08051 (SFD)i
• P.O. BOX 1504r-� No. 08051
Building 78-105 CALLE ESTADO
Address 54435 Val IeJo, LA QUINTA, CALIFORNIA 92253 _r)fCj
Owner% t�UL.� �
Mailing
Robert D. Owl BUILDING: TYPE CONST. OCC: GRP.
Address A.P. Number 774"122"019
911 Ma-d-rJA
City Zip "' Tel. '
CarlebaA SIM 02-76S$ Legal Description tat
Contractor Project Description Single Family @wailing
Address
AIM
ity Z' Tel.
r12� 3
State Lic. City
& Classif. , 3 Lic. # Sq. Ft. 272 No. No. Dw.
Arch., Engr.,
Size Stories • Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARftION
I hereby of that I am lic a /erovi�ions of Chapt 9 ommencing with Section
7 of Di i e dens ode, and license is in full force and
fe J.
IG U DATE
OW -BUILDER ECLARATIO Estimated Valuation
I hereby affirm that I am exempt from t ontractor's License Law for the following
reason: (Sec. 7031.5,Business and Profession Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also. AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT
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 pbea is plan Chk. Dep. 2 Q�
/or the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a
subjects the applicant to a civil penalty of not more than live hundred dollars ($500).
0 I, as owner of the property, or. my employees with wages as their sole compensation, will Plan Chk. Bal. M.66
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 6�Q
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, Mech. C �g
provided that such improvements are not intended or offered for sale. If, however, the building 62.00
or improvement is sold within one year of completion, the owner -builder will have.the burdenElectrical 140.32
of proving that he did not build or improve /or the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing �3��
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. fi.�
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
sa
❑ 1 am exempt under Sec. B..4^_p C. for this reason Grading 20.00
�j / Driveway Enc. 20.00
Date _1 � Wner Infrastructure 2098..8
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 ceI. (6Ln8800, or Code.)
Pokkcy``No. Company T %�
/Copy is filed with the city. ❑ Certified copy is hereby furnished.
//////'''"' TOTAL 13,614.45 $3.369.45
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE -
(This section need not be completed if the permit is for one hundred dollars $100 valuation - �: k�.%3�j; �r���,,�V � lu.n 1�il . w
or less.) ( 1 # i 1'�`;i a iA'�.1 1..�tf+ �'S
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 o/ Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions o/ 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 Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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. Issued by: Date 30 30AA
Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES'
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE 4114107Ak
ROUGH PLUMB.
YAR6 SPKLR SYSTEM '
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
GAS (ROUGH)
j DRAINAGE PIPING
WALL SO. FT.
HEATING (FINAL)
DRINKING FOUNTAIN
SO FT ®
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
ROOFING .8
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
FIREPLACE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
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 bI k* AP
G 1 I INyl*'
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 4114107Ak
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. 9/J A0
vv
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE �f
r
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING O
FINAL INSP.
ROOFING .8
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND Q
FINISH GRADING
FINAL INSPECTION
(l
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
To: 0UJA,
/ 'n*'Ie' NOTICE:
DATE:
THIS DCCU11147ENT CANNOT
BE DUPLICATE®L
This is to . ert i. y, that ,
developer of a w,, , which is
located atj , within
this District, has paid school facility fee4 imposed pursuant to the
authority
enerat d by Government ode Sectiol1 53080 in the a ount of L
covering a total of square feet of ( ) resi tial or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
VQ W �q for DESERT SANDS UNIFIED SCHOOL DISTRICT
White - Building Department 0 Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
II
;f. ST FEDERAL SAVINGS AND LOAN ASSO
FIRCIATION
i n Hill Blvd., Pomona, CA 91769
,•,y, 9�g, Pomona, CA 91769 Attn: Construction Disbursement Dept. Loan No.
,t
r
f •' Amount Voucher N 2 0.1- / u 19 -�-Q
Off Site On Site Lots Tract F
1(11 more than.oRe lot involved, show Lot Nos1002.)
