12470 (SFD)Building
Address 54-350 Herrera
Owner Jack Clark Jr.
Mailing
Address 54-065 Herrera
City Zip
La Quinta, CA 92253
Contractor
Same
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 12470
BUILDING: TYPE CONST. OCC. GRP._
A.P. Number 774.252-005
' Lot 20 Block 291
( Legal Description
Project Description SFD
City lZip I Tel.
State Lic. 506667 (City 1115
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
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 -
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,Susiness 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, 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
i such projects with a contractors) 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
❑ 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
i 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 I become subject to dhe Workers' Compensation
Laws of California.
ate ° Owner
TICE 1T0 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
Ihereby 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 of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft. 1640
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Permit does
not include
any block
walls or pool..
Permit
NOV,)
Validated by:
Validation:
LV
Estimated Valuation
$93, 807.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
271.08
Const.
622.50
Mech.
62.00
Electrical
12 1) , 54
Plumbing
141.00
S.M.I.
9.38
Grading
20.00
Driveway Enc.
.00
Infrastructure
21,1.10.66
Precise Plan
25.00
TOTAL
3,631.16
3,381.16
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street.Setback from Center Line
7
1 `
Side Setback from Property Line ------------
FINAL DATE
INS�R t
Issued by:
Permit
NOV,)
Validated by:
Validation:
LV
I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
N0. PLUMBING F45 -z-, \.I
1ST FL. SQ. FT. p $
UNITS
SETBACK
GROUND PLUMBING -g UNDERGROUND
A.C. UNIT
Y
ARD SPKLR SYSTEM
2ND FL. SQ. FT. p
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. p
ROUGH WIRING
DUCT WORK
ROCK STORAGE
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. p
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. p
GROUT
WALL SQ. FT. p
SERVICE
DRINKING FOUNTAIN
BOND BEAM
URINAL
SO. FT. p
GRADING
cu. yd.
$ plus x$
_$
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP. 6 [ ,� l [
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING1-7-2-clq Op
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.
SQ. FT. p c
BATH TUB
SQ. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID p 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR p 3/4c
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
GROUND PLUMBING -g 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.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE .s.
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. 6 [ ,� l [
FRAMING',
FINAL INSP.?- o -�
ROOFING1-7-2-clq Op
�_/�
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL 3-_3iq Ln
LATHING �s --3 -41 L/
MESH
INSULATION/SOUND S
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 619-775-3500
Date 11/22/93 Type of Permit La Quinta
No. 112539 Permit #112470
Log
Owner Name Jack Clark Jr
No. 54-350 Street Herrera
City La Quinta Zip 92253 Study Area 110
APN # 774-251-005 J Tract # I J Lot # 20 Square Footage 11640
Type of Development Single Family Residence 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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.65 x 1640 or $ 2,706.00 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 Jack Clark JR Telephone
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Peggy Reyes -
Payment Received
Signature 1" Check �N,o.- 192;
G -
Collector: Attach a copy of county or city plan check application form to district copy for all waiv�'rs,
Embossed Original- Building Dept./ Applicant Copy - Applicant/ Receipt Copy - Accounting
-,. d
..&4Zt*Ak�/
rit
i�
of
t u
Tit�1 Of Ed.,
Quinta
�uil�in� r�n� �'�fet� �ibiion
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
Code. certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For the following:
Use Classification
BUILDING ADDRESS 5.4-350 Ave Herrera
Single Family Dwelling Bldg. Permit No. 12470
Group R3 Type Construction VN Fre Zone _
Owner of Building Mr. Jack Clark Jr. Address_
C' L Q ' t Ca 92253
Use Zone
54=065 Ave Herrera
SR
qtY a uin
By, Daniel P. Crawford Jr.
Date: April 28, 1994
Building Official
POST IN A CONBPICUOlIS PLAC[
0
a
ORDER #'327348-62 li4
ESCROW # 5606 -IR WEEN RBWRDRD FOIL TO:JackClark Jr. W. Clark
id
%-P0 :' Box 1371 a V'
Q LaQuinta, CA 92253 f
SPACE ABOVE THIS LINj!FOR RECORDER'S
MOIL TAY STATE11EM1'S TO:
Jack Clark Jr.
' Suzanne W. Clark
"P.O: BOX- 1371
..—;_� _LaQui_�ta,--0922 Y ..� — R. •-_-----=- -_ —' ._. __- -
Ele
NT DEED
The undersigned grantor(a
,\ Documentary transfer tax
(X) computed on full valuconveyed, or
( ) computed on full valuof liens and encumbrances remaining at time of sale
unincorporated area: (X) City of LaQuinta
> ;p FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged:
'Geoffrey Nott and maryapu Mott, Husband and Wife as Joint Tenants
hereby ,C,RANT (S) TO
Jack .Clark, Jr. and SuS4ne W. Clark, Husband and Wife as Joint Tenants
Lot 20 in Block 291 of San Camelita At vale La Quinta unit No. 26 as per nap recorded in
Book 20, Page 50 of mpg, in the office of the County Recorder of Riverside County.
Date: January 9, 1992
Z, 4r�
Geoffrey Mott
STATE OF ������TTT(•••IJ. iR>� -t� )
- OF h `Uef`5 �} e ) M ann Mott
On Qf 02C4 �O \��2. before me, the
undersigned, Notary Public in and for
said State, personally appeared �e
personally known to me (or proved to me on
the basis of satisfactory evidence) to be
the person S whose name 5 a(*v— subscribed to
the within instrument and acknowledged that
executed the same. witness my hand and
offihial seal.
Signature,
Name (typed or pr
OFSEAL
IRENE E. pipg
�� NOTARY PUBLIC — CAl1i0
�� PRINCIPAL OFftCE N
my
RIPER&OE COUNTt'
COCOMMISSign Expires OCT 1. 1894
(This area for official notarial seal)
MOIL TAY STATEMENTS AS DIRBCTED ABOVE
T
5
CALVIN C. KAMINSKAS
Asslslant Commissioner
(714) 275.3000
OFFICE OF
AGRICULTURAL COMMISSIONER
. JAMES O. WALLACE, Commissloner
83-612 Avenue 45 Suite 7
Indio, CA 92201
(619) 342-8291
DATE X
DEVELOPER'S NAMEt
p
ADDRESS s 19. 40, d / %/
TELEPI IONS:
Dear Developers
DAN RILEY
Sealer, Welghls be Measures
1714) 275.3030
CASE NO. P C Ifk/ S 09 30 4
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ from plant material listed, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
Agricultural Comniss er's Office
cc:.Indio and Riverside
4080 LEMON STREET, ROOM 19, RIVERSIDE, CALIFORNIA 92501 — FAX (714) 275-3012
eIII ; IY
e � �h
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