9781 (SFD)P.O. BOX 15N I No. 9781
Building 78-105 CALLE ESTADO
Address LA QU I NTA, CALIFORNIA =53
Owner
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address A.P. Number
Cil Zip Tel.
Legal Description
Contractor Project Description
Address F D
City Zip Tel.
State Lic.j as C 2 7 '! C 3 :Okt*A
& Classif. C 4 2 2613511 trcN Sq. Ft. No. No. Dw.
Arch., Engr., Size _QV I Stories Units
Designer New 0 Add El Alter El Repair El Demolition 0
Address Tel.
D oe biock wall
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I a affirm that I am licensed under provisions at Chapter 9 (commencing with Section
z9b
7 of t ivisi on 3 of the Business and Professions CodVnd my license is in full force and
let -
SI 14ATUAr; DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation
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
apphcant for such permit
to r
do a vgned statement that
he Is icet1sed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Prafassians, Code, or that -he is exempt therefrom, and the bast sPlan Chk. Dep -
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
sVbjects the applicant to a civil penalty of not more than five hundred dollars ($500).
1!] 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
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 Const,
builds or improves thereon and who does such work himself or through his own employees, Mech.
pmvided that such improvements are not intended or offered for sale. If, however, the building 89.50
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical
of proving
that he did not build or improve for the purpose of sale.) 167 , 45
0 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law 93, 50
does not apply to an owner of property who builds or improves thereon, and who contracts for S. M. 1,
1
such projects with a confractor(s) licensed pursuant to the Contractor's License Law.)
Grading 15 . 10
0 1 am exempt under Sec. B. & P.C. for this reason 20, 00
Driveway Enc. -20.00
DateownerInfrastructure 3232. 3 2
125.77
WORKERS? COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. cornpany
171 Copy is filed with the city. 0 Certified copy is hereby furnished. TOTAL 5 K. 9 12 =-Z 1,
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.)
I certify that In the performance of thp work for which this permit is issued, I shall not
employ in any manner so as to become subject to the Workers' Compensation
Laws
Date Owner
NOTICE TO APPLICANT. it, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forlhwith
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Lin
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby alfirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Nam
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE —INSPECTOR
expiration if work thereunder is suspended for 180 days.
I Certify that I have read this application and state that the above informallun Is correct Issued by: DatePermitI 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 pu rposes, Validated by:
Signature of appilcanl Date
Mailing Address Validation:
City, State, Zi
CONSTRUCTION ESTIMATE
NO. I ELECTRICAL FEES I NO. I PLUMBING FEES
FL SQ. FT. ® $
UNITS
HEATING S AIR COND.
YARD SPKLR SYSTEM
7 FL. SQ. FT.
MOBILEHOME SVC.
BAR SINK
Ft. SO. FT.
qj UNDERGROUND
POWER OUTLET
ROOF DRAINS
A SQ FT
BONDING
HEATING (ROUGH)
DRAINAGE PIPING
FI P SQ Fr. ®
.LL SQ. Ff. ®
ROCK STORAGE
DRINKING FOUNTAIN
METER LOOP
URINAL
SQ. FT. ®
OTHER APP./EQUIP.
GAS (FINAL)
;"TIMATED CONSTRUCTION VALUATION $
!
"'GGL
WATER PIPING
:;PTE: Not to be used as property lax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
SYSTEM FAN EVARCOOL HOOD
SIGN
WASHER(AUTO)(DISH)
IANCE DRYER
GARBAGE DISPOSAL
DACE UNIT WALL FLOOR SUSPENDED
=$
LAUNDRYTRAY
1ANDLING UNIT CFM
ply Lj"/
KITCHEN SINK
RPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
PRESSOR HP
POLE, TEMIPERM
LAVATORY
-ING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
EE:R B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1Y4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/sc
HOUSE SEWER
GAS PIPING
IIT FEE
PERMIT FEE
PERMIT FEE
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE
SETBACK
SLAB GRADE
FORMS �y 01
FOUND. REINF. r
REINF. STEEL L
GROUT
BOND BEAM
r
LUMBER GR.
FRAMING T(q ( (go
ROOFING � ���
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
r
SPARK ARRESTOR
GAR. FIREWALL
Cl/q"co
MESH
INSULATIONISOUND
FINISH GRADING !!!
FINAL INSPECTION 4
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
LUMBING
ELECTRICAL
HEATING S AIR COND.
SOLAR
GROUND PLUMBING
qj UNDERGROUND
A.C. UNIT
COLL. AREA
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
SEWER OR SEPTIC TANK I OUGH WIRING
DUCT WORK
ROCK STORAGE
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
GAS (FINAL)
TEMP. POLE
!
"'GGL
WATER HEATER
SERVICE
FINAL INSP.
WATER SYSTEM
GRADING
cu. yd.
$ plus x3
=$
FINAL INSP. �l
FINAL INSP. ` 3 L G.
ply Lj"/
X `A ( Cq
REMARKS:
SIGNATURESIINITIALS
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 7/8/91 Type of Permit I La Quinta
No. 110707 Permit #
Owner Name Brian Merritt Log #
No. 50-905 street Calle Paloma
city La Quinta zip 92253 Study Area 0
APN # I Tract # Lot # Square Footage 12607
Type of Development I Single Family Residence No. of units
Comments NP.w con stm etion
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 533080
in the amount of 1.58 X ® or$ 4,119.06 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
Brian H. Merritt
Name on the check
By James E. Lively
Assistant Superintendent, Business Services
Telephone 244.3836
Fee collected /exepied by YKAthleen Emmeriin
1-1-77 Payment Received
Signa l Check No. 1453
Collector: Attach a copy .�f county or city check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting