14473 (SFD)2 1
Building 5
Addressi-050 Nisenhower
Ownei bouble .D Construction
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Address51 -960 Ave. Horrera
cLia Quirita, CAS Zip 92253 Tel• 771-1561
Contractor
Sante
Address
ty lZip
State Lic. City
& Classif. B 681932 Lic. # 323
Arch., Engr.,
Designer
Address Tel.
City(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 Busines an Professi "ns Code, r nd my license is in full fo c d
at
SIGNATURE # 0 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 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 exemptkm. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty 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 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.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to corn
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) ffcensed 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
O 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
or less.)
I certify that in the performance of the work forfwhich�this permit is issued, I shall not
employ any person in any manner so a9 to become subjject to "the
�Wo eers' C/o�m�pf nsation
Laws �[ Datef., II i`? Owner �1 Cr} I %..
NOTICEJ TO JAPPLICANT., N, alter 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.
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 t
ATTORNEY'S FEES.
This is a building permit when properly filled out, signed and validated, and is subject to
expiration 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 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. 14473
BUILDING: TYPE CONST. VN OCC. GRP. R3
A.P. Number 774--221-003
Legal Description
Lot 22 Block 297
_ SFD,
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 Pe "it _ N
Validated bv: rti
"ntl
DEG,Z 9 1994 .
Sq. Ft. 1400
Size-
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Permit does
not include
block walls or
pool.
Estimated Valuation
$87,983.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
223.5:
Const.
585.50
Mech.
49.00
Electrical
121.10
Plumbing
138.00
S.M.I.
8.80
Grading
20.00
Driveway Enc.
.00
Infrastructure
10900.08
Pre --Ise Plan
25.00
TOTAL
,321.15
3,071.35
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 Pe "it _ N
Validated bv: rti
"ntl
DEG,Z 9 1994 .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINi. FEE y ,
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE////7//e5/
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
HEATING (ROUGH)
.
FORMS
MOBILEHOME SVC.
BAR SINK -
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL) TEMP. POLE % yi
/
WALL SO. FT. ®
DRINKING FOUNTAIN
WATER HEATER SERVICE
URINAL
SO. FT. ®
BOND BEAM
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
LU ER GR.
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ZONE ROOFING
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
INSPECTOR'S SIONATURESIINITIALS
SQ.FT.GAR ® 3/ac
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 ,
S
GROUND PLUMBING !t [1N ERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE////7//e5/
OROUGH PLUMB.
HEATING (ROUGH)
STORAGE TANK
FORMS
I
y�B4O�yNDIINNG
SEWER R 7"ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
/
(ROUGH / Q METER LOOP
r
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL G /
GAS (FINAL) TEMP. POLE % yi
/
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$ =$
LU ER GR.
FINAL INSP.
FRAMING -4.
FINAL INSP.
ROOFING
/wY %/ww AV4
AVIV
REMARKS:
VENTILATION
ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING /G
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 112/28/941 Type of Permit I La Quinta
No. 113241 Permit #
Owner Name Double D Construction Log
No. 54-050 street Eisenhower
City La Quinta Zip 92253 Study Area 110
APN # I Tract # Lot # 0 Square Footage 11400
Type of Development I Single Family Residence INo. of units 0
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 1400 or $ 2,408.00 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 Double D Construction Telephone
Name on the check
By Dolores A. Ballesteros
Superintendent
LZ
Fee collected /exempted by Mar Lou Lopez �- j
Z
4
r, t:
Payment Received'
Signature �" r < 1519
check- No.
Collector: Attach a co of county or city plan chec a ication form to district copy for all waivers.
Embossed Original- Building Dept./ Applicant Copy - Applicant/Receipt Copy - Accounting
FIDELITY NATIONAL TITLE INSURANCE COMPANY
Order No. 250165
Z
Escrow No. 10-31190
NO
sw
Loan No.
16; Z
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O °' cc-�i
WHEN RECORDED MAIL TO:
Q it gr
MICHAEL D. DIETRICK
~ Y U U.
51960 AVENIDA HERRERA
Z W
LA QUINTA, CA 92253
Cr �id
G
Uti
W
c
MAIL TAX STATEMENTS TO:
SPACE ABOVE THIS LINE FOR RECORDER'S USE
ABOVE
DOCUMENTARY TRANSFER TAX $ . 6..bA..........................
X...Computed on the consideration or value of property conveyed; OR
.....Computed on the consideration or value less liens or
encumbrances remaining at time of sale
GENERAL ESCROW COMPANY
Signature of Declarant or Agent determining tax -Firm Name
APN: 774-221-003
(n.
TRA: GRANT
DEED
~
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
GEORGE R. DUTTON and KAREN E. DUTTON, Husband and Wife
`i
hereby GRANT(S) to
i
MICHAEL D. DIETRICK, a Single Man
the real property in the City of
County of Riverside
State of California, described as
LOT 22 IN BLOCK 297 OF SANTA CARMELITA AT VALE
LA QUINTA UNIT NO. 27, AS SHOWN BY MAP ON FILE
IN BOOK 19, PAGE 82 OFFICIAL RECORDS OF RIVERSIDE COUNTY, CALIFORNIA.
Dated NOVEMBER 18, 1994
STATE OF CALIFORNIA } ss.
COUNTY OF Sonoma }
On November 22, 1994 before me,
Roshell Pulk
personally appeared GEORGE R. DUTTON AND KAREN
E. DUTTON----------------------
personally known to me (or proved to me on the basis of satisfactory
evidence) to be the person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies). and that by his/her/their
signature(s) on the Instrumentfhe pe on(s) or the entity upon behalf of
which the person acted, gxecuted t instrument)
WITNESS my hand ar)6 officip"epr -
OFFICIAL SEAL - 969562
ROSHELL PULK
NOTARY PUBLIC - CALIFORNW
U
•, COUNTY OF SONOMA *,
Z v; My Comm. Exp. April 23, •4991
Signature (This area for official notarial seas
MAIL TAX STATEMENTS AS DIRECTED ABOVE 1002 (1/94)