12139 (AR)Building 51-200 12laz
Address
Owner
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
AM Construction
Mailing
Address P.O. Box 366
City Zip Tel.
La Quinta, CA 92253 564--4832
Contractor
Same
City
V.
State Lia 4$7854 (City
8 Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
No.
11LDING: TYPE CONST. OCC: GRP
P. Number
Legal Description_
Project Description_
Addendum to
626 sq. Ft.
Size -
;ity Zip State
Lic. #
LICENSED�CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Diviston9 of7Yhe Business and Professions Code, and my license is in full force and
effect: �c .4
I 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).
❑ 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, asowner 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' CO■■ PENSATION DECLARATION
I hereby affirm that I have a ce�ficate of conslent to self -insure, or a certificate of
Worker's Compensation Insurance, or jcer�ified copy -thereof. (Sec. 3800, Labor Code.)
Policy No..- -Compan , I
Copy is filed with the city. ❑tifted cop s ereby furnished.
r
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.
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 stale 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
I
121t39
� t
Bathroom. and office addition
permit #11805
s_9_4
,16 14
No.. No. Dw.
Stories ' Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
I . .
Estimated Valuation
$?,5flfl.fl0
PERMIT
AMOUNT
Plan Clik. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
U
Grading
Driveway Enc.
Infrastructure
b
TOTAL
10
REMARKS
ZONE: BY:
Minimum Setback Distances: 4
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
IST FL. SQ. FT. ® $
UNITS
SLAB GRADEROUGH
VY
PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. S0. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) -
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
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
LAUNDRYTRAY
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.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% 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.F
I CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEROUGH
VY
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./EQUIP.
REINF. STEE -
GAS (FINAL) -
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING 5
FINAL INSP.
ROOFINGK J Ln
✓ L'1
� al%��
1P
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUNp
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 5/3/93 Type of Permit La Quinta
No. 112186 1 Permit #
owner Name AM Construction Log
No. 51200 Street Avenida Diaz
City La Quinta Zip 92253 Study Area 114
APN # I Tract # I = Lot # 0 Square Footage 1150
Type of Development I Residential Addition I 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:
Add. of Sq. Ft. to New Construction
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
in the amount of 1.65 x 150 or $ 247.50
Government Code 53080
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 A & M Construction Telephone
Name on the check
By lames F. Lively
Assistant Superintendent, Business Services
Fee collected /exempted by
Tomi Doebereiner
Payment Received
Check No. 1133
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./ Applicant Copy - Applicant/ Receipt Copy - Accounting
Shower
Salt' to Tile
—typical
2680
M
6080
Bedroom 2
Carpet Typical
TA
CITY OF LA QU``
'N IT
BUILDING & SA'
ACCEPTED•
"R
SUBJECT TO
AND ALL APPLICABLE CODES
------
BY
Bath Option (48 SqFt
I
51-200 Avenida La Quintap CA
Plans & Specifications Reference: Permit 11805 dtd Feb. 9, 1993
Master Bedroom
Suite
51 SgFt
Minimum Opening
rte.
Office
6050 Saltillos Typical
6020 Fixed -s'
6080
LL
=
LU
_t
-)
Office Option, 1027SaWLJ
51-200 Avenida _ ; Quintal
CA
Plans & Specifications Reference:
Permit 11805
e