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05200 (SFD)P.O. BOX 1504 nrAIi ?diel.'}isF°ilg�sO;lLtJI uBuildin78-105t_�I��9��i�R Addrress 78-665 Sagebrush LA QUINTACCAL CALIFORNIA 92253 IS REOU'RED Uig THE JOB -SITE DURING Owner - ` ALL PHASES OF CONSTRUCTION # Address 44-401 19. Sun Down Crest City Zip Tel. - ' La OuInta 1 32253 Contractor Address State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address Tel. City IZip I State I 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 OWNER -BUILDER DECLARATION 1 hereby affirm that -1 am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Brskmss and Professions lode: Any city or county which requires a permit to construct, after, knDrove, 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 trig penally of not more than five hundred dollars (E500). ❑ 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 anproves thereon and who does such work himself or through his own employees, provided that such improvements are not kdended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-bukder will have the burden of proving that he did not build or kriprove 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 contractors) ficensedpursuant 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. Company . 0 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 If the penrdt 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 anyperson in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT H, after ma" this Certificate of Exemption you should become subject to the Workers' Conipensaeon provisions of the Labor Code, you must forthwith comply with such provsions 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 property filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certity 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 LDING: TYPE CONST. OCC: GRP. P. Number Description Project Description I _ F , is . REMARKS _ VV*_ 164 IV ,5u -irk 1,t:` ::r %24 xc: 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 12/29/88 Issued by: Date Permit Validated by: Validation: 14 Sq. Ft. Size 11540 No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $32,332 PERMIT AMOUNT Plan Chk. Dep.IA Plan Chk. Bal. ix Const. 412.00 Mech. Electrical A Plumbing SIA S.M.I. th %Z Grading >n r1O Driveway Enc. Infrastructure 2.039.29 Irvin aP.-Toed Lizard- 68. 117 TOTAL_ o3.157.02 '._19 9/1'7 42i9 REMARKS _ VV*_ 164 IV ,5u -irk 1,t:` ::r %24 xc: 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 12/29/88 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL SO. FT. BONDING YARD SPKLR SYSTEM ' POR. SO. FT. @ MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SO. FT. Q GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. OTHER APPJEOUIP. DRINKING FOUNTAIN. SO 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 SO. FT. ®c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 1'A c SEWAGE DISPOSAL SO.FT.GAR ® V4c 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 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 / �Q `- g a 4; 1 �l 3 �7 U Gl/ ( l REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS ' GARDEN WALL FINAL 1 as' Tw�t 4 4 0". 78-105 CALLE ESTADO — LA QUINTA, CALIFORNIA 9225:3 - (619) 564-2246 FAX (619) 564-5617 December 20, 1989 Mr..Toby Stanford 44-401 W. Sun Down Crest .La Quinta, CA 92253° Dear Mr. Stanford: The following is an itemized list of the refund due you for permit #05200 for a single family dwelling at'78 6`IB5`SagebrusYi issued on December 30', 1988. The Uniform Administrative Code allows for the: following refunds for fees paid for which no work was started. Plan Check Construction Mechanical Electrical Plumbing SMI Grading Driveway Encroachment Infrastructure Fringe -Toed Lizard Total Amount Paid Amount Refunded $ 353.74 $ 0 412.00 329.60 36.00 28.80 80.64 64.51 120.00 96.00 6.48 6.48 20.00 0 20.00 20.00 2,039.29 2,039.29 68.87 68.87 $3,157.02 $2,651.55 A warrant request is being processed and your refund should arrive within four weeks. Feel free to contact me if you do not receive the money within that time or if you have any other questions. Very truly yours, JERRY HERMAN PLANNING & DEVELOPMENT DIRECTOR Tom Hartung Building Official TH:bja BJ/LTRTH.013 'MAILING ADDRESS - P.O. BOX 1504 LA QUINTA, CALIFORNIA 92253 i T 4(4,4 C' OF fHE�wS 78-105 CALLE ESTADO —. LA QUINTA, CALIFORNIA_ 92253 - (619) 564-2246 fAX (619) 564-5617 December 19,-1989 Desert Sands Unified School.District 82-879 Highway 111 Indio, CA 92201: Dear Sirs: A permit was issued at 78-685 Sagebrush in La Quinta for. a single family dwelling. No work was started on the project and the City`is.in the process of refunding .the applicable fees. Should you have any questions concerning the above matter, please contact this office.. Very truly yours, JERRY HERMAN PLANNING .& DEVELOPMENT. DIRECTOR. Tom Hartung Building Official TH:bja cc File o BJ/LTRTH.012 MAILING ADDRESS P.O. BOX 1504 LA QUINTA, CALIFORNIA 92253 DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111' NOTICE: Indio, CA 92201 Document Cannot Be Duplicated(619) 347-8631 Date 12/5/90 No.. 110305 Owner Name Type of Permit La Quinta Permit # Log # Tooey Development No. 78-685 street Sagebrush City La Quinta zip 92253 Study Area APN # ' 617-381-018 Tract # Lot # Square Footage 1498 Type of Development Single Family Residence No. of units Comments At the present time, the Desert Sands Unified School District does not --ollect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant_ to Government Code 53080 in the amount of 1.58 X 1498 or$' 2,366.84 have been paid to D.S.0 S.D. for the property listed above and that building permits and/or Certificates .:)f Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Craig F. Courtemanche, Jr. Telephone 341-5096 Name on the check By Richard K Beck J1"G Director, Facilities Planning & DevelopmentM Fee collected/exem ted b p y Shelley D. Bennett Payment Redeh0i `) Signature - ? CFackto. 211 ►r. Collector: Attach a copy of County or City plan check application form to District cop. . Embossed Original -Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting WARRANT REQUEST FORM INSTRUCTIONS: Complete form. Send to Administrative Services Coordinator for approval:, 1. Namr and, title of requestee: ' 2. Date Warrant heeded: ICeLOr/tie ' 04it. HA2'C�lilr , %/e�GEssl,V�- 3. Explanation of warrant request: ��e 6!_s-.2 too ��Es liiF�2E /�•9..� �� r u���P /1/Ev�2 C��i�►E.tic� . 4. Warrant made payable to: Na -me of Payee Address 9c.2. ->s.3 City State ZIP S. Warrant AAnount : , $ a6 s3.5s 6. Account No. 7... Is this Wazrant Request in accordance with your,departmental budget? Yes ' No 8. Amount of funds budgeted for this expense? $ 9. Signature of Requestee 10: Approved by Dept. Head 11. Date of Request FM 12. APPROVED/DENIED Administrative Services Coordinator or City Manager Date. -