9713 (SFD)44
P.O. BOX 1504 \No. 9 713
Building 7&105 CALLE ESTADO.,
Address D53-925 Diaz LA QUINTA, CALIFORNIA 92253 r
Owner
Ir
David %�i�ltc'�
Mailingnng BUILDING: TYPE CONST. OCC: GRP.
-- Address P. O. Box 122 A.P. Number 774-151-035
i
CityZip Tel.
I
La Quinta 92253 Legal Description LO:: 9 Block 199
Contractor Project Description SPD
Pacific Trades
Address
P. 0. BOX 722
City Zip Tel.:
Cir i.. --a I 922S3 64»513.23
State Lie. City
& Classif. B 425391 Lie. # Sq. Ft. t No. No. Dw.
Size 240 Stories Units
Arch:, Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel. Permit does not include block wail
City Zip State or pool
Lie. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with section
70%',o f Div�ision.43 of the usiness anyd Professions Code, and')my license is in full 'force fand
effSIGNATURE" \ 1 DATE
\\ OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following 74.344.00
� 3�4 `�Q
reason: (Sec. 7031.5,Business and Professions Code: Any city or county --
which requires a
permit to construct, after, improve, demolish, or repair any structure• prior to 8s issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to - PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/ �•
Division 3 of the Business ad 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 Plan Chk. Dep. 250.00
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).. Plan Chk. Bal. - - --200.44
01, 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 527
Professions Code: The Contractor's License Law does not apply to an owner of property who. Const. - .00
builds or Improves thereon and who does such work himself or through his own employees, 9Q
provided., that such improvements are not intended or offered for sale. g, however, the building Mech. �! 9
or Improvement is sold within one year of completion, the owner-butlder will have the burden Electrical 3 a V . Dj
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 coo- Plumbing 129 , 00
strucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law n
does not apply to an owner o/ property who builds or improves thereon, and who contracts for S.M.I. 7 , 60
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading 20.00
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc. 20.00
Date owner Infrastructure 16314.49
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.
TOTAL 2954.03 274.03
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
0Y isr� 3-�` lid
(This section need not be completed i/ the permit is for one hundred dollars ($100) valuation ,t �• #'�•��rr•=� r t- .y n�
or less.)
I certify that in the performance of the work for which this permit is issued, 1 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 ZONE: BY:
subject to the Workers' Compensation provisions of 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 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
1ST FL. SQ. FT. ® $
UNITS
'
2ND FL. SQ. FT.
ROUGH PLUMZ.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
ROCKSTORAGE
DRAINAGE PIPING
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SQ FT ®
OTHER APPJEOUIP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FRAMING
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
FIRE ZONE ROOFING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3lhc
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 i?/;;L/A?/OUND
PLUMBING a%
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE '�l
ROUGH PLUMZ.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEW K
ROUGH WIRING
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
L
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. y� 9/
GRADING
�cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING
¢ /�/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
J
LATHING *1)&N9 /
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
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 8/19/91 Type of Permit I La Quinta
No. 10813 Permit #
Owner Name David Miller Log #
No. 53-925 street Diaz
city La Quinta zip 92253 Study Area 110
APN # 774-151-035 Tract # I Lot # Square Footage 1240
Type of Development I 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 1 X 1 40 or $ 1,959.20 have been paid to D.S.0 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 Ross Miller
Name on the check
By James E. Lively
Assistant Superintendent, Business Services
Fee collected/esemp d by Diana M. Allard
Signature 4Z
Telephone
Payment Received
Check
No. 2340
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
Building 9
Address 4
Owner
4 4 QUM&
P.O. BOX 1504 APPLICATION ONLY
/� 78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 3)1'��
City Zip Tel.
I Q Yom, I-)7<73 t (om 1%4 •Si�Z �
contractor
Address
• u• T%X I r_ r_
City Zip
State Lic. City
& Classif. 13114 K-381 Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
8g��eby affirrrhat I am licensed under provi$to sof Chapter 9 (commencing with Section
7 0)3 Divisio 3 oYto hq Bust Profession Code, and my license is infull o �e and
effe , : Jlt9f� v sc 1
tw
SIGNA*Re I DATE
OWNER -BUILDER DECLARATION
I hereby affir that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7)3 .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 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 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, Bufsness 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
orImprovement 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 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
0 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 an anne o a to become subject to the Wo kers' Compensation
Laws of alif rola. l_ a
Date q Owner �iw_
NOTICE YO PP /CANT: I, alter aking this Certi;Icate of Exemption you should become
subject to the Workers' Compensa ion provisions o/ the Labor Code, you must lorthwfih
comply wllh such provlslons 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 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
BUILDING DIVISION
BUILDING: TYPE CONS�T. OCC. GRP.
