15304 (SFD)44
P.O. BOX 1504
Buildino; 78-495 CALLE TAMPICO
Address 54--820 Avenida Vallejo LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address P.O. fix 7232
City Zip Tel.
La Quinta 92253 564-02,73
Contractor
PaCifia Tri des
Address
City
Zip
Tel.:
State Lica
City
& Classif.. 425381
Lic. # 1$Ss
Arch., Engr.,
Designer
Address
Tel.
City
Zip
State
Const.
626,00-
Lic. #
'NLICENSED CONTRACTOR'S DECtA ATION" .
I hereby affirm that I am Li under provisionkof Chapte (commenci � with
7000) o ..Drvis�Ion*3 of the Bug-nr es�and P�ofesslon�s Code, and Ilcens S irggfull'<
effect. i \ r ! \fir f 1C t �. Y i �i
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busfness and Professions Code: Any city or county which requires a
permit to construct, after, 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 rive hundred dollars ($500).
❑ I, as ownet 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 improvesthereon 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 soldwithin one year of Completion, the owner -builder will have the burden
of proving that he did not bulld 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.)
❑ I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereto affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's mpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) ,
Policy 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100.000), IN ADDITION TO THE COST OF COMPENSATION, .
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when properly filled out, signed and validated, and i's 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,
ddress city, State, ZIp
No. 153,04
BUILDING: TYPE CONST. . V—N OCC: GRP. R3
A.P. Number 774-302-003
Legal Description
Project Description SF D
Sq. Ft.
Size.
New
No:
0 Stories
Add ❑ *Alter ❑
No. Dw.
I Initc
Repair ❑
Demolition ❑
S wall
f'
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: Elateerm' Y 1
Validated by
. .� ,° � ►VIp Y 9 1995 �t ,
-vanuauv�,c
r7y 1
Estimated Valuation
PERMIT
AMOUNT
Plan Chk: Dep.
250. 00
Plan Chk. Bal.
279.96
Const.
626,00-
Mech.
acs _ 17
Electrical,
124 5A.
Plumbing
0a'3
S.M.I.
Grading
70.00
Driveway Enc.
Infrastructure
2177-06
Precisp Plan
75 1111111
TOTAL
371 Ea• 68 -1460;_fin
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: Elateerm' Y 1
Validated by
. .� ,° � ►VIp Y 9 1995 �t ,
-vanuauv�,c
r7y 1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FTfh ,
1ST FL. SO. FT. ® $
UNITS
ROUGH PLUMB. BONDING
2ND FL. SO. FT.
STORAGE TANK
YARD SPKLR SYSTEM
SEWER OR SEPTIC TANK ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH) �y 914 METER LOOP
O /
}`4
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
CAR P. SO. FT.
FINAL INSP.
WALL SO. FT.
WATER SYSTEM
DRINKING FOUNTAIN
SO. FT. ®
LUMBER GR.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN.
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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 ® 3/4c
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 S ?� ,(�
GROUND PLUMB UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF. (
GAS (ROUGH) �y 914 METER LOOP
O /
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL 9J
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
a FINAL INSP. / % G
v
FRAMING g3/ �/j�/
FINAL INSP.
ROOFING / QC ,
f v,
� �y �/
04'�O a f
I
v
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL17
LATHING ��
MESH
INSULATION/SOUND �i 9
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
,82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot -Be Duplicated 619-775-3500
Date 5/19/95' f Type of Permit I La Quinta
No. 113455, 1 Permit #
Log
Owner "Name David Miller.
No. 54-820 Street Vallejo
f' City La Quinta - Zip 92253 Study Area 110
APN # Tract# Lot # 0 Square Footage 11600 ;
Type of Development Single Family Residence No. of units 0
Comments
r.
r Y
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 1.72 x 11,600 or $ 2,752.00 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. David R. Miller Telephone 564-0273
Name on the check Q, ` ;' i\k
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Ma Lou Lopez -rr{u '� 4&-
Paymen;MAeceived
Signature 7Z�L ` 4515
lr i0CK6dk - No.
.1•.47.; 4 1
Collector: Attach a co of county or city plan chec16 plication form to district copy for "all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
l
M
oadrunner
. EscRow
CLOSING STATEMENT Roadrunner Escrow, Inc.
