9722 (SFD)Buildift
Address 52-200 Obregon
iew Villas
Address 52-228 Obregon
a 4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City Zip Tel.
%a Quinta 92253 564-4800
Contractor
Stauffer Construction Svcs.
Address .
74940 Hwv 111 4208
City Zip Tel.:
Indian wells 92210 564-5422
State Lic. City
& Classif. $ 578197 Lic. # 2554
Arch., Engr.,
Designer
Address I Tel.
CityI Zip 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 f the Business and Professions,Code, and my license is In full force and
effect f� 1• it ,.f,7 e, f �-7 L --.l f I /0, f Ir,- I 'r 4 r ",I- r ,, %r -Vi
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usiness and Professions Code: Any city or county which requires a
permit to construct, after, hwrove, 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 or 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 civft penalty of not more than five hundred dollars ($500).
❑ 1, 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 inproves thereon and who does such work himself or through his own employees,
provided Nat' 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
of proving that he did not build or 'reprove 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 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
1 hereby affirm that I have a certificate of consent torself•insure,/o a certificate of
Worker's Compensation Insurance, or a certified c, . there 7. (Secr3800 Labor Code.)
Poli ���iiiiiiNo ' company – O 1. t°p �` 1l 7 <_/r
Copy is filed with the city. ❑ Certified copy is hereby furnished.
i
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.)
1 certify that in the performance of the work for which this permit is issued, 1 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. ft, 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 it 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 authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant— Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST
A.P. Number 773-215-009
Legal Description Lot 9
Project Description SFD
No. 9722
OCC. GRP.
REMARKS
hr -r ra �•s'7 r.,•r' rtr "n._aa r. 44
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:
Sq. Ft. 1668
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Permit includes 40 if sof 3'
block wall
in front yard
and fence. Permit does
riot include any pools.
r
Estimated Valuation
97,125.20
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
289.30
Const.
630.50
Mech.
55.50
Electrical
131.96
Plumbing
166.50
S.M.I.
9.90
Grading
20A0
Driveway Enc.
20.00
Infrastructure
2140.32
TOTAL
9d
�34x.58
REMARKS
hr -r ra �•s'7 r.,•r' rtr "n._aa r. 44
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. ® $
UNITS
COLL. AREA
2ND FL SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL S0. FT.
GAS (ROUGH)
DRINKING FOUNTAIN,
SO FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
Cu.yd.
$ plus x$
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3AC
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
DERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE? / 9/ Ilk
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. 7 11l/
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.
FINALINSP
FRAMING 7 %..
FINAL INSP.
ROOFING � Q/
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING LD
MESH
INSULATIONISOUND 9 /
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
f
,DESERT. SANDS UNIFIED SCIiO.OL DISTRICT
82'8 -h' ay-: n
-1791-hg'W
NOTICE: Indio'CA 92,201
Document Cannot Be Duplicated
(619),,347-8631
Date 16/21/91 Type of Permit LaQuinta
No. 1068.5 Permit #
Log#
Owner Name Skyview Villas
No. 52-200 Street Obieg-d`h,
77
City L'hta Oulzip. 92253- Study Area 112
APN # 1773-215-009 Tract # I Lot # Square Footage 11668
Type of DevelopmentSi 916 Family "Resid6n6b.No..of units
Comments
At the present time, the Desek.Sands'Unifie'd School'DistricVdoes' '-6t; collect fees on
rp �s nisidimfial. additions under
garages/pa . orts, covered :1 patios/w,41kwa: 500 square feet,
detached accessory *structures or replace- mpnt It'*has c
mobil6ho'mes.1.{been determined
- "',
the above-named owner r . is exempt fronipay'inga �gchoo�f.'fees at this,time, due to the
following reason:
EXEMPTION' NOT APPLICABLE
This certifies that school facility fees unp6*4,pu'rs"u'a'nt't6',Gove0mment. Code 53080
00'9�635-44,.
in the amount of x 1-5687, have been paid to:D.S.US.D. for
the property listed above and ,that ,building: permits -and/o"r Certificates of Occupancy for
this square -footage in this ed
. propos. be issued.
Fees Paid By Mariam Kahn Telephone 5644"
Name on the check
By Richard M. Beck
Director, Faciliti6sPlanning & Development
Fee collected ted by Shelley D. Bennett
Payment Received
-7
Signature 11 .. Che"Ckl�o*.-638.6'
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 - Acco'unting
RECORDING REQUESTED BY
Recording Requested By a /'
CHICAGO TITLE COMPANY
AND WHEWRECORDED MAIL TO S b
lame;. MIRIAM KAHN .
treat P. O. Box. 936. '
,ddress La Quinta, CA, 92253
ity
fetk &`L J
e
MAIL TAX STATEMENTS TO'.
lame ABOVE ADDRESS
treat
ddress
:ltv & L
tate
THIS LINE, F.OR RECORDER'S USE
CAT. NO. NN00582 Indivi:dual:: Grant D
TO 1923 CA (2-83) THIS FORM:FURNISMEO(1 YCOR TITLE INSURERS
The undersigned grantor(s).`declare.(s): PARENTAL TRANSFER„TO DAUGHTER TO CLEAR TITLE
Documentary transfer tax :is $ NONE
) computed on full value of property conveyed, or.
