09200 (SFD)Building
Owner
Address P.0 nx X771
City I Zip ITel.
Cont
Address
State Lic.I City
& Classif. Lic. #
P.O. BOX 1504��''
78-105 CALLE ESTADO
LA OU1NTA_ CALIFORNIA 92253
Arch., Engr., I
'Designer
Address I Tel.
City (Zip (State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. ! % /—r" i (
SIGNATURE _ o ' 0 TE
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 thathe 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).
O 1, 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 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.)
O 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
O Copy is filed. with the city. O 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 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 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of appl
Mailing Address_
City, State, Zip_
No.
LDING: TYPE CONST. OCC. GRP.
P. Number
09200
Legal Description Tont- A W nc-k 271 111-a3 tr ?9;
Project Description SM
Sq. Ft.
Size
New ❑
No.
Stories
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
2=.,12
r'?,.i1n
62-00
nA
303 56
3-35-A-0
K QEC
20.00
20.00
IRAR .A7
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
FINAL DATE
Side Setback from Property Line
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. @ $
UNITS
SLAB GRADE /y
2ND FL. SQ. FT.
ROUGH P MB
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. @
DRAINAGE PIPING
WALL SQ. FT. @
OTHER APP./EQUIP.
DRINKING FOUNTAIN.
SO. FT. @
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING 37
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
SQ. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/sc
HOUSE SEWER
MESH
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 311
GROUND PLUMBING3�J/9/
UNDERGROUND A.C. UNIT
COLL. AREA
SLAB GRADE /y
ROUGH P MB
BONDING HEATING (ROUGH)
STORAGE TANK
FORMS
SEWE @
ROUGH WIRING DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
k
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
FINAL INSP. � �/ cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING 37
FINAL INSP.
4.11—BOOFING
J////^'7
I /
71,
//e/ o
- y low/ �
((( [
/ `� 2 -lel
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
-• P.O. BOX 1504' APPLiCi�TlOp• Olt.?' ''
Aa teas 7&105 CALLE ESTADIO'
LA _ v
OUINTA,.CALIFORN1A•�
Maul iLi3i" 'O -OCC. ORP. i - -
Address '
:Humber
Cit P Tel.
inm
•Con f 'litltla>i C
Address r
City ip Tel..
State UC,
Classif. ;IJc. li Sq. Ft. :114a.
Size Stories° - •Uynits" _.._
` Desipner�NellwoAdd'17 MW O :L anctitltm ❑
r .
a
Cita . yyS��t�atw
a c. ]Y
I aflNlffndMa'1 ran lbaalaad urtdar proNsbne a Cfraptar g (conwrenckrg with
section
I `a DiN�loh�a'tha Busliras d Profeeetona Coda and my license
is 1, full Ydos and _
DATE
OWNE1411111IDEA DECLA11ATION -Vallration �• -
r 1•haMy.arMrp1r00 1 am atampt from the Contactors tioenae taw fa tfw.fofloMinp
1 ratfaorr.(Bee 7031:#Ak*teaa and Prolaasbrs Cade: Any all or county wAloh hwpausas s'
PswhaR a damorMh, or rep* any strucum Prior to b bausrce alb
aprr« w applbrd'lcr saueh'Pweti ro u. aaa�W afatarrhara tMt M Is loarrad parsaa ro �PERMiT = AIM�GAJNT
tM Prortrana d/ w Qbrrwatabrle lioanse Lar CJr�Mr Y (aonrnarrokrD WWI secon 7000) of
DWOM1 3 0 w erralrsas and Profagbns Gods, -or OW. he it eorw4w drars/rca, and We batt
Y for the a9apad enhrown: Any Wnkflon- (of section 7031.5• by "arty I for -a pane•F�Plan
lan Chk. Dep. - ••� =• - - �.
f srgedsrwaq(faextoaokraperraryarmorrnw.tbwlw.benarddnArs.(taoo)• Chk. Bal: `
O 1, all: owner a ma property, « my wnpAoyes moan wags as than tot compensation, will
do the work, sand tM strUCtufa k Ilbt Mtanded «Offawd f« sada (Bee: 7041, Ramses and Const.
firdfaeabn Oslo: The, Canbactors boat. Law does not apply to w owner of praparty who
bt*& or arprovws wraart' mod- who dots such work frlaseff or dvoeyh fat own Mpbysim -Mach.
provided NW such arpoeMrwxs are not Mended or offered for sat. M, _however, w buMV
` or Irporwnwr is sold webs+ one yew of oonpl tion, Me owner-burder we how w burden Electrical
ap r+.r nw an nor mrd or rpors rorwe pv«oaa saw.)
tdarer a ms propa►
ty, ata aexcluslvelty contracting with licensed contracts to ooh. Plumbing
atruct the project (Bar-A01e, 6uebass and Proissabne Code: 7M Coahectors LAeswe Law
dost not +Iph to an owner a1 Property who bolds of Mproves awson, and who cawwca for
such pgtcar s W. a --_Q Iloanasd pors"t to V* Contraelors Lk sn" Lar.) l"sradin
0 lwn am ep under sac a P C. for D
Driveway Enc.