BUYER' Palrn Desert, P-0: Box 121.3
California 92261-1213
David Ross Miller Closing Date:
53430 Avenida Carranza April 21, 1995
`.I;a Quinta, CA 92253 Escrow No. 7099
Page 1
Property:.
APN #774-302-003, La Quinta, CA 92253
Total Consideration
DEPOSIT(S):
Deposit
DEBITS.
20,000.00
CREDITS
By: Miller
500.00
Deposit
By: Miller
10,200.00
ADJUSTMENTS:
Land Draw - Capital Bank
10,000.00
PRORATIONS:
Taxes at $123.36 per 6 months
47.97
From 04/21/95 to'07/01/95.
DISBURSEMENTS:
_ -Wire Transfer Fee
25.00
Paid To: Orange Coast Title,
TITLE CHARGES:
Binder Policy
36.00
Record Grant Deed
26.00
Record Interspousal Grant Deed
18.00
ESCROW FEES:
Escrow Fees
250.00
.-Prepare Interspoual Grant -Deed
40.00
Preliminary Change.Report
25.00
Check Herewith
232.03
Totals
20,700.00
20,700.00
SAVE FOR INCOME TAX PURPOSES
REPORT OF FIELD COMPACTION TESTS
OUR ��EPORT NO.: CUENT: C C:'�� t o� �"'i•"� �-
w...•. C
GATPROJECT:.
E: +C - �- � f F �r y Ii/i�'.
II;
NUCLEAR GAUGE INFORMATION AND
DAILY STANDARD
CALIBRATION NUMBERS
VAPJATION. PERCENT.*/•
GAUGE ADJUSTMENT % VARIATION FROM
C - RETEST OF PREVIOUS TEST
COUNTS
FROM SHEETS
5 SOIL CEMENT
LAST USE
CALIBRATION -.
COMPACTION cA
REQUIREMENTS, %/
MOISTURE '"
REQUIREMENTS,
GENERAL LOCATION:
GAUGE TYPE TRO XLEAlCAMPSELL
MOISTURE:
MOISTURE:
MOISTURE:
MOISTURE:
� f..•-
DENSITY:
1
DENSITY:
DENSITY:
'
DENSITY:
MODEL NO-*
READING
QUOTIENT/
PCF .
SOIL
ID NO.
TEST
DEPTH. IN
PROCTOR INI'URmA1I�n
SOIL ID x
VISUAL CLASSIFICATION OF SOIL
MAX. DRY DENSITY, PCF
OPTIMUM MOISTURE.
�(
C - RETEST OF PREVIOUS TEST
4 SUBBASE
O - MOISTURE IN EXCESS OF,SPECIFICATIONS
5 SOIL CEMENT
E- MOISTURE BELOW SPECIFICATIONS
D-
COMPACTION cA
REQUIREMENTS, %/
MOISTURE '"
REQUIREMENTS,
GENERAL LOCATION:
PERCENT
COMPACTION
COMMENTS
TEST
NO.
READING
QUOTIENT/
PCF .
SOIL
ID NO.
TEST
DEPTH. IN
ELEVATION
OF TEST
MOISTURE
CONTENT,
%
WET/DRY
DENSITY,.
PCF
TECHNICIAN:%
D-
U`
D-
►.EM
4
A�Ica1 �ul•a .. •.•r • r.••n r •r ....••v.v
2 BACXFI L
B -COMPACTION PERCENTAGE DOES NOT COMPLY WITH SPECIFICATIONS
�(
C - RETEST OF PREVIOUS TEST
4 SUBBASE
O - MOISTURE IN EXCESS OF,SPECIFICATIONS
5 SOIL CEMENT
E- MOISTURE BELOW SPECIFICATIONS
D-
i
M
D-
TECHNICIAN:%
COMMEWS:I - F.ILL MAI tJUAL
A�Ica1 �ul•a .. •.•r • r.••n r •r ....••v.v
2 BACXFI L
B -COMPACTION PERCENTAGE DOES NOT COMPLY WITH SPECIFICATIONS
3 BASE COURSE
C - RETEST OF PREVIOUS TEST
4 SUBBASE
O - MOISTURE IN EXCESS OF,SPECIFICATIONS
5 SOIL CEMENT
E- MOISTURE BELOW SPECIFICATIONS
6 OTHER