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)
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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
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EMM 60a