10967 (SFD)TA-tyl
P.O. BOX 1504 No. 10967
Building 53-760 Montezuma
7&105 CALLE ESTADO
53
Address LA QUINTA, CALIFORNIA 92253 C
Pauld3n Evans
Mailing
Address 41665 Boardwalk 0112
ci'h1m Desert 'ip92260 JT6 #40--4445
Contractor
General Construction management
Address
Same as above
City Zip Tel.'
State Lic. City
& Classif. B 599424 1 Lic. # 1918
Arcn., tngr.,
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
X1 -hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
/7000), of Division 3 of theeusiness and Professions Cod@land my license is in full force and
x
effect.
�/
/ SIGNMRE - 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 exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a cMl penafty of 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 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 6nprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to com.
Strutt 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.)
❑ 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 o. Company
Capy is filed with the city. ❑ 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 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: If, 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.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
This is a building permit when properly fil!ed 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
t t
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 774-141--001
Legal Description Block 196 Lot 23
Project Description SFD
Sq. Ft.
Size
New ❑
2091 No.
Stories
No. Dw.
Units
Add ❑ Alter ❑ , Repair ❑ Demolition ❑
Permit does not include block spalls
or pool
121,549.70
* PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
352.17
Const
716.50
Mech.
55.50
Electrical
147.97
Plumbing
156.00
S.M.I.
12.20
Grading
20.00
Driveway Enc.
t (j
20.00
Infrastructure
2932.65
Arts in Publiy
`
53.87
TOTAL
4716.86
4466.86
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 Permit
Validated by:
Validation:
E
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES-
EES1ST
ISTFL SQ. FT. ® $
2ND FL SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. I SQ. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL 'HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SEWER OR SEPTIC TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRYTRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE ,PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACKGROUND
IsUNDERGROUND
PLUMBINGIt
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 (ROUG A'O /_„ s
v
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL), --,v
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -plus-x$_
_$
LUMBER GR.
FINAL INSP. �� `
FRAMINGFINAL
INSP. 1A !
ROOFING /CCC h �'�
f9l-ew� oe-7 /1742
I [ L i
kK
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING S L�
MESH
INSULATIONISOUND G
FINISH GRADING
FINAL INSPECTION Q
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
il
� FYm� ��21F y+� • ,1 � II%III��l1��
78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
July 17, 1992
RE:c.--5:3:t�76=0=Avenida—Montez"u"ma�
Lot 23, Block 196, Unit 19
TO WHOM IT MAY CONCERN:
The City of La Quinta states that there are no known geological or
environmental reports effecting the property. City also states
property is not in a special studies zone as designated under
SS/2621-2625, inclusive, of the California Public Resources Code.
City states property is'located in flood hazard zone "X" (areas of
500 year flood; areas of 100 year flood with average depths of less
than 1 foot or with drainage areas less than 1 square mile; and
areas protected by levees from 100 year flood) per the revised
F:I.R.M. (panel 060709 0005 B, effective August 19, 1991) for La
Quinta.
Sincerely,
BUILDING AND SAFETY DEPARTMENT
Tom Hartung
Director of Building & Safety
/lec
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
07-161992 15:56
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TO: Tom Hartung
DATE: July 18, 1992
P.02
x
SUBJECT; • Disclosure statement -58-760 Av. Montezuma, Lot 28, Blk 196, iWt 19
CITY OF LA QUWTA STATES THAT THERE ARE N0.'KN6WN GEOLOGICAL OR `
ENVIRONMENTAL DEPORTS EFFECTING THE PROPERTY. CITY ALSO STATES PROPERTY IS
NOT IN A SPECIAL STUDIES ZONE AS DESIGNATED UNDER 88/2621-2825, INCLUSIVE, OF THE
CALIFORNIA PU13UC RESOURCES CODE. CITY STATES PROPERTY IS LOCATED IN FLOOD
HAZARD ZONE W, AS SET FORTH ON A FEDERAL EMERGENCY MANGEMENT AGENCY, (FEMA)
"FLOOD INSURANCE RATE MAP" (FIRS, OR "FLOOD HAZARD BOUNDARY MAP" (FHBM), WHICH
DESIGNATES, (please describe designation.,.)
N
j
16-1992 15:56
LUPI F R
(619) 345-2527
FAX: (619) 360-0229
45000 CLUB DRIVE, INDIAN WELLS, CALIFORNIA 92210
SENDING TO: 5 �¢ - F4 _F 7
FA,X NUMBER
ofel
ATTENTION: m
FROM: 9 (-Ji c- So
TOTAL NUMBER OF PAGES SENT INCLUDING
COVER PAGE: —2—
—.j
IF YOU DO NOT RECEIVE ALL THE PAGES, PLEASE CALL:
(619] 345.2527
MESSAGE:
----------------- J
_-_T------ s _,,-_---------
P.®1
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 6/2/92 Type of Permit I La Quinta
No. 11451 Permit #
Owner Name Paulden Evans Log #
No. 53760 street Montezuma
city La Quinta zip 92253
Study Area 111
APN # Tract # �� Lot # Square Footage 12091
Type of Development Jr6ingle Family Residence 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 ff—.581 X 12.091 1 or $ 3,303.78 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 _ General Construction Management Telephone 340-4445
Name on the check
By James E. Lively
Assistant Superintendent, Business Services
Fee collected /exempted by Vickie J. Durrettr
Payment Rece1ved
Signature" Check., No. 6178
.
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
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General Construction Management
41-$65 Boardwalk #112
Palm Desert, CA 92260
Fax Cover Letter
Phone: 619-340-4445
Fax: 619-779-1.516
Date:
l_
,i
To:
n
Number of Pages after this one:
40
Atten: Z y
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