INSPECTOR Issued by: Date Permit Validated by: Validati DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 5/29/92 1 Type of Permit I La Quinta No. 111436 Permit # Log # Owner Name Expectation Construction No. street See Below city La Quinta zip 92253 study Area APN . # I Tract # 1 Lot # Square Footage 13,654 Type of Development INo. of units I Single Family Residence 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 ® or $ 5,773.32 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 Roger Snellenberger & Assoc., Inc. Telephone 7714501 Name on the check By James E. Lively Assistant Superintendent, Business Services Fee collected /exempted by Shelley D. Bennett t Paymenticeivt"��y� Signature D.M Ch ,eCl No. -,13 + 5 + E r r Collector. Attach a copy of county or city plan check application form to disti-iet copy for all wRivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounti:ng .1 EFT Y: r VETERANS ADMINISTRATION/U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT IIUD/FILA On VA CASE NO. HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER -SUPPLY AND SEWAGE -DISPOSAL SYSTEM IIUUlFIIA On VA OFFICE IMPORTANT—This form should be completed and filed as required by exisling law 38 U.S.C. 1904 and 18111.. PART I—TO BE COMPLETED BY IIUD/FHA On VA ORTGAGEE NAME AND ADDRESS (include ZIP Steve Connor 85-236 Bagdad Coachella, Ca 92236 TOTAL NUMBER LIVING UNITS ::73 DROOMS BATHS 1 2 WATER -SUPPLY BY: OPUBLIC SYSTEM ❑COMMUNITY SYSTEM ❑INDIVIDUAL SEWAGE -DISPOSAL BY: ❑PUBLIC SYSTEM ❑ COMMUNITY SYSTEM [INDIVIDUAL IS THEnE A BASE. IS THIS A NEW MENTI INSTALLATION) MORTGAGOn On SPONSOn PROPER Form Approved OMB No. 2900.0081 51-465 Avenida Velasco LaQuinta, Ca 92253 SUBDIVISION/LOT NO. CAN THE ATTIC OR OTHER AREA BE MADE INTO ADDITIONAL BEDROOMS? (If "Pear,"how many)/ ❑YES ®NO I jUYES 0 N I OYES ®NO PART II—TO BE COMPLETED BY HEALTH DEPARTMENT IN SKETCH (TO REPORt liS.BUILT'DEVlAT/ONS PROAf APPROVED PLAN) SYSTEM DESIGNED FOR - NO. OF BEDnOOMS ;GAnBAGE DISPOSAL y� 3 {DYES ONO It Is the opinionor the ❑ Stale ❑ County t]4 Locai beparlulcnl of I lenlih that this Individual water -supply system j4Ls ❑ is lot sallsfactory as a dnmesllc water -supply for the subject property. 7 It is the opinion of the ❑ Slate ❑ County Aocal Department of I Icalth that this individual sewage -disposal system with proper malnteuance� Can be expected to function satisfactorily, and is not likely to create unsanitary conditions ❑Cannot be expected to function salisfactolily. DATE SIG TUn Cl 9 TITLE NOTE: The health authority should complete the appropriate opiniol Icule it above and affix date, signature and title in the spaces provided. NOTE: Use of the reverse of this form is at the option of the health authority. PART III—FOR USE OF FIELD OFFICE 1 have reviewed the foregoing and the pertinent Compliance Inspection Report and recolnnlend that the individual water -supply system be considered ❑acceptable.❑ not acceptable and that 'tile sewage -disposal be considered ❑ acceptable ❑ not acceptable DATE SIGNATUnE TITLE ❑ TIUO ARCHITECTUnAL SECTION CHIEF OR DEPUTY CHIEF ❑ VA CIIIEF ArPn AISAL SECTION On DESIGNEE VA FORM 26.0795, ArR 1982 Sur1:1151'IHd; VA I r IUd'Jf..G195, UCI Ir %G. HUD FORM 92573 J J WIIICII WILL PI CIT FIE USED. I . REPORT OF INSPECTION — INDIVIDUAL SEWAGE -DISPOSAL SYSTEM PRIMARY TREATMENT consists of ❑Septic tank 1:1 Cesspool Septic Tank: ' Distance from well, feet. Material, Number of compartments Total liquid capacity, (4 gallons. Capacity inlet compartment, gallons. Inside