9686 (SFD)• Y; il�
Ate• ,
M1'
44
P.O. BOX 1504
Building�, 7&105 CALLE ESTADO
Address 79185 Jack Rabbit Trail LA QUINTA, CALIFORNIA 92253
Mitch Kempton
Mailing
Address
City Zip Tel.
1.
Contractor
M-ner/$udder
Address
lZip
State Lic.I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic: If
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
M7000) of Division 3 of the Business and Professions:Code, and my license is in full force and
t. i �� -Z 1 ;
SIGNATURE /"-•. "— '�•--\- W DATE
OWNER;BUILDER DECL'ARA`TION
I hereby that I am exempt from the Contractors License law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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).
0^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 or property -who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
iJ 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 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—L---Owner
NOTICE TO APPLICANT., If, alter 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 Address
City, State, Zip
ILDING: TYPE CONST
No. 9686
_OCC: GRP.
Number
I Description Lot G 3
Project Description
SF.D
ZONE: BY:
Minimum Setback Distances: /
Front Setback from Center Line—
Rear
ine 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:
Sq. Ft. ��
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Permit does
not include any block walls
or pools
Estimated Valuation
284.242.20
PERMIT
AMOUNT
Plan Chk. Dep.
25€3 „ 0 0
Plan Chk. Bal.
778.27
Const.
1287.08
Mech. _
109.00
Electrical
2-31.72
Plumbing
199.50
S.M.I.
27.90
Grading
20.04
Driveway Enc.
20.00
Infrastructure _
6000.00
A -r -Es •'ifs Public 460.61
TOTAL
9393.90 9133.91
REMARKS
ZONE: BY:
Minimum Setback Distances: /
Front Setback from Center Line—
Rear
ine 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. PLUMBINAbEEES
1ST FL SO. FT. ® $
2ND FL � SO. FT.
POR. SO. FT. ®
AAR. SO. FT. ®
•
CARP. SO. FT.
WALL SO. FT. Q
SO. FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
\ "
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP:IEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SO. FT. ®c
BATH TUB
INAL IN SP. y O •,2—
sssssalTTTTT�
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Yic
HOUSE SEWER
VENTILATION
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK '
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP:IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP..
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus' x$
-$
LUMBER GR.
INAL IN SP. y O •,2—
sssssalTTTTT�
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
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) 347-8631
Date 10/2191
No. 110907
Owner Name
Type of Permit
Mitch Kempton
1, No. 79-185 street Jack Rabbit Trail
±,city La Quinta Zip 92253 Study Area 0
y'
APN # Tract # Lot # ® Square Footage 13,692
Type of Development I Single Family Residence No. of units
Comments
La Quinta
Permit # 19686
Log #
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:
1'
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.58 X ® or $ 5,833.36 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 K and V Construction
Name on the check
r
By James E. Lively
Assistant Superintendent, Business Services
Telephone 602.497-9150
Fee collected /exe p d by Kathleen Emmerlin
Payment Received
Signature Check No. 1017
f
Collector. Attach a copy Lounty or city p4 check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting