08756 (SFD)C&hf
' 4
0�.
P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address 7A..71 rw f'-',%11, c+ rp'.41n t* LA QUINTA, CALIFORNIA 92253
Owner
mauing
Address 100 N. Lake Ave #205
City I Zip ITel.
Contractor
ress
City Zip
State Lica I City
& Classif. B 390365 Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
i' LICENSED CONTRACTOR'S DECLARATION
I hereby affirmm licensed=under provisions of Chapter 9 (commencing with Section
7000) of Division 3 bjthat;l e,Buside" and Professions Code, and my license is in full force and
effect.
SIGNATURE 1`..g -/d' DATE
`af- 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 five hundred dollars ($500).
O 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. 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 contractors) licensed pursuant to the Contractor's License Law.)
O 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 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 dorars (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: 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 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
ateMailing Address
City, State, Zip
BUILDING: TYPE CONST. 5 OCC: GRP.
R
A.P. Number 9"4*561"AARX7 7AQ-1 19—ii1,f1?
Legal Description Lot 124 Unit 5 149 21/61--62
Project Description Single Family Dwelling
Sq. Ft. -No. No. Dw.
Size 27119 Stories I Units
New 9 Add ❑ Alter ❑ Repair ❑ Demolition ❑
— 312 If s%f A •
;timated Valuation
152083.90
PERMIT
AMOUNT
Plan Chk. Dep.
250, 13
Plan Chk. Bal.
A47-22
Const.
825-0
Mech.
sm_ an
Electrical
At;
Plumbing
S.M.I.
2
Grading
2A sin
Driveway Enc.
2in. an
Infrastructure
4
Arts in Pnbli _
1.30-21
Precise Plan
25.00
TOTAL
51 7 _ jRA
REMARKS
40
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. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
s
2ND FL. SO. FT.
YARD SPKLR SYSTEM
FOR. Sp, FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. @
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN.
SO. FT. @
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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 @ 11/4 c
SEWAGE DISPOSAL
SO.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 I / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
V
01
GROUND PLUMBING ll1
L�0l1NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE V
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS � (ROUGH) _/ I I /,
II
METER LOOP
HEATING (FINAL)
OTHER APPJEGUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE f l d
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
S
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
I / L
FINAL INSP. y R
FRAMING q C
1.
FINAL INSP.
ROOFING l� q0 G
VENTILATION 11
,p.
VH Foot's's 0 (2 a p ( b LP
—�' r
l
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�Q
THING
MESH
INSULATIONISOUND t qt _V 44�7
FINISH GRADING
'
FINAL INSPECTION' G
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 11/26/90 1 Type of Permit I La Quinta
No. 110277 Permit #
Log #
Owner Name Charles Behm Family Trust
No. 78-715 street Calle Tampico
city La Quinta zip 92253 Study Area 0
APN # 769-135-002 Tract # Lot # Square Footage 12706
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 11.58 IXIZ706 Jor$4,275.48 have been paid to D.S.U.S.D. for
the property listed above and that building permits and/or Certificates of Occupancy :or
this square footage in this proposed project may now be issued
Fees Paid By The Behm Family Trust (Cashier's)
Name on the check
Telephone ' 773-0772
By Richard M. Beck }' y
Director, Facilities Planning & Development r ti ..
Fee collected /exempted by Shelley D. Bennett
a
Pa ym iAt,R'-Piti;c•il) ti
Signature i Y CheckWo. 202268
Collector: Attach a copy of County or City plan check application form to Dieti,ictwonv:
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
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ffi# . Is :C tificcte 'issued; pursuant to the requirements of Section _;3 of .the :Uniform Building•
*Cod cert Eying that qt he time. of ssuahce thisstructure was jpmp11gnce with the various. r
I
Y . t 7~w
rdinances_.� of Che City regulating build:ing�construction` or use F th.e following:
� ,' '; .... "
+ � � � � I I'' i� I Y t � as `i, x . • . - "• ` � � I . , � ,
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GING D 7 7'15- CALLE TAMP do I li ; i I!
8 1j
<' BVL A P.RE .S
d `
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�r i !"� fi• �t�Wse Classifmalign _ dq ilrrmit No. 5 I i
I
BI 087 6
',• I. I q, ; it a. �. ..
k" y } GroyP R 3 Type Construction V N'' Fin Zonq 'Use zona 3)t . - i
� ^_ - •'•� : . '': • �'` � ` `'�� •..;• .. �. � , I it '
~*� Owner of Buj�dinq CHARLES BEHM FAMILY TRUSTAadrm 100 N. LAKE `AVE. , #205, PASADENA, CA I i
r 91101
;-PASADENA, CA 91101
LONNIE DAY'.PYI
11 �i
Date; APRIL,' 19•,''1991
• ; } ^c -, y .�, �< } 8uildin, OfficJol
t 9 POST IN A WWG*1000U! 'PLACt
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