15636 (SFD)y � �
Calle P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 77-821 Ensenada LA OUINTA, CALIFORNIA 92253
C'7./ner Rosendo and Tania Diaz
AE. ress 84--541 Via Durango
City Zip Tel.
Coachella, CA 92236
Contractor
Owner/Builder
Address
State Lic.
& Classif.
Arch., Engr.,
' , r Designer
Address
City
Lic. #
ZipIState
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.
SIGNATURE DATE
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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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
subie he applicant to a civil penalty of not more than five hundred dollars ($500).
as owner of the property, or my employees with wages as their sole compensation, will
d 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 0,
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.)
❑ I am exempt under Sec. B. & P.C. for this reason
mate �+ d "i vomerr.Wt 1 It
!i
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Cgrnt fisatt�nsln u nc0cA(a certified copy thereof. (Sec. 380,!Ybor Code.)
PoliiccyiNo. ! a 'Company '�' ea, Et_ .!'_:9
Ltrc;opy Is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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: ff, after making this Certificate of Exemption you should become
subject to the Workers' Compensatfon provisions of the Labor .Code, you mustforthwith
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 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
No. 15636
BUILDING: TYPE CONST. V7 OCC. GRP.
A.P. Number 773-303-001
Description Lot 2 Block 106
t Description S?D
Sq. Ft. No.
Size -,2010 Stories
No. Dw.
Units
New ❑ Add ❑ . Alter ❑ Repair ❑ Demolition ❑
Per-rait does not include block walls
or pool.
stimatgd Valuation ; $118,928.00
I
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
AMOUNT
Mech.� t.
68.50
Electrical
142.49
Plumbing
144.00
S.M.I. r
11.89
Grading
20 .00
Driveway Enc.
00
Infrastructure
2.646.23
TOTAL
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setbacklr�m Property Lin_E
�q
FINAL DATE INSPECTOR
Issued by:
Validated
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FF,&S
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT. p
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCTWORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. SO. FT.
TEMP. POLE
WALL SO. FT. ®
GROUT
DRINKING FOUNTAIN
SO. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
_$
FLOOR DRAIN
MECHANICAL FEES
FRAMING
7
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® I% c
SEWAGE DISPOSAL
MESH
SO.FT.GAR ® 3/4c
HOUSE SEWER
INSULATIONISOUND
FINISH GRADING
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 :
SEWE S
ROUGH WIRING
DUCTWORK
ROCK STORAGE
FOUND. REINF. /
GAS (ROUGH)
METER LOOP'
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL 9
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. /f
FRAMING
7
FINAL INSP.
ROOFING` � 1
6w Td gwl*pd
[y��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION / f
CERT. OCC. err
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 8/18/95 1 Type of Permit I La Quinta
No. 113621 Permit #
Owner Name Rosendo & Tanie Diaz Log
No. 77821 Street Calle Ensenada
City La Quinta Zip 92253 Study Area 112
APN # 773-303-001 Tract # I J Lot # 0 Square Footage 12010
Type of Development Single Family Residence INo. 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 1.72 x 2 010 or $ 3,457.20 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 CASH
Name on the check
By
Dolores A. Ballesteros
Telephone, )t�
Superintendent '= "
Fee collected /exempted by Pauine Pearson
Payment Received C
Signature � A a 1 p 4A p , Q�p� �X►,Q�„ Check No. Cash
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
I
COACHELLA VALLEY WATER DISTRICT " �a,s,
CASH RECEIPT DETAIL
Received
Address:
Account No. Lots) Ll
Service Address
. :: ..
...... .........., .' r"i
ate
M r(s)
Service(s
I�
. - ❑ Back,mw(s)
❑ House Leleral(s)
❑ Detector Check(s)
❑ Mater Surcharge
�Senitation capacity charge ''61
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
.. ❑ Inspection Fee - Tract -
.. Fee-
. ❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
/ --a -i--O Q '
TOTAL S —� f S • �y
Remarks:
❑COPY to:
Cash
Water Service —�
Check
Money
Order
'•
CaShler /
CVWD-�3ahvas)/
RECORDING REQUESTED BY
Continental Land Title Co.
AND WHEN RECORDED MAIL TO
r �
Mr. and Mrs. Rosendo Diaz
2517 Grand Avenue
ass Huntington Park, Cal.
90255
yL J
MAIL TAX STATEMENTS TO
e Same as above
1
Iss
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CAT. NO. NNO0582 Individi
TO 1923 CA (2-83) THIS FORM FURN
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SPACE ABOVE THIS LINE FOR RECORDER'S USE
nail GrOnt Deed
(SHED BY TICOR TITLE INSURERS
The undersigned grantor(s) declare(s):
Documentary transfer tax is $ 14.30
a( x ) computed on full value of property conveyed, or
( ) computed on full value less value of liens and'encumbrances remaining at time of sale.
( ) . Unincorporated area: ( x ) City of ' La Quinta , and
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FOR A VALUABLE CONSIDERATION, receipt, of which is hereby acknowledged,
WILLIAM H. MARTIN and MARY MARTIN, husband and wife
hereby GRANT(S) to
ROSENDO M. DIAZ and TANTE DIAZ, husband and wife as joint tenants
the following described real property in the City of La Quinta
County of Riverside State of California:
Lot 2, B1ock;.106, Unit 11, Santa Carmelita at vale La Quinta, as per map
recorded in �ook 18, page 75 of Maps, in the office of the County Recorder
of Riverside County.
Dated: March 19, 1988
STATE OF CALIFORNIA
COUNTY OF Riverside }Ss-
On
21 March 1988 before
mr, the undersigned, a Notary Public in and for said State,
William H. Martin
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115
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SPACE ABOVE THIS LINE FOR RECORDER'S USE
nail GrOnt Deed
(SHED BY TICOR TITLE INSURERS
The undersigned grantor(s) declare(s):
Documentary transfer tax is $ 14.30
a( x ) computed on full value of property conveyed, or
( ) computed on full value less value of liens and'encumbrances remaining at time of sale.
( ) . Unincorporated area: ( x ) City of ' La Quinta , and
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FOR A VALUABLE CONSIDERATION, receipt, of which is hereby acknowledged,
WILLIAM H. MARTIN and MARY MARTIN, husband and wife
hereby GRANT(S) to
ROSENDO M. DIAZ and TANTE DIAZ, husband and wife as joint tenants
the following described real property in the City of La Quinta
County of Riverside State of California:
Lot 2, B1ock;.106, Unit 11, Santa Carmelita at vale La Quinta, as per map
recorded in �ook 18, page 75 of Maps, in the office of the County Recorder
of Riverside County.
Dated: March 19, 1988
STATE OF CALIFORNIA
COUNTY OF Riverside }Ss-
On
21 March 1988 before
mr, the undersigned, a Notary Public in and for said State,
William H. Martin
FA,gl L pp _