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15221 (AR) F • IIIIIIIIVIIIIIIVIIIIIII 69 .V y �'' IE P.O.BOX 1504 N o. 1,5221 Building43�64�� 1'rri8 pr. 78-495 CALLE TAMPICO ' Address LA QUINTA,CALIFORNIA 92253 Owner Jerry H£?l:,n BUILDING: TYPE CONST. VW OCC.GRP. ' Mailing Address Same A.P.Number City Zip ITel- La Quinta, LA 92258 Legal Description Contractor Add neva morning room and ConstructionGeme� ConstructionProject Description Address bad', r'3Ia43del storage roam into P.O. Box 21464 workout room, remodel 2 bathrooms Yucca Valley, 18ik 9228E h3--'9+445 State Lic. City &Classif. 280103 Lic.# 1001 Sq.Ft. No. No.Dw. Arch., Engr., Size 190 Stories Units Designer New ❑ Add ❑ Alter ❑ Repair❑ Demolition ❑ Address Tel. City Zip State Lic.# 4 L,F LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions oeCh pfeT9(commencing with Section 7?fW)of Division.3 of the-Business and Prof ssi�onst:Code,and my license is in full force aq� ,effect.' Cr y t, 7 r SIGNATURE DATE OWNER-BUILDER DECLARATION Estimated Valuation s2s a 001 00 1 herebyof irm 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, alter, 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 PERMIT AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or - Division 3 of the Business and Professions Code, or Nat.he is exempt therefrom, and the basis - Plan Chk. Dep. 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 rive hundred dollars($500). ❑I,as owner of the property,or my employees with wages as their sole compensation,will Plan Chk. Bal. 168.03 do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and Const. 2�$ �� 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, Mech. .00 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 Electrical 27.65 of proving that he did not build or improve for the purpose of sale.) _ O I,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing 45.00 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. 2.60 such projects with a contractor(s)licensed pursuant to the Contractor's License Law.) Grading 0 1 am exempt under Sec. B.&P.C.for this reason Driveway Enc. Date Owner Infrastructure 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.) PolieyiNo. Company Copy is filed with the city. ❑Certified copy is hereby furnished. TOTAL S 01 7 8 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS'COMPENSATION INSURANCE (This section need not be completed it the permit 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 any person in any manner so as to become subject to the Workers'Compensation Laws of California. Date Owner NOTICE TO APPLICANT. N, after making this Certificate or Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND Side Street Setback from Center Line SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(51 00,000),IN ADDITION TO THE COST OF COMPENSATION, Side Setback from Property Line DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 information is correct. Issued by: Date -Perms.Tilt 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. Validated by: Signature of applicant -Date- Mailing ateMailing Address Validation: ,�UIV % 1995I City, State, Zip r CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES, 1ST FL. SO.FT.® $ UNITS ` 2ND FL. SO.FT.@ YARD SPKLR SYSTEM POR. SO.FT.® MOBILEHOME SVC. BAR SING: GAR. SO.FT.® POWER OUTLET ROOF DRAINS CAR P. SO.FT.® DRAINAGE PIPING WALL SO.FT. DRINKING FOUNTAIN SQ.FT.® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE:Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM 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 SO.FT.®c WATER HEATER MAX.HEATER OUTPUT,B.T.U. SQ.FT.RESID®11/4 c SEWAGE DISPOSAL SO.FT.GAR®3/ec 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 /y GROU UNDERGROUND A.C.UNIT COLL.AREA SLAB GRADE v ROUGH PLUMB. BONDING HEATING(ROUGH) STORAGE TANK FORMS '� SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE i FOUND.REINF. /lam GAS(ROUGH) METER LOOP HEATING(FINAL) OTHER APPJEQUIP. REINF.STEEL GAS 9 GAS(FINAL) TEMP.POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING LUMBER GR. FINAL INSP. cu.yd. FRAMING 11104 . FINAL INSP. $ plus x$ =$ ROOFING c ��/}�� yg/ REMARKS: VENTILATION w��s��'�/_ %j� / FIRE ZONE ROOFING ��z��L FIREPLACE - - SPARK ARRESTOR `v /7P GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL IIIIIIIIIIIIIIIIIIIIIIIII 70 DESERT SANDS UNIFIED SCHOOL DISTRICT --- 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 Date 11/9/95 1 Type of Permit I La Quinta No. 113857 Permit # Log Owner Name Jerry Horn No. 49641 Street Avila Dr. city La Quinta zip 92253 Study Area 122 APN# Tract# Lot#0 Square Footage 1190 Type of Development Residential Addition No.of units Comments Add new morning room, bar, remodel storage room into workout room, remodel 2 bathrooms 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: Residential Addition 500 Sq Feet or Less EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 0.00 x 190 or $ 0.00 have been paid to D.S.U.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 N/A Telephone Name on the check By Dolores A. Ballesteros Superintendent _ w Fee collected/exempted by Pauline Pearson Si ature \� 4, A I xa�ag 21 AJ AA1 (NvL � � gn $O.0 Check No. N/A 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