SFD (10588)Building
Address X2-73 0
Owner
'6iarro , - ;
ion A. Shollenberaer
Mailing
Address • O . $OX 59 -
City Zip
L Quinta 92253
Contractor
- • Gty-'7.i¢3Y'al C6nttac't 14c"t,i'ac'3
Address. ,.
s € -me
City lZip
cu
P.O. BOX 1504 No. 10588
78-105 CALLE ESTADO
•LA'OUINTA,"CALIFORNIA 92253
BUILDING: TYPE CONS'. ' OCC: GRP.•
A.P. Number 773--305-012
Tel.
564-1486 Legal Description Lot 12 Block 140
enProject Description ' :SFi3
State Lic. City
& Classif. 524325 Lic. # 1235
Arch., Engr.,
Designer
Address Tel
Sq. Ft. 2231 • No-' No. Dw. >.
Size Stories -Units
New ❑ - Add. ❑ Alter ❑ Repair❑
Demolition ❑
_
City
Zip
State
•
Lic. #
tax' anti
_
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'andProfessions. Code, and my license is in full force and
,^.\ feces
SIGNATURE�- ' ..�. DATE
,1 -
'- \ OWNER -BUILDER DECLARATION .. i � • . ^ —
• •.
Estimated Valuation
I hereby affirm that I am exempt from the ConEiaclors'-License Law for the following
1
526 90
reason: (Sec.. 7031.5, Business and Professions Code: Any city or county which requires a
.125 , •
' permit to construct, alter, improve, demolish, or repairany structure, prior to its issuance also;
requires the applicant for such permit, to file a signed statementthathe is .licensed pursuant to
PERMIT' AMOUNT -
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section' 7000) of
, _
" Division' '3of the Business and Professions Code, or that. he is exempt therefrom, and the basis • • '
• for the alleged exemptlon.•.Any•viola[ton o/:Section 7031.S,byrany.applicant lorrapermil ,.-._PlanChk..•Dep.
:., , AA.
_
• "-, subjects the applicant to a'civil penalty of not. more than five hundred dollars.($500). ='• ^ '
❑ I, of the property,
= - -
Plan Chk. Bal: f 7- 90
as,owner or my employees with wages as their sole. compensation; well •,
do the work; and.the structure.is not intended or offered for sale. (Sec., 7044; Buisness and: •.
.,7..
COr1St. �7 o nn !�
. Professions Code: The Contractor's License Law does not apply to an owner of property .who'.
7 30 . 50
builds or Improves thereon and who does such work himself or through his -own employees,. -
-- , provided that' such improvements are not intended. or offered for. sale. If, however, the building
_•• Mech. 89. 5 0
or Improvement is -sold within one 'year of completion, the owner -builder will have the .burden..
• or proving that he did not build or improve for the purpose of sale.):
Electrical .�f -
' ❑:I, as owner of the property, am exclusively contracting with licensed contractors to con- .
Plumbing • ,. 1:78. s o
- struct the project. (Sec. 7044, Business and Professions Code: -The Contractor's License Law_
does not apply to an owner of property who. builds or improves. thereon, and who contracts for
S.M,I. 6o -
-- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) .
- O I am exempt under Sec. B. 8 P.C. for this reason
Grading
Driveway Enc. 20.00
Date owner
Infrastructure 2786•11 ,
WORKERS' COMPENSATION DECLARATION
hereby affirm that_1 have a certificate of consent to self -insure, or a certificate of
ke
Worr's Compensation Insurance,, or a certified copy thereof. (Sec. 3800, Labor Code.)
t-
Policy'No. .Company
C &opy is filed with the city.. ❑ Certified copy is hereby furnished. e
- - -
-'
TOTAL 4693.28 4433.28. -
CERTIFICATE OF EXEMPTION FROM • -
REMARKS
WORKERS' COMPENSATION INSURANCE
.
(This section need not be completed if the permit is for one hundred. dollars ($.100) valuation
-
• or less.) 1•t
I certify that in the performance of thg work for which this permit is issued,'I shall not
� { } �_ ! €i
t��1s,R., .�("'(in� rF�axl �,ti
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
-ZONE:'' '- BY:
to the Workers' Compensation provisions of the Labor Code,lyou'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
CONSTRUCTION LENDING AGENCY ' 1
Side Street Setback from Center.Lirle
I hereby affirm that there is a construction lending agency for the performance of the-
workfor which this permit is issued. (Sec. 3.097, Civil code.)
