15835 (AR)+ s P.O. BOX 1504
Building " 78-495 CALLE TAMPICO
Address56— 098 Pebble Reach LA QUINTA, CALIFORNIA 92253
--..._.. Virginia Cuffing
Mailing -
Add ressmaame as, above
. City ip
Z
La Qui1ta 92253
Contractor t
Address
City Zip Tel.:
La Quiut 92253 564-1309
State Lic. - , L City
& Classif..91DO90 Lic. # 402 ,
Arch., Engr.,
Designer Pa' ul Anders'
an
Address Tel.
j`- 74..-854 Velie Way #6,
-City" Zip State
-Pal"i D" rt'•: 92260:• Lic. #
LICENSED CONTRACTOR'S DECLARATION
if hereby affirm that I am licensed under. PrgQsldns of Chapter 9 (commencing with Section
7.000) of Division 3 of the Business a .Professions Croddee;¢and my licensejis.injuull force and
effect. >f f..!�r'�: iJ^-.f a l ,- 3 tlfa 9
SIGNATURE ./ " .y' • i; Y —I DATE
f OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following.
reason: (Sec. 7031.5,Busfness 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 rile 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 or 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 rive 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, 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 knprove for the purpose of sale.)
O 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 contractors) licensed 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
"' Polic-,L- .Company
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 ff.. the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thq work for which this permit is issued, I shall not
employ any erson in any manner so as to become subject to the Workers' Compensation
No. 1-5835 '
BUILDING: TYPE CONST. •V—N OCC: GRP. R3
A.P. Number
Legal Description' '
Project Description' Enclose Atrium
' Date Owner
_°
ZONE:
Sq. Ft. 99
Size
:No. '; No. Dw.
Stories Units
„
.' .
New ❑ Add:' - "Alter ❑ Repair ❑ 'Demolition.❑•-
Front Setback from Center Line
:.
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND
Side Street Setback from Center Line
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,
orf..;�•
•'.., a
Estimated Valuation • 1 s. tii2 - 00-
y7,. l
r.
• PERMIT;.
AMOUNT
Plan Chk. Dep..-
.
This Is a building permit when properly filled out, signed and validated, and is subject to .
Plan Chk. Bal.
in 4
expiration it work thereunder is suspended for 180 days.
Const.
I certify that I have read this application and state that the above information is correct.
Mech.
4
1,
Electrical
1 $4
Plumbing21
of)
construction, and hereby authorize representatives -of frthis city to .enter the above-.
mentioned property for inspection purposes. r i' p7
S.M.I.
77
/
Grading
Driveway Enc.
Infrastructure ,
.•'
. Signature of applicant�I } •r Date'
I
Mailing Address ' 3 t
Validation:
I
TOTAL
1 '
REMARKS
Laws of California
' Date Owner
NOTICE TO 'APPLICANT. ff,.afer making this Certificate of Exemption you 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: - ,
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND
Side Street Setback from Center Line
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,
Side Setback from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF. THE, LABOR CODE, INTEREST; AND '
ATTORNEY'S FEES.
FINAL DATE
INSPECTOR t
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.
Issued by:
Date •--Permit
�l agree to comply with all'city and county ordinances and state laws relating to building
I , :
'
construction, and hereby authorize representatives -of frthis city to .enter the above-.
mentioned property for inspection purposes. r i' p7
Validated by:
/
1.
Iyy SJ
.•'
. Signature of applicant�I } •r Date'
I
Mailing Address ' 3 t
Validation:
I
City, State, Zip
�-�
By. .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. @ $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. I SQ. FT.
WALL SQ. FT.
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM 1►.
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.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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'
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 APPJEOUIP.
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 SIGNATURESIINITIALS
GARDEN WALL FINAL
'.:-rl:iYica:e of comaliancs: Residential
GoFF-1 116 AT124 VM C -Al,,-
olect Title
Z%�wocl$ Kew
olect Address
' 'AOL - 4:57. M4 DSPS1
xumentation Author it is
?t�� D
amobance Method tFacxage. Point System or Computer)
Lj!ii% CNIN10
to
1ENERAL INFORMATION dq
'otal Conditioned Floor Area: -t i tt2
:uilding Type: Single Family Addition
:heck one or morel Multi -Family Existing -Plus -Addition
:ront Orientation: North / East / South / West / All Orientations
(Input orientation in degrees and cirde one.)
vumber of Dwelling Units: >'
=1oor Construction Type: Slab Raised Floor (circle one or both)
(Daae i or 2) CF -1 R
Building t%enntt w
Plan ChecK r nate
Field ChocK I Uate
Agony use only
BUILDING SHELL INSULATION
Construction
:,omponent Insulation Assemoly LocatiorvComments
ryne R -Value . U -Value (Attic. to garage. tyotcal. etc.)
