643-16 (SPIN)T-Atyl 4
P.O. BOX 1504 APPLICATION ONLY
Building! l V1 7&105 CALLE ESTADO
�'%
Address -S/ S ,4 MOA)- J60 LA QUINTA, CALIFORNIA 92253
OwnerGG-
b I L S14llC�� BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 1S11 16 16F-5 Ae 3• 14�z_(s _"K A.P. Number
C, ?t Zip Tel. _ 7
/ Legal Description
Contractoro�
C D A%67 -,V 77,0, Project Description
Address
City Zip Tel..
oS�T C -A 3L/19 3S�z
State Lic. City
& Classif. g-0 J 3U Lic. # S Sq. Ft. '3�% No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer SHA.) J%111L.4- -4-- New ❑ Add ❑ Alter Repair ❑ Demolition ❑
Address Tel.
City Zip State } ,
A%li/>qA) G�FiIS 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 Estimated Valuation
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, 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 PERMIT - AMOUNT
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 Plan Chk. Dep. 9
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal.
1] 1, 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 Const. t
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, Mech. �2 ,. f]
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 Electrical ,� `. ,� 7
of proving that he did not build or improve fordhe purpose of sale.)
" I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
Strucl 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 S.M.I. 2-3,70
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading �2_0 —
17 1 am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc. —0--
Date-Owner
-Q'^Date Owner Infrastructure jft Q
2 s
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of ,/ tf'
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) J 6 / Policy No. Company t 3G
Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
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 thg work for which this permit is issued, I shall not I �/ 11,60 1 n
employ any person in any manner so as to become subject to the Workers' Compensation j I /
Laws of California. t /',,'9_t A J
Date Owner
NOTICE TO APPLICANT: If, after .making this Certificate of Exemptionyou should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: I
Front Set:)ack from Center Line 1\
Rear Settack from Rear Prop. Line
CONSTRUCTIONIENDING AGENCYSide Streit Setback from Center Line 1.
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) ., Side Settack from Property Line .
Lender's Name
Lender's Address 1
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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. Issued by: Data Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-. -
mentioned property for inspection purposes. Validated by: -
Signature of applicant Date
Mailing Address _ Validation:
City, State, Zip "
BUILDING DIVISION
CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO. ELECTRICAL FEES
140. PLUMBING FEES
Q
1ST FL. ` S0. FT. @
2ND FL. SO. FT. @
POR. SD. FT. @
GAR. SO. FT. @
CAR P. S0. FT.
WALL SO. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION
�r-�f /
$'R D / t/
y3
1 D
$
UNITS
MOBILEHOME SVC.
POWER OUTLET
BONDING
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
STORAGE TANK
NOTE: Not to be used as property tax valuation
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
FLOOR DRAIN
FOUND. REINF.
MECHANICAL FEES
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
WATER SOFTENER
GAS (FINAL)
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
GROUT
WASHER(AUTO)(DISH)
SERVICE
APPLIANCE DRYER
BOND BEAM
WATER SYSTEM
GARBAGE DISPOSAL
GRADING
cu. yd.
$ plus x$
FURNACE UNIT WALL FLOOR SUSPENDED ?j
LUMBER GR.
LAUNDRYTRAY
/
AIR HANDLING UNIT CFM
ROOFING
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
FIRE ZONE ROOFING
POLE, TEM/PERM
LAVATORY
/
HEATING SYSTEM FORCED GRAVITY
SPARK ARRESTOR
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
LATHING
BATH TUB
MESH
SO. FT. @ c
WATER HEATER
INSULATIONISOUND
MAX. HEATER OUTPUT, B.T.U.
