15730 (SFD)Building
Address
Owner
414 Q
fRF P.O. BOX 1504 No. 15730
78-495 CALLE TAMPICO
47-270 Via Ravenna LA QUINTA, CALIFORNIA 92253
Landau Development Co. Inc.
Mailing
Address P.O. Box 1725
City Zip Tel.
Palm Springs 1 92263 324-1476
Contractor 7.pexial Sun Construction
Address P.O. Box 2082 I
City Zip Tela
Palm Springs 92263 328-2277
State Lic. City
& Classif. 479669 Lic. # 3787
Arch., Engr.,Kendell Veith
Designer �'
Address P.O. Box 2050 Tel. 320-'1211
Cit Zip State
Paim Springs 1 92263 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
71000) of Division 3 of the Business and Professions Code, apd my license is in full force and
Xect. q—II—q.,
%SIGNATURE+• ° "°""' -`"' f r 4 DATE
OWNER -BUILDER DECLARATION''
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Businass 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 ft 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 or not more than five 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 Gnprovements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of conpletron, the owner -builder will have the burden
of proving that he did not burnt or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
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) icensed 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.Compan
t ❑.Copy is filed with the city. ertified copy is hereby furnished.
V' 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 for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: It, 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 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
ATTORNEY'S FEES.
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.
Signature of applicant Date
Mailing Address
City, State, Zip
11LDING: TYPE CONST. Vin OCC. GRP. R3
P. Number 643-100-009-7
gal Description Lot 188 Tract 26152
roject Description
S F D Plan 1R
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
Validatior
Sq. Ft -2794
Size
No.
Stories
No. Dw.
Units
New ► Add ❑
Alter ❑
Repair ❑ Demolition ❑
Permit does
not include
block wall or
Pool.
Estimated Valuation
$167,436.00
PERMIT
AMOUNT
Plan Chk. Dep.
$258.00
Plan Chk. Bal.
$491.05
Const.
$877.00
Mech.
$109.00
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
$176.03
$ .00
Infrastructure
$3,738.59
Arra In -Fu -1511a PlacesIn-Fu-1511
fits.5y
TOTAL
r►
>r-�6
REMARKS
,IK
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
Validatior
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING. FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE 0
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
re*A-S (ROUGH) /7 1/ y/
/
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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
S
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vac
SEWAGE DISPOSAL
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 PLUMBIt��fJ�
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 0
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS /Q /�1�SEWER
OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. �D 9✓�
re*A-S (ROUGH) /7 1/ y/
/
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL A / J�
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/ ,O /2
�j(
D!�/ , v 0 A, low
/�w/' / ,�/6 �� �.1�f�•4 /_
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
.
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION S
CERT. OCC.
FENCE FINAL ,
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
T4ht 4 4 "
F.O. BOX 1504 APPLICATION ONLY
Building � �� � � 0 AA I F�, /A 7&10i , CALIFORNIAE ESTAD9
Address ,}!1( /V LA QUINTA, CAORNIA 92253
Mailing Po
Address
CityZip 3�8
Tel.
gl'a-c"m '�t4� q�� h3
Contractor F
Address
/-�)
City Zip Tel.
�'� /,� 5��7f'rC s raa v3 �a y
State Lic. / ` City ?^
& Classif. 7 7 40 1
0 C, _ Lic. # J / S 7
Arch., Engr.,,, ! 'L
Designer VV EL_ t) 10, L L V0 t` 4 k
Address Tel.
4�5,)J 0 V 0aevrC 39P o -ia I I
City / Zip State
Lic. a csa
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Sect on
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE rATE
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, alter, improve, demolish, or repair any structure, prior to its issuance iso
requires the applicant for such permit to file a signed statement that he is licensed pursuanr to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000P of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation or Section 7031.5 by any applicant for a pernit
subjects the applicant to a civil penalty or not more than five hundred dollars ($500).
I ' 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 Ind
Prolessions 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 employ®s,
provided that such improvements are not intended or offered for sale. If, however, the buildng
or improvement is sold within one year of completion, the owner -builder will have the bur -den
of proving that he did not build or improve for the purpose of sale.)
I'
I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License _aw
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.)
! I am exempt under Sec. B. 8 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 certificaE of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
I 1 Copy is filed with the city. ❑ 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) valLRtion
or less.)
I certify that in the performance of thg work for which this permit is issued, I shat not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should be.ome
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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.)
Lender's Name
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 cosect.
Iagree to comply with all city and county ordinances and state laws relating to bui ding
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
BUILDING DIVISION
1ILDING: TYPE CONST. OCC. GRP.
P. Number
Igal Description
oject Description
Sq. Ft.
Size
New
No.G.a..
Stories
( Stories G
Add ❑
Itimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
No. Dw.
Units
Alter ❑ Repair ❑ Demolition ❑
AMOUNT
3 U.
Issued by
Validated
Validatior
TOTAL
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
Validated
Validatior
CONSTRUCTION ESTIMATE
NO, ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL, SO, FT.
POR. SO. FT. Lal
GAR. SQ. FT. @
CARP. SO. FT. @
WALL SO. FT. BEd
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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT, @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR raT 3hc
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE _—JCO
NST. 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)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
VR JJIVMNIYACJ/1191tIHlJ
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 9/11/95 1 Type of Permit I La Quinta
No. 113671 Permit #
Owner Name Landau Development Co., Inc. Log
No. 47270 Street Via Ravenna
city La Quinta Zip 92253 Study Area 123
APN # 643-100-009 Tract # 126152 Lot # 188 Square Footage 12794
Type of Development Single Family Residence I No. of units
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 2 794 or $ 4,805.68 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 Imperial Sun Construction, Inc. Telephone 328-2277
Name on the check
A
By Dolores A. Ballesteros '
Superintendent -
Fee collected /exempted by Pauline Pearson
Payment Received
Signature ; ,(`� i_� c n n o A -C 0 ,O t n ,A ,CLin ' _ . +
� e t $4,805'.68' Clheck No. 14079
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