Pay to
t 0a
i't�I DOLLARS
Er
(Description o r, services, equipmenbr material furnished)
(Descrrtft(,on of labor, services, equipment or material furnished)
(Description of labor, services, equipment or material furnished) (through date)
Inhi
.,� .
address) ( ity
;VOUCHER MUST BE ACCOMPANIED BY PAYEE'S INVOICE. THE LABOR AND MATERIAL WAIVER AND RELEASE ON
` If MUST BE COMPLETED.
'AWNf►frrtt purpose of inducing PFF to make payment of the above sum, the undersigned certifies that the above described labor,
w pM, equipment, or material have been actually performed or delivered by the persons, firms or corporations named herein,
'S` tjMbQt�1i1 they conform to the plans and specifications for the job submitted to PFF and that there is no agreement to accept any
,I
*bili or of money, labor, services, equipment, or material from an
7 , y,y person or firm with respect to this Voucher. The
-24 sp /fft ed also unconditionally requests PFF to pay this Voucher in full, and holds PFF harmless in connection. with such
y ,
w • i
(Borrower Name)
d
<. (Au orized Signature) (Telephone No.) (Date)
R�%,ICMER WILL NOT BE PAID IF THE WORK COVERED BY THE VOUCHER HAS NOT BEEN INSPECTED BY A PFF
k::wUCT10N INSPECTOR.
I
N
S�
Penal Code Sections 484b and 484c provide that it is a crime to willfully submit false Vouchers and/or misuse
ion loan funds. A Vouchermay be mailed in or presented for payment in person during regular office hours. PFF mustme
`+I IId One day prior to presenting a Voucher of $100,000.00 or more.
Only)
t apr.proved: Check No. Paid by Date
�Mblbwing Certification is a part of the Labor and Material Waiver and Release on the reverse side of this document.
I,"
CERTIFICATION
r PJrPose of Inducing Pomona First Federal Savings and Loan Association to Issue a check In payment of the total amount
I�sn On the faceof the accompanying voucher ($ amount of voucher) the undersigned Payee represents and car -
41) that the labor, services, equipment, or material, set forth below, have actually been furnished to the job site descrlb3d
(or materials have been taken from Payee's stock If Indicated); (2) that unconditional payment for such labor, services,
111snt, or material (Including any fringe benefit payments due pursuant to a collective bargaining agreement) has actually
!h made In full to the date Indicated on the accompanying voucher, or that if any of such amounts remain unpaid, the proceeds
*0 accompanying voucher are being taken In trust for their payment; (3) that the listing below of laborers, material or equili-
l+ppllers, and subcontractors Is a full and complete listing of all those who were employed (or delivered services, equip-
a'dsr material) for this job In connection with the work described below; and (4) that there are no straw or dummy persons, nor
b!ils, included, and that there are no rebates or "kickbacks" agreed to, or to be made to, any owner, general contractor,
•contractor, or employee thereof, or any person, In connection with the work described below, or the job premises described
00w.
31iK 2310 1 C-88
i
COACHELLA VALLEY WATER DISTRICTte
CASH RE:EIPT DETAIL
Received Fro is ° `
`'i",�_ �! �'
�U V+•+d}
Gt �t t
Dater j
"
may)
Y Q
1S 'xR
Address: `
Y ► 1CCG�. t 1 ` "6cy
Account No. (000 ,
C)' V Lots)
Tract
SG eZi aZ
Service Address S3—
G.A. Code
n
(a U
09.,Nleter(s)
$�o;
CSI --Services)
❑ Backflow(s)
❑ House Laterals)
❑ DetectorCheck(s)
❑ Meter Surcharge
9-19anitation Capacity Charge
_
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee -Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
w
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
�� 0
Remarks: L �� Q'IL
n1A-\-
TOTAL
$
i
❑Copy to:
+ WaterService IA
'heck�!
��-
!Cash
oneyCashier
rder
nz �`,^'�'''
CVWD-438(11189)
r
10 V
V
DATE: W
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11 uttbtn allb 3141Pm011
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:
BUILDING ADDRESS 53-635 Vallejo
Use classification SFD Bldg. Permit No. 08051
Group R3 Type Construction VN Fire Zone Use Zone SR
Owner of Building Robert Chamley Address 411 Calle Familia
City Carlsbad, CA 926.72
By; Mark Harnl a
� Dote; June 17, 1991
Building Official POST M A CON8PI000US PLACE