07913 (SFD)Building
Address
Owner
Mailing
Address
City
48-840 Eisenhower
lel Been
414tt�f 1,rCV
P:O. BOX 1504 { No. 07913
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
C
4
BUILDING: TYPE CONST. OCC: GRP.•
A.P. Number fi�—��rttts
Tel.
Legal,Description SVA
Project Description Single Family Dwelling
a 2N
Tel.;
State cjcy.
Lic. #
Arcn,, tngr., . -
Designer,.
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affi
ffecrm. that am licensed under provisions of Chapter 9 (commencing with Section
700 of Division 3 of the Business and Professions Code, and rn license is in full force and
SIGNA R — -
OWNER -BUILDER DECLARATION
(,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.constnxt, atter, 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, o/ the Contractors License Law, Chapter 9 (commencing with Section 7000) o/
Division 3 o/ the Business and Professions Code, or'that, he /a exempt therefrom, and the basis
for thealleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a permit
sub)ects the applicant to a civil penalty o/ not'more than five.hundred dollars ($500).
O I, as owner of the property,, or my employees with wages as their sole compensation, will
do the work, and' the'structureAs not intended or offered for sale. (Sec. 7044, Buisnass and
Professions Code: The Contractor's License Law does not apply to an owner o/ 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. I/, however, the building
orImprovement is sold within one year of completion, the owner-bullder 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 ths'project. (Sec. 7044, BusinessandProfessions Code: The Contractor's License Law
does not apply to am owner of property who builds or Improves thereon, and who contracts /or
such,prolects'whh a,contractor(s) licensed pursuant to the Contractor's License, Law:)
❑ 1 am exempt underSec. 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800; Labor Code.)
Policy,No Company
O Copy Is filed with the city. ❑ Certified copy Whereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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 pereon in any manner 'adas to become subject to the Workers' Compensation
Laws of Call omia.
Date Owner
NOTICE: TO APPLICANT. 8, 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 downed. revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work forwhich,this permiT.ls issued. (Sec. 3097, Civil Code.)
Lender's Name
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
explr'atiori it 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 tiullding
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
Sq. Ft.
Size
New ❑
No. No. Dw.
Stories —Units,-
Add
nits.
Add ❑ Alter ❑ Repair ❑ Demolition ❑
mated Valuation
PERMIT
Plan Chk.'Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS yyyh,
bi xr+:i cv i tt� wt
ZONE: BYt
Minimum Setback Distances:
Front Setback from CenterLine
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE-INSPECTOR
Q
Issued by: Date - Permit
Validated" by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® S
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SO. FT,
DUCT WORK
ROCK STORAGE
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
rl
ROOF DRAINS
CAR P. I SO. FT. ®
DRAINAGE PIPING
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN-
SO. FT. ®
WATER SYSTEM
FINAL INSP. --pj l (
FINAL INSP. ' -Za �q� (
URINAL
ESTIMATED CONSTRUCTION VALUATION $
I
WATER PIPING
NOTE: Not to be used as property:tax valuation
FLOOR DRAIN
MECHANICAL FEES
MATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SPARK ARRESTOR
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
INSPECTOR'S SIONATURESIINITIALS
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® I% c
SEWAGE DISPOSAL
SO.FT.GAR ® 34c
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 / I�
GROUND PLUMBING76 Q NDERGROUND
A.C..UNIT
COLL. AREA
SLAB GRADE �
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
Lp SEWER OR SEPTIC TANK)V„HOUGH WIRING.
uMETER
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) 15--q` METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. --pj l (
FINAL INSP. ' -Za �q� (
GRADING
cu. yd.
$ plus x5 =S
LUMBER GR.
FRAMING
ROOFING
, /
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}
0 ,�%� J I 1 /3 v` O
(6(? fy Z,
REMARKS
bw
VENTILATION
FIRE ZONE ROOFING;
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified SchoolDistrict
CERTIFICATI F PAYI4ENT
00Cu s%69oL FACILITY FEES
TO. G� I ��G DATE: 51361010 f(�q
3 ld►r Dlpfi
This is to gertif tha
developer of which is
located at - within
this District., has paid school facility fees imposed pursua to the
author'ty e.rat b, Go rnment _ CoSection 53080 'n t amo nt of
covering a total of D square feet of ( ) re 'den ial or
( ) industrial/commercia-1 development and that buildi g permits for
this footage in this development may now be issued by your jurisdiction.
