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15537 (AR)` v 4 �' 4, - P.O. BOX 1504 NO. 15537 Building 78-495 CALLE TAMPICO Address 78-860 W. Harl.-and Drive LA QUINTA, CALIFORNIA 92253 OwAer : " iir. Joc Borba ming Address same as above ity Zip Tel. La Quinces, LA 922.53 360-055 95ne'r`/Builder . Address State Lic. & Classif. Arch., Engr., Designer el.' City Lic. # City_ IZip I Lict# LICENSED. CONTRACTOR'S DECLARATION I hereby affirm that l 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 affirin that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5.13ushess and Professions lode: Any city or county. which requires a permit to construct, after, improve.- 'pan odah, or -repair. any structure. prior to Its Issuance - also requires-dre.appilcarrr for such pemrft ro-Ide a s/gned stetamsnt that he is Ibensed pursuant to the provlsbns 'or the Corrfraororii Lkwrrae law, Chapter 8(commeocargw/lh Becton 7000) of Ofidslon 9 of the Business and Profe'sabne Cade, or that. he Is exempt Iherelrom, and the basis for the adeped .exemp8an. Any'rlofatlori' o/ Section 7031.5 Dy 'any applicant /ora permit me eppricerrr ro a clro pernafty or trot more roan nve Hundred da/ars (s5oo). owner of the property, w my employees with wages as their sole comp,ensetIon, will Xd.s and Profess/ons Code: The Contractor's License Law does not apply to an owner of property who builds or approves thereon and who does such work himself or through his own einpbyees, provided that such • Improvements are not Intended or offered for sob. d, however, the building or Improvement Is sold wrthtrr one year of completion, the owner -budder will have, the burden or proving that he did not build or approve for the purpose of safe.) ❑ I, as owner of the property, amexclusivelycontracting with licensed contractors to con- struct the project. (Sec. 7044, .Business and •Profesabns `Code: The Contractor's License Law does- not apply'to an ownw of property who builds or approves thereon, and who contracts for such proJecfs wftha carrtractor(s) licensed pursuant to the Contractor's License Law.) ❑ I attmjjexempt•under Sea R. & P.C. for this reason bete ('I / Owner 3"(t�io ■ �r WORKERS' COMPENSATION DECLARATION I hereby affirm that I have i certificate o1 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 tiled with the city. ❑'Certified copy Is hereby furnished. CERTIFICATEOF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (obisess.secdneed not be completed ff the permit Is for one hundred dollars ($100) valuaUm or l)on - I certify that in the performance of.th¢ work for which this, permit Is issued, I: shall not empio 111 ppeerson in any manner so as to become sub)ect to the, Workers' Compensation Laws of Cebfor Date ,. Owner NOTICE TO APPLICANT: ft,. after malft this Certificate or Exemption you' shvukd become subJect 10 1119 ft tars' Compensation provfebns of the Labor Code, you must forthwith oompty with such provisions or iNs_ permit shad be deemed revoked. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SULfJECT AN EMPLOYER TO CRIMINAL PENALTIES AND'CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700.000), IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. This,ls a building permit when property filled out, signed and validated, and Is, subject to expiration if work thereunder Is suspended for 180 days. I certify that I have lead this application and state that the above Information ls,corect I agree to comply with all cland county ordinances and state laws relating to building construction, and hereby au representatives .of this city . to . enter the above. - mentioned property for Inspection purpose& Signature of applicant Date Melling Address City, State, Zip LDING: TYPE CONST. - OCC. GRP.. P. Number al Description 1200b CAPA'A ject Description Arid IM14 room and decd to existing dwelling Sq. Ft. No. Dw. New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ TOTAL REMARKS rJ l a t3 %'FM f 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: Validated bv- I � 1 11..1 ..` �J I Estimated Valuation PERMIT AMOUNT Plan Chk. Dep: Plan'Chk. Bal. IN . O `v i Const: ' ?',7 Mech. M. 0 ../ Electrical 4� Plumbing • S.M.I.. �. GradingZU*VU Driveway Enc. Infrastructure TOTAL REMARKS rJ l a t3 %'FM f 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: Validated bv- I � 1 11..1 ..` �J I CONSTRUCTION ESTIMATE NO. ELECTR ,CAL FEES NO. PLUMBINU FEES 1ST FL, SO. FT. ® E UNITS COLL. AREA 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 1. ,WALL SO. FT. ® GAS, (ROUGH) DRINKING FOUNTAIN SO FT ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION S GAS (FINAL) WATER'RIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER HEATER IWATERSOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER WATER SYSTEM GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING . cu. yd. = plus -4-=$ LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC i 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.. F7. RESID ® 1 V c SEWAGE DISPOSAL SQ.FT.GAR ® 3Ac HOUSE SEWER; SPARK ARRESTOR 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) STORAGETANK FORMS SEWER OR SEPTIC TANK 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 iFINAL INSP. BOND BEAM WATER SYSTEM GRADING . cu. yd. = plus -4-=$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING A� /�1\ VV J Q , l� REMARKS:- EMARKS:VENTILATION VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR., F►REWALL LATHING MESH Al INSULATIONISOUND FINISH GRADING FINAL iINSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL DESERT SANDS UNIFIED SCHOOL DISTRICT 82-819 Highway 111 NOTICE: Indio, .CA 92201 Document Cannot Be Duplicated 619-775-3500 Date. 11/9/95 1 Type of Permit I La Quinta No. 113858—T Permit # Owner Name Joe Borba Log No..78860 Street W, Harland Dr. City La ;Quinta Zip 92253 Study Area 233 APN # Tract # Lot # 0 Square Footage 1361 Type of Development Residential Addition No. of units 1 Comments Add pool cabana room and deck to existing dwelling .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: Residential Addition 500 Sq, Feet or Less EXEMPTION NOT APPLICABLE This certifies that school ,facility fees imposed, pursuant to Government Code 53080 in the amount of 0.00 x 361 or $. 0.00 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 projecUmay now be issued. Fees Paid By N/A Telephone Name on the check` By Dolores A. BaResteros Superintendent Fee collecteP d./exempted by Pauline Pearson Signature A A , 0 UA- OP I Al Ak IVVV $0.00 Check No. N/A. 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 Ff 4 BOB HOFFMAN, Structural Engineer Six Alfaro Drive, Rancho Mirage 92"270-4.758 296 7737 9 ,:,Y: (=e- ar =Gs 01 ,.-.00 F/- ow,r �'ljo3 AN )c /8 ,000.000 ✓/— 2S 3 G i�ro a0'��.Q� 1 7i -w v'." ` ✓'.�.,s /6 01'49 .�C. X 6 /i110=01r- /2 y1f/r c Ar ?8 sex -1 7364,V4', e-4 oe.Coe vot"';5' �w Xvz �ab. 4=.