10895 (SFD)4 4 Quif 0
P.O. BOX 1504
Building ?7--$00 Madrid 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253liz
Jack Clayton
Mailing
Address 6009 Carpenter Ave.
City Zi Tel -
;1606 1606 818/761-3038
Contractor
Brett Simison Construction
Address .
2255 Eagle Drive
Tel.:
714/593-5507
State Lic. City
& Classif. B 386679 1 Lic. #
Arch., Engr.,
Designer Roger Clayton
Ad60l.
09 Carpenter Ave ss 818/761-3038
CityZip State
N. Hollywood 91606 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
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, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 civil penalty of not more than five hundred dollars (5500).
❑ 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 or 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
or proving that he did not build or improve 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 or 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, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 thg 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 filled 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 autporize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 10894
LDING: TYPE CONST. OCC. GRP.
P. Number
Description Lot 12 Block 297
Project Description SFD
Sq. Ft. 1630
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Permit includes block walls; pool
permit rust
be obtained prior to manx
construction of 5' walls in front yard
Estimated Valuation
106, 059.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.90
Plan Chk. Bal.
306.02
Const.
A64.00
Mech.
55.50
Electrical
128.50
Plumbing
141.00_
S.M.I.
10.70
Grading
20.00
Driveway Enc.
20.00
Infrastructure
2053.46
Art in Public 25.00
Precise Plan 25.00
TOTAL
3674.18 3424.18
REMARKS
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SQ, FT, ®
GAR. SQ, FT. ®
CAR P. SO. 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
PLUMB. BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (FINAL) TEMP. POLE g
v
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.
SQ. FT. ® c
BATH TUB
FRAMING / in
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1V4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE 7NST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEROUGH
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 g
v
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.'
/
FINAL INSP. il3
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING / in
ROOFING O
/j
ww
fre 3` TZ (
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING 81' 0
MESH
INSULATIONISOUND 19 r✓%
FINISH GRADING
FINAL INSPECTION -
NSPECTION
CER T.
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 5/13/92
No. 11384
Owner Name
Type of Permit
Jack Clayton
No. 77800 street Madrid
city La Quinta zip 92253
La Quinta
Permit #
Log #
Study Area 110
APN # I Tract # 1 Lot # Square Footage 11630
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 11.58 1 XF_.63-51 or $ 2,575.40 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 Jack/Joan Clayton Telephone (818)7614038
Name on the check
By James E. Lively .,-, 'N( (
Assistant Superintendent, Business Services r _,r" , .;t
F
Fee collected /exempted by Shelley D. Bennett
Payment Received V,, -f k4
Signature 'Check No.,- J23
Collector: Attach a copy of county or city plan check application form to district copy for: ewa..ivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO
'Jame r
MR'. & MRS. JACK CLAYTON
'treet 7111 Heath Drive
address Port Richey, Florida 34668
:ity &
'tate L
Jame
treat
address
Ity &
tate L
MAIL TAX STATEMENTS TO
ABOVE ADDRESS
CAT. NO. NNO0582
TO 1923 CA (2-83)
J
J \
SPACE ABOVE THIS LINE FOR RECORDER'S USE
Individual Grant Deed
THIS FORM FURNISHED BY TICOR TITLE INSURERS
The undersigned grantor(s) declare(s):
z Documentary transfer tax is $ 26.95
a a (KX ) computed on full value of property conveyed, or
(. ) computed on full value less value of liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( XX ) City of La Quinta ,and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
. WILLIAM R. RILEY, an unmarried man
3 hereby GRANT(S) to
JACK CLAYTON AND JOAN CLAYTON, husband and wife,
as Joint Tenants
`NV the following described real property in the City of La Quinta
County of Riverside State of California:
Lot 12 in Block 297 of Santa Carmelita at Vale Unit #27,
as per.map recorded in Book 19, Page 92 of Maps, in the
office of the county recorder of said county.
t STATE OF CALIFORNIA - - 'COUNTY OF. Riverside ySS.
On before
me., the under ' ned, a Notary Public in and for said State,
personally appeared William R. -Riley
personally known to me or proved to me on the basis of sat-
isfactory evidence to be the person whose name ; s
subscribed to the within instrument and acknowledged
that heexecuted the same.
WITNESS my hand and official seal. /%
Signa
Title Order No.
Escrow or Loan No,
MAIL TAX STATEMENTS
OFFICIAL SEAL
FRANCES BRIDGES
s a : Notary Public -California
RIVERSIDE COUNTY
My. Comm. Exp. Aug. 3, 1990
(This area for official nutarlal seal)
DIRECTED ABOVE
i• I