( ) computed on full value less value of;hens and encumbraneesremaining.at time of'sale.
( ) Unincorporated area: ( ) City of La Quinta; - ,and
FOR A VALUABLE CONSIDERATION, receipt of which Is:hereby'acknowledged, s
KURT H. KAHN.AND LISBET KAHN, .husband and"wife
hereby GRANT(S) to
MIRIAM.KAHN, an unmarried'woman
the following described real property in.the City 'of'.La. Quinta.
County of Riverside Stateaof California:
Lot 9, Block 1, Unit #1 of •Santa Carmeliat at Vale La Quinta, in
the County of Riverside,,,.State of California; as per maprecorded
in Book 1:8,'Page 46 of Maps, in'the office of the county recorder
of said county.
Dated: June 20th, 1991
STATE. OF CALIFORNIA
COUNTY OF }SS.
Ora=g® 1
On before
me, the g4dersigned, a 'Notary•Public .in 'and for said State,
personally appeared Kurt H:<=Kahn and;.
Lisbet Rahn s
personally known to me -or proved -to me owthe basis:of sat-
isfactory evidence to be.the•person�whose name. -s, are -
subscribed to the within instrument and .acknowledged
that tcute the same.
WITNESS my hand ao official seal.
Signatu
O�OQIlC�{1
NOTARYtPUBLIC
STATE OF CALIFORNIA
Courriy of Orenpe
JOSEPH H. CRUTCHLEY
LWAW ppohltment
Er-0has August 21, 1992
(This area for official notarial seal)
ITitle Order No. Escrow i-,Loan�No.
MAIL TAX`STATEMENTS,AS;'DIAECTEb ABOVE'
•...K T� H..KAHN
O�OQIlC�{1
NOTARYtPUBLIC
STATE OF CALIFORNIA
Courriy of Orenpe
JOSEPH H. CRUTCHLEY
LWAW ppohltment
Er-0has August 21, 1992
(This area for official notarial seal)
ITitle Order No. Escrow i-,Loan�No.
MAIL TAX`STATEMENTS,AS;'DIAECTEb ABOVE'
�`u��`:�'.. �._"w-;,�gv��''a"p�`�"•{+`R"aYr'p';�`�'��`,� `Sfi`^'y'�,tY'"
TH •- AsNsaors P.ro.I No. _
•RECEIPT NO. Issued By Date
DISTRICT: ❑ Riverside, b -,-4X- ❑ Hemet O Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 3/90) DISTRIBUTION: WHITE Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
OWN
COUNTY OF RIVERSIDE DEPARTMENT OF HEAL
ENVIRONMENTAL SERVICES DIVISION.
PERMIT APPUCATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County speculations as indicated on the attached. check list
�`A nod; 5efurd►,dable filing fee (see below) is required when the application Is submitted. Check must be made payable to the County of
A l ^^! Y
Riverside. Approval' of this application shall remain valid for a period not to exceed one year from date of approval.
VERIFY ITEMS)ihtSECTION A FROM BUILDING &.SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION L G #
}
"Contract . Contact Pe"rso`n
µa �' � Address &Firm ,
r
UJOwner-
Cn
�/_ /
�i/ "'
Phone
0
Mailing Address
CI1y
Ste a
Zi
Job Property Address
Description Prop. (PM,Traet ,Lot) .:
AMA 11
Lot Slie
ter Agenc , f
Use of Permit P/P, CU. etc.
Other �1�.�` Edi �f./. • .
f �
�® X 1010
&`
elli H r p, etc. "
�e�(Y�"•'/
�f �f�I /
Signature of Applicant
Date .
CATEGORY: REV CODE FEE
�
CATEGORY: REV CODE FEE
U SUBSURFACE DISPOSAL' • 1238 `$ 00 1
CU/
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
CD
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348.. $ 17.00
Z
a 1st 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year)
b. Each Parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
U)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $ 47.00
"
Critical Area 7346 $111.00
❑ ALTERNATIVE/EXPERIMENTAL '7345 $222.00
I7 Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
DATE
Holding Tank Agreements Completed ❑ Yes WIN"o, I " j '' J V 9
Certification of Existing S.D. System Required ❑ Yes QON
W.00B Clearance required. (Attach Form ❑ Yes
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes
Special Feasibility Boring Report Required. ❑ Yes A+'
Detailed Contour Plot Plans Required (1 to 5 n interval) ❑ Yes P N
Other . _ ❑ Yes
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection Date
Soils boring report by Project !t Date
Soils Map Page Soil Type C 6i �- Approved by sr Date
U
•
No. of Systeme
Type of Systems)
No. Dwelling
(1) Septic Tank
Soil Rate
Greses/Sand
O❑
Ing Tank O Existing �
re Units
',�ntop
�Unnitss y
n�t�t lF�VYI�
/ Gal
Gd
U)
&:each Line Sq. Ft
trench area
Sidewall albwence
n rock/ fL, `.