- Side Setback from Property Line
Lender's Name
l �^
Lender's Address
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: Date Permit
I agree to comply with all•ci4 nd 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.
Validated by:
• Signature of applicant, Date'
!
Mailing Address
Validation: .
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SQ. 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
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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
WATER SYSTEM
FINAL INSP.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
FRAMING `U/
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
GROUND PLUMBINUNDERGROUND
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
FINAL INSP.
FINAL INSP. Wm ,�
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING `U/
ROOFING LI Gj
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE'
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTIO w Gf
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 2/7/92 1 Type of Permit I La Quinta
No. 111176 Permit #
Log #
Owner Name John Shollenber
No. 52710 street Avenue Navarro
city La Quinta zip 92253 study Area 112
APN # Tract # I:ot # Square Footage 12231
Type of Development Single 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 1.58 X 12.231 or $ 3,524.98 have been paid to D.&U.S.D. for
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposedproject may now be issued.
Fees Paid By Michael Bangerter Telephone 564-1486
Name on the check
By James E. Lively:
Assistant Superintendent, Business Services
Fee collected /exempted by Vickie J. Durrett `y
Payment Received
r
Signature "Ch ck No. 106
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
Building
Address
Owner
Address P
City
11,o,Q)
Contractor
a
7
P.O:BOX 1504 APPLICATION ONLY
78-105 i�41_1_E ESTADO
LA QUINTA, CALIFORNIA 9225
BUILDING: TYPE 1`� _OCC. GRP
A.P. Number
ITel.
Legal Description eg� L2 :�z iLIle,
Project- Description- F=:/A
WORKEFLT'COMPENSATION DECLARATION
U 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 .
0 Copy is filed with the city.- - 0 Certified copy is hereby furnished:_
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This se6don need not be completed ff the permit is for one hundred dollars' ($100) valuation
or less.)
I certify that in the perforrnance, of thp 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 C,,i
crura
DateOwner
NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become
subject to the Wbr*efs' 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 'Nam
Lender's Addressvalidated,
This isabuilding permit when property filled but, signed and and is subject to
expiration if g
work thereunder is suspended for 180 dais.
I cer tity 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
BUILDING DIVISION
I-
• City -
Zip
Tel..
02 L
State-Lic.— - -
A Classilf.
City___,_
Lic. # 11li
Sq. Ft.
No. No. Dw.
TOTAL
?K2 7 r
Size -2_�?_
Stories - r Units
Arch., Engr.,
Designer
New 0 Add 0
Alter 0 'Repa.ir 0 -Demolition 0
Address
Tel.
LASH I IWAL I
Z UU
Ail
City
Zip
State
- BY:'
l,
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
OWNERCB—UILDER-DECLARATION,
I hereby affirmthat I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,0ushess and -Professions -Code: Code: Any city or county which requires a
Estirbated Valuation—
25 9ro
PERMIT
AMOUNT
..Pemdt to construct, after, improve, demolish• or repair. any structure, prior to its Issuance also -
requires the applicant for such permit to fide 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 the Business and Professions Codeor Nat.heis exempt therefrom, and the basis
for the exemption.
" a4ed -Any violation of -Section 703 1. 5 - by "any r applicant -for a'permit
subjects the applicant to a chd penally of not more than, two hundred dollars ($500).
-0 I,asowner of the:property, ormy employees with,wages as their, sole compensation, will
Plan Chk.
-25 0
Plan Chk. Bal
7 7, 910
Const.
Sej
do the work and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Protesskms Code: The -Contractor's License Law does not apply to an owner of property who
-Mech.
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 safe. If, -however, the building -
Electrical
AFVI 35-
or Improvement is sold wfthh one year of completion, the owner -builder will have the burden
of proving that heidid not build.or knprove for.the purpose of safe.)
Plumbing
Q
7,? - 5-
b I, as owner of the property, am exclusively contracting with licensed contractors to coif
struct.the project (Sec. .7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of properlyy-who bull& or improves thereon, and'who'contracts for
S.M.I:
[Grading
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
D I am exempt under Sec. R & P.C. for this reason
22o
Driveway Eric.
20
WORKEFLT'COMPENSATION DECLARATION
U 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 .
