11239 (SFD)P.O. BOX 1504 N o . 11239
Building 78-105 53-680 Herrera LA QUINTAC
Address CALIFORNIA 92253
John R. Valencia
Address
City Zip Tel.
1916/
Contractor
Owner/Builder
Address
Zip
State Lic. City
& Classif. I Lic. #
Arch., Engr.,
Designer Michael Hurst
Address Tel.
P. 0. Box 1362 619 770-7817
City Zip State
Palm Desert 32261 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 Contractors 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 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 penafty of not more than rive 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 knproves 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 snprove for the purpose or sale.)
*EI 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ I 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. 1
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.
k 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, Chill Code.)
Lender's Name
Lenders 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
)I`
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 774-124--010
Legal Description Lot 15 Block 229
Project Description SFD
Sq. Ft.
Size 1492
No. No. Dw.
Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑
Demolition ❑
Permit does
not include block
wall
or pool.
Estimated Valuation
92,191.60
PERMIT
AMOUNT
Plan Chk. Dep.
265.00
Plan Chk. Bal.
260.67
Const.
608.00
Mech.
49.00
Electrical
125.80
Plumbing
129.00
S.M.I.
9.30
Grading
20.00
Driveway Enc.
Of)
Infrastructure
1966.64
TOTAL
3418.41 316X3.41
REMARKS
ZONE: 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 INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES"
1ST FL. SO. FT. ® $
UNITS
"
2ND FL SO. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN.
SO FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
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
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
_$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING it ( -1
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
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
0,
GROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER Og4W+W4@-'MN�
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
`
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM l�Q
OO
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING it ( -1
FINAL INSP.
ROOFINGa
VENTILATION
() u)
l !/
/d o qz cp
llll
REMARKS:
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
W
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION ?�93�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
:d
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 8/7/92 Type of Permit I La Quinta
No. 111625 Permit #
Owner Name John R. Valencia . Log #
No. 53680 street Herrera
City La Quinta, zip 92253 study Area 111
APN #, 774-124-010 Tract # I ILot # 0 square Footage 11492
Type of Development 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 1.58 1 X 11,492 or $ 2,357.36 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 John R. Valencia
Name on the check
By James E. Lively
Assistant Superintendent, Business Services
Telephone
Fee collected /exempted by Vickie J. Durrett
_ Payment Received
Signature Check No. 123
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
SENT BY-WILKE,FLEURYIHOFFELT ; 7-30-92
RECORDING REQUESTED aY
14, 7f'?•EN RFS:OiiUfo MAI'_ Tt(S O6E� ,N! 'U -4t'55 t?iri:fl15'ISe $Y.OWN 82tO'J:
MA -1, TAX R1.-ZMZ,yt T]
achn Valencia/Louise Johanson
1437 Marian vlay
Sacramento
CA 95818
John Valencia/Louise Johanson
1437 Marian qday
Sacramento t
CA 95818
!I
TLE 38--33039-` 0rokgc 9445JH I
' 1
850 ;
9164412430-1
cc
Is
c
�o
i
619 342 10094 2
--r
Q r+
LA -
SPACE ABOVE THIS LINE FOR RECORDER'S USE ✓'�
GRANT DEED
APDL; 774-124-010
THE UNDERSIGNED GRANTCR,S) DECLARE(S)
DOCUMENTARY TRANSa=R TAX IS $ 25.85
xomouted on full value of prcperty conveyed, or j
corr'nuted on full value less value of liens or encumbrances remaining at time of sale,
I
_ urincorpoi ated ai Ea
Zty o` La Quinta AND i
FOP.A VALUABLE racelpt of :shish is hereby acknowledcec,
THE PERRIN FAMILY TRUST dates' November 11, 1988, DEUR L. PERRIN- and I
ELIZABETH ANN PERRIN, Trustors and Trustees,
hereby GRANT(s) to
JOHN R. VALENCIA and LOUISE A. JOHANSON, Husband and Wife as Community
„I Property,
A
1
the following described real property in the !
City of :La u�p:ta
QQ I
County of Riverside , State of�alilorrla-
Lot 15, BlQck 229, Santa Carmelita Vale La Quinta Unit No. 22, as shown
in Book 20, Page 24 recorded in Book of Maps, County Recorder's Office of
said County.