THERMAL MASS
Area
L 174E c ��
Rwlyd.Lnuiry 1902
Thickness
(inches) Location/Description (kitchen, batn. etc.1
�� or- �� r jk
e�
!�i
/�'DJm/NtNCr �p/kGE'S
/t'nE' lAjT�1'ZI> Gs+N�I•TL�U.
Wall ..............
Wall ..............
Root .............-
Floor .............
Floor .............
Slab Edge ....
FENESTRATION
Shading Devices
Fenestration
Area
Fenestration
Interior Exterior
Overhang Framing Type
Ives/no) (metaltwoodNtnyl)
Orientation
(St)
U -Value
(roller -blind. etc.) (shadescreen. etc.)
Front..... (—)
�.
O
N •'
f=ront..... ( )
Left.......
Lett .......
Rear..... ( )
''
Rear ..... ( )
Right.....
Right.....
Skylight .......
--- "`
Skylight .......
---
THERMAL MASS
Area
L 174E c ��
Rwlyd.Lnuiry 1902
Thickness
(inches) Location/Description (kitchen, batn. etc.1
�� or- �� r jk
e�
LA
Z.
0,ertifficate Of Compliance: Residential
(Page 2 of 2) CF -1 R
prni—t i1#1 .
COO Fl? IN Gr- AVa-idPW
2;i
HVAC SYSTEMS
Note: Input hyaronc or comolned hydroma data under Water Heating Systems. except Design Heating Load.
Distribution
Heating Equipment Minimum Type and Duct or
Type (furnace, heat Efficiency Location Piping
pumo, etc.) rAFUE/HSPF) (ducts/attic. etc.) R Va ue TYpe Thermostat
�ii� 1517 Aft%. s ss.
Cooling Equipment Minimum Duct
Type (air conditioner, Efficiency Location Duct Thermostat
heat pumo, evao. coolino! (SEER)
(attic etc) R Value TVpe
4reX14W& riwY ..... -
WATER HEATING SYSTEMS
Configuration
(sold or oacka
Rated t Tank Energy. External
Water Heater Distribution Number Input (kW Capacity Factor or Tank
Type T e in S stem or 8tu/hr1 (gallons) ERecovery Standbys Insulation
l-5,nAlC� Hicien Loss /o) R -Value
1. For smell pee storage (rated input S 7s,00o 8twhr►, electric resistance and Met pump crater haeters, list EnergyFactor.
F r.
For large gee storage wetgr heaters crated input 2 75.00o StWhr). list Rated Input. Recovery Efficiency and Standby Loss.
For Imstantan"us gse water heaters, list Rated Input and Recovery Effieiency.
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This certlticate of compliance lists the building features and performance specifications needed to comply mlh Title 24. Parts t and 6, of
the California Code of Regulations, and the administrative regulations to Implement them. This certificate has been signed by the
Individual with overall design resoonslaGty. When this certificate of compliance Is submitted for a single building plan to be built in multiple
orientations, any shading feature that Is varied is Indicated In the Special FeatureVRemarks section.
Designer or Owner (p« @using" & Professions Code)
Name: �L�(! �. �. ► A
Tide/Firm: "G7'. �Ihli'. /4jU 5 i'x
Address:
Lie.
G
Enforcement Agency
Name:
Tide:
Agency:
Telspltons:
(stprlaarerstamp) (�)
devised January 1992
Documentatlon Author
Name: _'1J(, �' h74r
Tills/Firm:
Address:
s
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 11/9/95
No. 113852
Type of Permit I La Quinta
Permit #
Owner Name Virginia Coffing Log
No. 56098 street Pebble Beach
City La Quinta Zip 92253 Study Area 106
APN # I Tract # I J Lot # 0 Square Footage 199
Type of Development I Residential Addition No. of units 0
Comments Rmv,pdr Sytoi,
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:
Residential Addition 500 Sq Feet or Less
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in. the amount of 0.00 x 99 or $ 0.00 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 N/A
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted byPauline Pearson
Signature r[� , ti Q o ��.e \: o (1t ni4.3�
Telephcirse a, .
01
r_ Z
1 tit
$0.00 Check No. N/A
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