A.P. Number i C) 3-!!;—
Legal Description
Project Description
ZONE: r 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
Issued by: Date
Validated by:
Validation:
INSPECTOR
Permit
Sq. Ft. /� //O
Size !
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
`
i�f'Ld04
Estimated Valuation
K 3 7 ,J , Oig
PERMIT
AMOUNT
Plan Chk. Dep.
a% "'—
Plan Chk. Bal.
Const.
rte
Mech.
. ov
Electrical
(. fD
Plumbing
V
S.M.I.
7,60
Grading
Driveway Enc.
.�—
11� irastructure
3
,2 .9rit. 0 0 .03
05i��„t,0 249 � 96-04-9 ,_ 14
TOTAL
n .r., i
REMARKS
ZONE: r 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
Issued by: Date
Validated by:
Validation:
INSPECTOR
Permit
CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO. ELECTRICAL FEES
NO. PLUMBING FEES
SQ $_16&+•
1ST FL.FT.
SLAB GRADE
i UNITS
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
YARD SPKLR SYSTEM
�—
2ND FL. SQ. FT. ®
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
MOBILEHOME SVC.
GROUT
BAR SINK
SERVICE
POR. SQ. FT. ®
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
GAR. SQ. FT.
LUMBER GR.
POWER OUTLET
FINAL INSP.
ROOF DRAINS
FINAL INSP.
ROOFING
DRAINAGE PIPING
REMARKS:
CAR P. I SQ. FT.
VENTILATION
WALL SQ. FT. ®
FIREPLACE
DRINKING FOUNTAIN
SO. FT. ®
SPARK ARRESTOR
URINAL
GAR. FIREWALL
ESTIMATED CONSTRUCTION VALUATION $
LATHING
WATER PIPING
MESH
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINISH GRADING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
CERT. OCC.
WASHER(AUTO)(DISH)
APPLIANCE DRYER
INSPECTOR'S SIGNATURESIINITIALS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GARDEN WALL FINAL
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
a
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
+
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
+
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ec
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
PL.CK.FE�
CONST. FEE
ELECT. FEE
SMI FEE
PLUMB. FEE
FMECH.FEE
VV
1140
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./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
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 SIGNATURESIINITIALS
GARDEN WALL FINAL
P.O. box IN4
76 t09 CALLS ESTADO
LA Ol1INTA. CALIFORNIA 9225
Contractor � � F� C, Owner
Address
_y3D Nat, C��2►'2�. Job Address�Z-
La Quinta City License No.: i5 �� Expires: Bldg. permit No.:
This form shall be posted on the job with the Building Inspection Card and it
shall be the duty of the General Contractor or if Owner -Builder Permit, the owner
to see that all sub -contractors sign this card, giving his City of La Quinta
Business License Number, Contractors License Number and a current certificate
of Workman's Compensation Insurance Certificate when he starts the job. Failure
to comply may cause Building Inspectors to stop work, or complaints to be filed
against such contractors or owners.
.CITY CONT.
SUB -CONTRACTORS NAME LIC. NO. EXPIRES LIC. NO. EXPIRES
I. Grade i Excavate
2. Pipelines
3. Cement -Foundations
4. Cement Walks i Drives
5. Asphalt Paving
6. Framing
7. Steel Structural
S. Masonry
9. Plumbing
LO.* Lathing
ll. Drywall
L2. Plastering
L3. HVAC
L4. Electrical
L5. Roofing
16. Sheet Metal
17. Floors -All Types
18. Glass - Glazing
19. Insulation/Weatherstri
20. Sewage Disposal
21. Painting/Decorating
22. Tile
23. Cabinets -Installations
24. Ornamental Metal
25. Fences/Blockwalls
26. Landscaping
27. Others
28.
DO NOT REMOVE THIS CARD
Before Final Building Inspection Will Be Made
This Form Must Be Completed and Filed With Title 24 Calcs and Plans