Datad Feb. 4, 1992
�•o-
STATE CF CA! I =/CgNIA
CC:iNTY OF
f r^essonallya;ca}ared
personalty known io ma (or proved to 4,ne on the basis of satisfactory I
evidence) to be the nersoni.$) whose narnecs) is/are subscribed to the
within instrument and aGknowledflsd to me that he,'she they evacuted the
same in his/her/their authorlrec caoacity(ies). and that ;,y h s/hertneir
signatures) on the instrumen? the personis) or the enmity t,pon behalf of
which the persons) acted. executed the Instrument,
WITNESS my hart and official seal,
£G tfiE (nC:V 7-911
The Perrin Family Trust
dated November 11, 1988
Deuk L. Perrin
Elizabeth Ann Perrin
OFF)C(AL NOTA)4v SEAL
: •� z Tc'SSIE WOOSTER
Gomm. .YG1Y 17.1995
MAIL TAX STATEMENTS AS DIRECTED ABOVE.
I lv% area for .Ifivai 1,013hal Seall
Received From: `" ' �-
' <'
Date: 6
,G`
Address: _? ��_
/�'{=
G�cv � C:d G-
1
i- :z 0
Account No. '� LotO �-�
Tract
Service Address -
`' Z.[ - L£°-
G.A. Code
Meter(s)
i
$ �. d
_
Services)
G
•
❑ Backflow(s)
❑ House Lateral (s)
❑ DetectorCheck(s)
❑ Meter Surcharge
Sanitation Capacity Chargee
c--
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
,a
❑ Other
TOTAL
Remarks:
❑Copy to:
Cash
� Q
Water Service
Check �� L?
Money L�
Cashier
Order
,r•
CVWD-438 (11189)
.�
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing�to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
EPROPERTYADDRESS
PERMIT NUMBER(s)
0
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An Owner/Builder building permit has been applied for in your name and bearing your
signature.
Please complete and return this information in the envelope provided at your earliest
opportunity to,avoid unnecessary delay in processing and issuing your building permit.
No building permit will be issued until this verification is received.
1. I personally plan to provide the major labor and materials for construction
of the proposed property improvement (yes or no) JQ D
2. I (have/have not) AJAL) , signed an application for a building
permit for the proposed work.
3. I have contracted with the following person (firm) to provide the proposed
construction: ,, n
NAME:
ADDRESS:
CITY:
PHONE:
STATE
CONTRACTOR'S LICENSE NO.
4. I plan to provide portions of the work, but I have hired the following person
to coordinate, sulpervise a the major work: '
NAME:
ADDRESS :g �- $ cl k� o o (► •�� e 0A. ,
n�
CITY: �v.) c l6 STATE 6vi
PHONE: �1�Z2 D ( CONTRACTOR'S LICENSE NO.
5. I will provide some of the work but I have contracted (hired) the following
persons to provide the work indicated:
NAME
.PA
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-105 Calle Estado
La Quinta, CA 92253
(619) 564-2246
FAX: (619) 564-5617
ADDRESS
PHONE
TYPE OF WORK
PROPERTY ADDRESS
PERMIT NUMBER(s)
4 4'Qa&rcv►.O. Box IN4
7b 105 CALLE ESTADO
LA (XUINTA. CALIFORNIA 92253
Contractor j���-�.��-� �d� y- Owner
a�
Address
Job Address
La Quinta City License No.: 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
Grade i Excavate 0 w ale, k-
2. Pipelines
( 'j.) Cement -Foundations COk'Odel- (2,4r,
4. Cement Walks i Drives 3 tgw
5 Asphalt Paving
Framing S U U l T� #35'8T i9
7. Steel Structural
8. Masonry
Q�' Plumbing
L0.' Lathing e#-IW� e VC.,
Ll. Drywall lkf
L2. Plastering
l3. HVAC ,^�a.'V,F"SC- .CEctrZ9Z
4Electrical &dV`S ��L/SJ
L5
-f:rl 60:�6Y/
q?(
Roofing
L6. Sheet Metal Dc� k `S A/c- Z9 Z !-� `/ZTo i2-l3f Ys- ,6•
17. Floors -All Types
18. Glass - Glazing
19. Insulation/Weatherstrip
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