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10448 (SFD)Building Address T 6 0 4hf 4 4 a" P.O. BOX 1504 78-105 CALLE ESTADO 52-810 Lonteztuaa LA QUINTA, CALIFORNIA 92253 No. 10448 Jett ShivelyMailing BUILDING: TYPE CONST. OCC. GRP. Address P. 0. Box 1774773-311--055 A.P. Number Legal Description Lot 22 Block 169 Project Description SFD City La Quints Zip 1 92253 Tel. 56 —Ut35 IMBL 774-3413 Contractor Owner/Builder Address City Zip Tela State Lic. City & Classif. Lic. # Sq. Ft. 2114 No. No. Dw. Size Stories Units Arch., Engr., New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Designer Address Tel. Permit includes garden perimeter wall; City Zip State Lic. # pool permit to obtained separately 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 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, atter, 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). O 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, Suisness 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 or p oving that he did not build or improve for the purpose of sale.) Estimated Valuation 125,836.20 PERMIT AMOUNT Plan Chk. Dep. 250.00 Plan Chk. Bal. 366.94 Const. 730 50 . Mech. n 62 OD Electrical 147.0'.2 Plumbing 169 . 50 I, as owner of the property, am exclusively contracting with licensed contractors to con- Act 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) licensed pursuant to the Contractor's License Law.) O I am exempt under Sec. B. 8 P.C. for this reason S.M.I. 12 . 60 Grading 20.00 Driveway Enc. 20.00 Date -7yz owner e, Infrastructure 2624.18 Arts in Publi, 64.59 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. t' ' �',` 1 A t - + TOTAL 4467.33' ' "" 4217 33 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (This section need not be completed 9 the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of lhp work for which this permit is issued, I shall not employ any pperson in any manner, o as to become subject to the Workers', Compensation Laws ofalifornia. / /{{{yyy / r, Date 1 ✓ v Owner/�� . 1 NOTICE TO APPLICANT: If, aJfer,ralalnng,1 is Vdificate-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. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line 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.) Side Street Setback from Center Line Side Setback from Property Line Lender's Name FINAL DATE INSPECTOR 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. Issued by: Date Permit Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. Ff. ® $ 2ND FL. SO. FT. ® FOR. S0. FT. ® GAR. SO. FT. ® CAR P. SO. FT. WALL SO. FT. ® SO FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM � BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES STORAGE TANK WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROCK STORAGE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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 BOND BEAM SO. FT. ®c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. SO.Ff.GAR ® 3/sc HOUSE SEWER FINAL INSP. C ROOFING GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE 7r7 ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK G ROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS EWER C..fiOUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) .L 2 METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL y GAS (FINAL) TEMP. POLE 9a Gf% GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. f/� L FRAMING FINAL INSP. C ROOFING C(/G/ J —5� ►rq� Y if / dG[�� �`1/l / u0�� lC REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE `-OA„ �f�rZ�1 2 SPARK ARRESTOR GAR. FIREWALL LA ING MESH INSULATION/SOUND ( FINISH GRADING��� FINAL INSPECTION- ✓% r CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL =r DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 1/16/92 No. 111122 Owner Name Jeff Shively No. 52810 street Montezuma Type of Permit La Quinta Permit # Log # City La Quinta zip 92253 Study Area 112 APN # 773-311-055 Tract # I Lot # Square Footage 12114 Type of Development Single Family Residence No. 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 of1.58 X 12.114 or $ 3,340.12 have been paid to D.S.0 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 Jeff/Janet Shively Telephone 360.2847 Name on the check By James E. Lively Assistant Superintendent, Business Services Fee collected /exempted by Shelley D. Bennett ^ ` .w Payment Received Signature - r t. Y �'� Check`No. 1015 • t Collector: Attach a copy of county or city plan check application form to district copy fQiti 11 waivers. Embossed Original- Building De tJAPPlicant Copy - Applicant/Receipt Copy - A:co�un..t.iQ � ' Recording Requested By AND WH(=N RECORDED.