0 Copy is filed with the city.- - 0 Certified copy is hereby furnished:_
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This se6don need not be completed ff the permit is for one hundred dollars' ($100) valuation
or less.)
I certify that in the perforrnance, of thp 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 C,,i
crura
DateOwner
NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become
subject to the Wbr*efs' 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 'Nam
Lender's Addressvalidated,
This isabuilding permit when property filled but, signed and and is subject to
expiration if g
work thereunder is suspended for 180 dais.
I cer tity 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
BUILDING DIVISION
I-
&hhir 41keeJ
63, ;F7_
02 L
1331;
TOTAL
?K2 7 r
REMARKS"
O�51 R? 10 -7420 01-31-92
10 -
LASH I IWAL I
Z UU
ZONE:
- BY:'
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback frorri Rear Prop. Line
Side Street Setback fr6m"Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date .Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. 2 SO. FT. ® $
SLAB GRADE
UNITS
BONDING
HEATING (ROUGH)
STORAGE TANK
2ND FL. SO. FT.
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
YARD SPKLR SYSTEM
FOUND. REINF.
GAS (ROUGH)
METER LOOP
MOBILEHOME SVC.
OTHER APP./EQUIP.
BAR SINK
GAS (FINAL)
FOR. SO. FT. ®
GROUT
WATER HEATER
SERVICE
GAR. SO. FT.
POWER OUTLET
WATER SYSTEM
ROOF DRAINS
GRADING
Cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
DRAINAGE PIPING
FINAL INSP.
CAR P. SO. FT. ®
ROOFING
REMARKS:
WALL SO. FT. ®
VENTILATION
DRINKING FOUNTAIN
SO. FT. ®
FIREPLACE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
-
SPARK ARRESTOR
WATER PIPING
GAR. FIREWALL
NOTE: Not to be used as property tax valuation
LATHING
FLOOR DRAIN
MECHANICAL FEES
MESH
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
FINISH GRADING
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
CERT. OCC.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
INSPECTOR'S SIGNATURES/INITIALS
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GARDEN WALL FINAL
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
®O
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
6
SO. FT. ® c
WATER HEATER
0
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
SO.FT.GAR ® -/.c
6
HOUSE SEWER
GAS PIPING
PERMIT FEE
"
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
-f—
MECH.FEE
PL.CK.FEE
CONST. FEE
ELECT. FEE
SMI FEE
PLUMB. FEE
7EE
047
Off�o
X7
/5y�3
• e
/ 7P5 0
• STRUCTURE PLUMBING ELECTRICAL 7.3,0,3'0 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
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From: �o i /1�er A � . c. cwrr_ f c% It, x l d c r� µ • �..� r 7 Date:
Address: , . ,> C9 5,1 1 ' ! </ 7—,4 i c.: ! `� 7
-'A `'Account No. �� ^� I , < ' • (f) , G Lot(s) Tract
Service Address Cn� _ 7/0 -vi" i v/R.1)• G
G.A. Code
� '; ice(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check (s)
❑ Meter Surcharge
ta'Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge'
❑ Uncollected Account -Name
❑ Inspection Fee - Tract -
- Fee -
❑ Plan Check Fees Water 1 Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt. Y
❑ Customer Deposit
❑ Other
TOTALIv $ i.J r /
Remarks .-�F C7� f �''�� X41 U O � f l B i 7c _;
❑copy to:
Cash
' Water Service
Check
Money Cashier
Order
ro CVWD-438(1118 )
i
± �
CALVIN C. KAMINSKAS # DAN RILEY
o . Sealer, Weights & Meosures
Assistant Commissioner. a (714) 275.3030 .
(714)275.3000
4
OFFICE OF
AGRICULTURAL COMMISSIONER
JAMES O. WALLACE, Commissioner
83-612 Avenue 45 Suite 7
Indio, CA 92201
(619).342-.8291
DATE Z q= .� L CASE NO. —,'> L
DEVELOPER'S NAME: -C >1 c LP C. Co 4-rcc
ADDRESS: �1 I
(� G.' cA-_ S 2.253.
TELEPI IONE: (� ) 5� `4 y $ 6
S -Z (CJ /`hut Novo,v,v- I<<°
Dear Developer:
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ from plant material listed, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
L A
Agricult al Commissioner's Office
cc: Indio and Riverside
40$0LEMON STREET, ROOM 19, RIVERSIDE, CALIFORNIA 92501 — FAX (714) 275-3012
0