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. -