�qq T IS DEED AN T Ke :�l9EY, --C,ueS ed y AX srnTtMINr ToNORTH TITLE COMPANY r � Jeffery J. Shively 78-650 AVE 42 # 1008 BERMUDA DUNES, CA 92261 �L J ASSESSOR'S PARCEL NO. 773-311-055-5 V" iESCROW NO. 3540 OTITLE ORDER N9._ GRANT DEED -The undersigned grantors) declare(s): Documentary transfer tax is $ 3,;2. �s ( ) computed on full value of property conveyed, or ( ) computed on full value less value of liens and encumbrances remaining at time of sale. ( X ) Unincorporated area: ( ) City of , and By this instrument dated JULY 12; 1990 JAMES R. STROUP, A SINGLE MAN hereby GRANTS to , for a valuable consideration, JEFFERY J. SHIVELY and Janet L Shively, Husband and Wife as joint Tenants the following described real property in the State of California, County of RIVERSIDE Lot 22 om Block 169 of Santa Carmelita at Vale La Quinta, Unit 17 as per map recorded in Book 19, Pages 19 and 20 of Maps, in the office of the County Recorder of Said County. VACANT LAND STATE OF CALIFORNIA ) SS. COUNTY OF Riverside ) On July 17, 1990 before me, the undersigned, a Notary Public in and for said County and State, personally appeared James R. Stroup personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) T s subscribed to the within instrument and acknowledged that he executed the same. Signatu e 21.9050 9183 OFFICIAL SEAL JULIE L. WATTI:ER tP m NOTARY PUBLIC-AUFORNIa I( RIVERSIDE COUNTY My comm. expires DEC 25, 1993 d i 1C 1, G SPACE ABOVE THIS LINE FOR RECORDER'S USE GRANT DEED -The undersigned grantors) declare(s): Documentary transfer tax is $ 3,;2. �s ( ) computed on full value of property conveyed, or ( ) computed on full value less value of liens and encumbrances remaining at time of sale. ( X ) Unincorporated area: ( ) City of , and By this instrument dated JULY 12; 1990 JAMES R. STROUP, A SINGLE MAN hereby GRANTS to , for a valuable consideration, JEFFERY J. SHIVELY and Janet L Shively, Husband and Wife as joint Tenants the following described real property in the State of California, County of RIVERSIDE Lot 22 om Block 169 of Santa Carmelita at Vale La Quinta, Unit 17 as per map recorded in Book 19, Pages 19 and 20 of Maps, in the office of the County Recorder of Said County. VACANT LAND STATE OF CALIFORNIA ) SS. COUNTY OF Riverside ) On July 17, 1990 before me, the undersigned, a Notary Public in and for said County and State, personally appeared James R. Stroup personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) T s subscribed to the within instrument and acknowledged that he executed the same. Signatu e 21.9050 9183 OFFICIAL SEAL JULIE L. WATTI:ER tP m NOTARY PUBLIC-AUFORNIa I( RIVERSIDE COUNTY My comm. expires DEC 25, 1993 • quura P.O. sox 1504 79, 105 CALLE ESTADO LA Ou1NTA. CALIFORNIA 92253 contractor Owner Address, Job Address r r La Quinta City License No.: Expires: P Bldg. Permit No.: This form shall be posted on the job with the Building Inspection Card and it shall be the duty of the General Contractor or if Owner -Builder Permit, the owner to see that all sub -contractors sign this card, giving his City of La Quinta Business License Number, Contractors License Number and a current certificate of workman's Compensation Insurance Certificate when he starts the ]cb. Failure to comply may cause Building Inspectors to stop work, or complaints to be filed against such contractors or owners. CITY CONT. SUB -CONTRACTORS NAME LIC. NO. EXPIRES LIC.• NO. EXPIRE! 1 - Grade i Excavate 2- Pipelines ``,,ll 3- Cement -Foundations (. W, 4• Cement Walks i Drives S- Asphalt Paving 6 • Framing Set F 7• Steel Structural 8• Masonry. 9- Plumbing e 10.' Lathing U. Drywall 12. Plastering 13. HVAC 14 • Electrical�1i�o 15. Roofing 16. SheetlMetal 17• Floors -All Types 18. Glass - Glazing 19. Insulation/Weatherstrip 20. Sewage Disposal 21• Painting/Decorating 22. Tile 23. Cabinets -Installations 24- Ornamental Metal 25. Fences/Blockwalls 26. Landscaping 27.. Others 28. DO NOT REMOVE THIS CARD Before Final Building Inspection Will Be Made This Form Must Be Completed and Filed With Title 24 Calcs and Plans