: • Install I
r I ine(s) n long f1 wide
Leach Bed eq. n
3%
per running ft.
min. below drakylines or&,bottom
area
t
LeeChtines/bed special design for slope:
Applicable
(3) Pit Diameter'
No. Pita
PR Below
Inlet (BI)
Seepage Pit Total Depth
(TD)
Other.
Other:
Max. Albyrable�th
/
8m" 6
! ^
�
N/A Overburden factor
�Q
No.2 System f� IA
REMARKS.'
This application i PPROVED' - E0fa the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompan p plan usi tie requirements..seWenh-in-SEGTIGN.ERa o huiIdio rmit is necessary for the installation, of the.
above -designed system. constnrctbn is permitted in the'required reserved 100% expansion area.
1) Septic tank and sewer tines must be 50' minimum from any wells g�/� Q
r
2 Leach lines must be 100' minimum from any wells, including expansion ar �1v<
r 3 Seepage pits must be 159' minimum from any wells including expansion rea4/ /;—A42
ZWDate
Signature of Health" �ificial / tv
TH •- AsNsaors P.ro.I No. _
•RECEIPT NO. Issued By Date
DISTRICT: ❑ Riverside, b -,-4X- ❑ Hemet O Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 3/90) DISTRIBUTION: WHITE Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
OWN
Contractor
kddr)ess _
L•
y:
•1
a� •
ne
0 Job- 7►ddiess " k �p 0
�.
•
La Quinta City License :No. ` �-� Expires:. x Bldg. Permit No.
This form shall be posted<on the•jobii
shall be the duty of' h dene al` Cont'i
to see that -'all sub-contiacfors,sig
Business License Number, Contractors ]
Of Workman' s,'Compensation•.Insurdnce' 6
to . comply may, cause.=Building• Inspector
against such contracfors.a owne=s'
lith the_.°Building- Inspection Cazd and it .
,.+ .
.actor or,if°Owner-Buildei,Permit, the owner
his card, giving his-_Tityof La Quint&,
. cense'Number•-and :•a..current.o.ceitifica.te`
zt�i'fcate when fie starts `theK job. Failure
w -to stop work, or complaints'to be filed
"-CITY CONT.
SUB -CONTRACTORS NAMEL.IC::`<NO: EXPIRES ''LIC,:• NO. EXPIRES.
1• Grade i Excavate
2• Pipelines
3. Cement -Foundations
4. Cement Walks-& Drives t �
5'. Asphalt Paving
6. Framing
7• Steel Structural `
8. Masonry
9- Plumbing
l0.' Lathing
Ll. Drywall
L2. Plastering '
l3. HVAC.
l4. Electrical'
L5. Roof-ing
l6. Sheet Metal i.• y ;`tip
17. Floors -All Types
18. Glass - Glaring
19• Insulation/Weatherstrip y. l
20. Sewage Disposal '
21.
Painting/Decorating
22. Tile
23. Cabinets-
Installations
24. Ornamental Metal
25. Fences/Blockwalls
26. Landscaping
27 Others G"
28.
4/
DO NOT kill VB THIS CARD
Before �F rial `Built n'q Ivnspection:;Will Be Made
This Form Must B`e..Completed and'°Filed With Title';24, C.alcs and Plans
Certificate of Occupancy
City of'L. a
Building and Safety Dopartment
This, Certificate issued pursuant to' the re"quireme�is of Section 109 of :the Uniform Bui/ding Code,
certifying that,.at the: tune of=issuairce; this'structure Was in cornp/iance with the various ordinances
of the City regulating bui/dlin4 construction or use: - For. the -fol%wing.
BUILDING ADDRESS: : -52-200. AVENtDA.'OBR'EG'0`N
:Use Classification: SINGLE FAMILY bWELLING Bldg. Permit No.: 9722
Occupancy Group: R-3 - Type of Construction: VN Land Use Zone: SR
:3r,
Owner of Building: SKYVIEW.VILLAS Address: 52-228 AVENIDA OBREGON
City: `tA QU1NTA, 'CA., 92253
By: MARK HAROLD
Building Official `
Date: 2/6%91
POST.IN A CONSPICUOUS PLACE