SQ, FT. RESID @ 1 I c
SEWAGE DISPOSAL
FINAL INSPECTION
SO.FT.GAR @ 3/4c
HOUSE SEWER
2
{ FENCE FINAL
'
INSPECTOR'S SIGNATURES11NITIALS
GAS PIPING
PERMIT FEE
C ��
PERMIT FEE
/
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
2�.00
PL.CK,5,4
�3a'
CONST. FEE
(119—
ELECT. FEE
�a3�67
SMI FEE
PLUMB. FEE
2lI�S'D
STRUCTURE PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
{ FENCE FINAL
'
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL
r'
DESERT SANDS UNIFIED SCHOOL DISTZICT
82-879 Highway 111, ;
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 12/8/94 Type of Permit La Quinta
No. 113216 1 Permit #
Log
Owner Name Dilsaver
No. 47-515 Street Via Montigo
city La Quinta Zip 92253 Stud} Area 123
APN # Tract # Lot # 0 Square Footage 13870
Type of Development Single Family Residence No. of units 0
Comments
At the present time, the Desert Sands Unified School District does n.Dt collect fees on
garages/ carp' 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 3 870 or $ 6,656.40 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 Mannes Construction Telephone 340-3522
Name on the check
By Dolores A. Ballesteros
Superintendent 'g,
Fee collected /exempted by MaryLOu Lopez r ` Aa
Payment ;-ZeceivPd � r n
Signature -i^ c ` k • No.
� ; 3283
� v� ` .hec
Collector: Attach a c y of county or city plan c eck application form to disirict;cupy.foT,alhwaivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/ Receipt Copy `Accounting
�•��� .� 6197739289
SENT BY: XEROX" Telecopier 7017;10-124'-94 ,10 22AM ' i 1" 214 '386, 2909;#
RECORDING REQUESTED BY.
AND WHEN RECORDED MAIL TO
Nome
Charles J. Dilsaver 6
Margaret D. Dilsaver, Trustee
Addiem 844 Colorado Blvd, #106
Los Angeles, CA 90041
city &.
S1pf0 ,
SPACE ABOVE THIS LINE FOR RECCROER'S USE
Tr- 100 (Rev•aioc)n _ GRANT DEED
APN No, 094; 4 Title No. / 3•y 55q EscroW No.
THE UNDERSIGNED GRANTOR(s) DECLARE(s)
DOCUMENTARY TRANSFER TAX Is $ 154.00 CITY TAX
EX -computed on full value of property conveyed, or
G computed on full value less value of liens or encumbrances remaining at time of sale,
D Unincorporated area; Z C}ty of 'L'A QUINTA
and
FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged, '
"WILMA-LA QUINTA L.P.,, A DELAWARE LIMITED PARTNERSHIP
hereby, GRAN T(s) to CHAR :5 J. DILSAVNR AND MARGARET D. DILSSAVRR; as Trustees
of the CHARLEs J. AND RE
MARGAT D. DILSAVER LXVYNG TRUST
the following described real property In the
County of.: RIVERSIDE Stats of California;
SES EXHI$IT""A ATTACHED
WILMA-LA QUINTA L.P, A DELAWARE
LIMITED PARTNER:S.HIP
BY: CENTRUM" PORT .PAVILION LTD,, p"
A DELAWARECORPORATION, AS GENERAL ?
Dated;PARTNER
July 21, 3994
BY: WILMA SOUTH MANAGEMENT CORP, ,
A GEORGIA CORPORATIO ,"IT.S ATTORNEY
A -
IN FACT
State of,cQWern►a .
Coun ofs9.
On before m ,
(here Insert name) Notcry PUbilc,
appe
�1119tt1►,, I`
per Wally ared ` E " , oal l,afh
06rsonally known tome (or proved to me on the basis of sctlsfoctory evidence) to be the persons b � r�subscribed to
Me within Instrument and acknowledged to me all that he/she/they executed the some In hls/had ity(les), and
that by hls/her/thelr slgnature(s) on the Instrument the person(s), or the entity upon behalf of wh�h t G r ci ecuted the
i6strument.
WITNESS my hand and,offlclol seal 7 ! GEORGIA
COU�a�'�
Signature
� •� a�nluntl�aa d.
0MY QeQ, WIWI) Wder s
tiv , LXZ q�, CSyNN r15 0
C01'V11�t.1/=-s i/V l7� 71? t�lC 1
W ALL4 N= me amu. C V2