length, feet. Inside width, feet. Liquid depth, feet. Cesspool: Distance from well, feet; foundation, feet; nearest lot line at ❑front C3 side ❑rear feet. Inside diameter,feet. Depth, feet. Liquid capacity, gallons. Lining material SECONDARY TREATMENT consists of ❑ Tile disposal field Weepage pits ❑ Other (Specify) Tile Disposal Field: Distance from well, feet; foundation, feet; nearest lot line at ❑front Total length of the lines, feet. Number of lines, Distance between lines Trench width, inches. Total effective absorption area in bottom of trenches, Length of each line, feet. Depth, top of tile to finish grade, Type of filter material: ❑ Gravel ❑ Broken stone ❑ Other (Specify) Depth of filter material beneath tile, inches. Depth of filter material over tile, _ Seepage. Pits: Number of pits, . Outside diameter, feet. Depth, feet. Lining material _ Distance from well, feet; building foundation feet; nearest lot line at ❑ front ❑ side Inspection made by: ❑State ❑County ❑ Local Health Authority Date of inspection Inspected by , 19_ ❑ side ❑ rear' feet. feet. square feet. (Title) _ inches. inches. ❑ rear feet. REPORT OF INSPECTION — INDIVIDUAL WATER -SUPPLY SYSTEM Distance to nearest public water main, feet. Size of main, inches. Individual wells ❑ are ❑ are not customary in neighborhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood ❑are ❑are not being developed with both individual water -supply and sewage -disposal systems. Lot size: feet wide, feet deep. Dwelling set back from front property line, feet. Individual water supply from: ❑ Drilled well: ❑ Driven well ❑ Dug well ❑ Bored well. Distance of well from: Building foundation, feet; nearest lot line at Elf ront ❑ side ❑ rear feet; cast iron sewer, feet; the sewer, feet; septic tank, feet; disposal field, feet; seepage pit, feet; cesspool, feet; other sources of possible pollution, feet. Well construction: Diameter, inches. Total depth, feet. Type of casing, Depth of casing, feet. Approximate depth to pumping level of water in well, feet. Approximate yield, gallons per minute. Sealed watertight to depth of feet. Exterior space around casing sealed with: ❑ Cement grout ❑ Puddled clay ❑ Ordinary backfill. Well cover: ❑ Concrete ❑ Wood ❑ Metal. Openings in well cover watertight: ❑ Yes ❑ No. Pump: ❑ Shallow well 13 Deep well. Length of drop pipe, feet. Pump capacity, gallons per minute. Located in: ❑ Basement ❑ Pumproom off basement ❑ Pumphouse above ground ❑ Pump pit. Pumproom properly drained: ❑.Yes ❑ No. Pump mounting watertight: ❑ Yes ❑ No. Type of storage: ❑ Pressure ❑ Gravity. Capacity, gallons. Has bacteriological examination of water been.made? ❑ Yes ❑ No. If answer is "Yes," give date '19 Quality of water ❑ is ❑ is not satisfactory for human consumption. Installation ❑ does ❑ does not comply with approved exhibits, if any. Inspection made by: ❑State El County ❑ Local Health Authority. Date of inspection Inspected by ,19 :•: U.S. GOVERNMENT PRINTING OFFICE: 1982-361-488/354i (741e) Rol I., ( t, .j. OF � uutnt j! 11 !!,t i ltttn�Safjot�V it This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following:. ' ' i 51-465 Avenida Velasco BUILDING ADDRESS l �! I'SINGLE ill :'i `•'j FAMILY DWELLING 10455 Use Classification Bldg. Permit No. I! E Group ft3 Type Construction VN Fire Zone Use Zone SR I I Owner of Building' EXPECTATION CONSTRUCTIOliddress 54-295 AVENIDA DIAZ (+ City LA QUINTA, CA 92253 LONNIE DAY I� By. � `�✓P I !I �`��--��_UUST DMe: AG14, 1992 Building Official POST IN A CONePICUOU! PLACE -- Ewa --�� EMM 60a