I� fotq iaA f) -
r DESERT SANDS UNIFIED SCHOOL DISTRICT
White - Building Department 0 Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
Order Np. V Y " 11
t Escrow No. j
i`' Loan No. Rewrding Requested By
� Chicago Title � � '.
C1 WHEN RECORDED MAIL TO:
Mr. and Mrs. William A. Hall
78040 Calle Norte
La Quinta, CA 92234
MAIL TAX STATEMENTS TO -
DOCUMENTARY TRANSFER TAX $ ......::......6A.2.0....................
XX ,,,,,, Computed on the consideration or value of property conveyed; OR
Same -`as above. _._ _ _ .. Computed on the consideration or Value less liens or encumbrances
remaining.at,timeofsale.
coy- 3 �/ V � � � Slgnatura of Declarent,or Agent determining tax - Firm Name
GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
WALLACE F. REYNOLDS AND MARGARET M. REYNOLDS, husband and wife as joint tenants
hereby GRANT(S) to
WILLIAM A. HALL AND PHYLLIS HALL, husband and wife as joint tenants. the real property in the City of Lta
County of Riverside , .State of California, -described as
Lot. 303 of La puinta Golf Estates No. 1, as shown by Map on file in Book 37, Pages
__96,97-and--98.-of Maps,,-Riverside-Gountg-Records,._-
Dated September 11, 1,989
STATE.OF CALIFOEiNIA Iss,
COUNTY OF RI erside I
on September 28, 1989
before me, the undersigned, a NotaryPublic in and for said State, per+
sonally appeared, Wallace F. Retlnolds
and Margaret M.. Reynolds
--------------------
personally known to me (or proved to me on the basis of satisfactory
I
evidence) to be the person(s) whose name(s) Is/rAoubscribed to the
within . Instrument and acknowledged tome that he/she ey ecuted
the same.
6OFRCLALSEAL
LENUMROEK
Nafe-CedlorNa
RCOUNTY
e 30,19 fes
WITNESS my hand and official seal. s
Signature- �i ( (This area for official notarial ..seal)
t
1002 _(6/82)
MAIL TAX STATEMENTS AS'DIRECTED ABOVE
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VE TMIS LINE FOR RECORDER'S USE
MAIL TAX STATEMENTS TO -
DOCUMENTARY TRANSFER TAX $ ......::......6A.2.0....................
XX ,,,,,, Computed on the consideration or value of property conveyed; OR
Same -`as above. _._ _ _ .. Computed on the consideration or Value less liens or encumbrances
remaining.at,timeofsale.
coy- 3 �/ V � � � Slgnatura of Declarent,or Agent determining tax - Firm Name
GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
WALLACE F. REYNOLDS AND MARGARET M. REYNOLDS, husband and wife as joint tenants
hereby GRANT(S) to
WILLIAM A. HALL AND PHYLLIS HALL, husband and wife as joint tenants. the real property in the City of Lta
County of Riverside , .State of California, -described as
Lot. 303 of La puinta Golf Estates No. 1, as shown by Map on file in Book 37, Pages
__96,97-and--98.-of Maps,,-Riverside-Gountg-Records,._-
Dated September 11, 1,989
STATE.OF CALIFOEiNIA Iss,
COUNTY OF RI erside I
on September 28, 1989
before me, the undersigned, a NotaryPublic in and for said State, per+
sonally appeared, Wallace F. Retlnolds
and Margaret M.. Reynolds
--------------------
personally known to me (or proved to me on the basis of satisfactory
I
evidence) to be the person(s) whose name(s) Is/rAoubscribed to the
within . Instrument and acknowledged tome that he/she ey ecuted
the same.
6OFRCLALSEAL
LENUMROEK
Nafe-CedlorNa
RCOUNTY
e 30,19 fes
WITNESS my hand and official seal. s
Signature- �i ( (This area for official notarial ..seal)
t
1002 _(6/82)
MAIL TAX STATEMENTS AS'DIRECTED ABOVE