R 1114'e- bat► AwnMtructul
VORKERV COMPENSATION'DECI.ARATION
r I'halaby affirm that I have a oertificate a t to self•InWre, • certificate of
v Workers e�wtth
ante, or aaertif e B , zbor Cede.)
_ 1
�r opy�b9 oily. O Certified Dopy Ia tersby fumtshed.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This awctlan need not W osrptted M w pamr Is for one hundred dbllrs (9700 vskaition
or vasa.)
I certify that M the performance of the wouk for which this permit Is Issued, I shall not
haw Chad H«Ma pefon In any manner so se to become subject to the Workers' Compensation
NOft
� 15 r p affle, m&tkv Ow Cndwcate of P.aw wtbn you Would 6eronha
AdIlaet to w ttbrkwrar' C4npxua0on provWais, of the Labor Code. you must fbrtbwld)
mwpy w#h such provbbn* or DMa panel' &half be dewed revoked.
- CONSTRUCTION LENDING AGENCY
I heroby afilrm that there Is a construction lending agency f« the performance a the
work
=% this permit is Issued. (See. 3097, Cht Cods.)
Landers 'Name - -
LuMer's Address
This is a building penult when propeAy filled out signed and validated, and Is subject to
aplatlon 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
aonatructlon, and hereby authorize representatives def this city to anter the above..
mentioned praparty f« inspectlon purposes.
Signature of applicant rate
.Halling Address
Cly, state, Zip
7..'L, ?FINANCE .
REMARKS
ZONE BY. '
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop: Cine
Side Street Setback from CbntWLbe
Side Setback from Property Lute
FINAL DATE INSPECTOR
Issued by Date Permit
Validated by:
Validation:
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 2/13/91
No. I 10420
Owner Name
Type of Permit
Karen Betscher
No. 54-565 street Diaz
city La Quinta zip 92253
La uinta
Permit i
Log #
Study Area 110
APN i Tract g Lot 4 square Footage 11573
Type of Development 16ingle Family Residence No. of unite
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 1.58 X 1573 or $ 2,485.34 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 Dennis/Karen Betscher Telephone
Name on the check
By Richard M. Beck
Director, Facilities Planning & Development
Fee collected /exempted by Shelley D. Bennett
Signature f�.P
C
Payment ReceFx.ed
Check No. 105
Collector. Attach a copy of county or city plan check application fora to district doxy for all waivers.
Embossed Original- Building DeptJApplicant Copy - ApplicanVReceipt Copy - Accounting
RECORDING REQUESTED BY
ADGMY NATIONAL. TITLE INS. C4.
~ AND WHEN RECORDED MAIL THIS DEED AND UNLESS OTHERWISE SHOWN BELOW � \
MAIL TAX STATEMENT TO:
Name Dennis G. .Betscher, Trustee
/yyAtlie3 2205 Valley View Blvd. )9x T �� � w
K� atya E1 Cajon E !
stateCA 92019 `E a _
C W eeI f; l�
A MAIL 1'ATdTATEMENTS TO }. t..3.7
Nm(-.
Dennis G. Betscher, Trustee " ? s
...Slleei
Address E1 Cajon
41;
city CA 92019 -
State
TITLE ORDER NO. 1044 4 rIS SPESCROW NO. 2-11172
SPACE ABOVE THIS LINE FOR RECORDER'S USE
GRANT DEED
THE UNDERSIGNED GRANTOR(S) DECLARES)
DOCUMENTARY TRANSFER TAX IS $ 27.50
" mputed on fuN value d•frc�pe�ty.,:o�Tveyed, or _.
0 computed on full value less value of liens or encumbrances remaining at time of sale.
El unincorporated area
❑ Zity of LA QUINTA , AND
r FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
I VALCON, A California General Partnership
hereby GRANT(s) to
Dennis G. Betscher, Trustee for the Karen M. Betscher Trust
the following described real property in the City of LA QUZNTA
County of RIVERSIDE State of California:
Lot 4 in Block 271 of Unit No. 25, Santa Carmelita at Vale La Quinta, as
shown by map on file in Book 19, pages tO.:and 51. of maps, records of
Riverside County, CA
VALCON, A Calif. Gen, Part.
Dated July 19, 1990 .._...By:
STATE OF CALIFORNIA SS_ B.Y
COUNTY OF
On this day of in the year 19
before me, the undersigned, a Notary Public in and for said State,
personally appeared -- •• •--
personally known to me
(or proved to me on the basis of Satisfactory evidence) to be the
person whose name subscribed to the, within
instrument, and acknowledged to me that _ he — executed it.
WITNESS my hand and official seal.
Signature ..._. _�.. .
rrhle emo Mr nffW.l —,11
RI O
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