003436 (SFD)44
P.O. BOX 1504 No. 003436
Building FF -3-121 Qbon 78-105 CALLE ESTADO
Address LA OUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 247 E. Tahouitz Wa 42 - A.P. Number. 774-044-018
City Zip Tel.
Palm nrincirs 92u62 322-10 2-0 Legal Description
Contractor Project Description Pla" Al s i -t alp_ palm. IV r*wpv
�1�►at1+'s� f''rr'atn�4r'�ateil�'ti,rlo: .
Address
Same
City Zip Tela
State Lic. City
& Classif. 3Ri��A Lic. # � Sq. Ft. 1 1Q No. No. Dw.
Size Stories Units
Arch.; Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
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 Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following $76#
4 41
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 PERMIT AMOUNT
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 �r ry �y/�-
for the alleged exemption. Any violation of Section. 7031.5 by 'any applicant for $250
a permit Plan Chk.-Dep. - .00
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). -
q 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 39-14
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 364.-00
Professions Code: The Contractor's License Law does not apply. to an. owner of property who
builds or improves thereon and who does such work himself or through his own employees, tl;t
provided that. such improvements are not intended or offered for sale.. ll, however, the building Mech. 33.
00
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical �. Z
of proving that he did not build or improve for the purpose of sale.)
0 I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing. 1103. 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.l. 5. 36
such projects with a contractors) licensed pursuant to the Contractor's License Law.) -
Grading 20(30
❑ .I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc. 20.00
Date Owner Infrastructure 1,121. 12
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
❑ 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 p j rfnance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address i
This is a building'permit when property filled out, signed and, validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certity that 1 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
HARD COPY
TOTAL
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 10/8!8=Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. y PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
FOR. SO. FT. ®
GAR. SO. 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
Gl
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
( (f /
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
ROOFING �/
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
(ROUND PLUMBIGN[��j
�, UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
Gl
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
/
SEWER OR SEPTI T K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.�I
( (f /
AS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
MP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING �/
3 �{�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION ff��
*SUBSURFACE,
PERMIT APPLICATION FORA SEWAGE DISPOSAL SYSTEM—
kplan
Applicant: Submit this form with four copies of a scaled plot (1.20 scale) drawn to County specifications required on the attached check list.
A non-refundable filing fee of:'$37 is required when the application is submitted. Check must be made payable to the County of Riverside.
.OP"Otp
11
Building Department Application Log #
Name (Owner, Agent, Contractor, Etc.)
Mailing Address
ZAA1Q
awl E.-Zl*i1l d, lox wow ' 2
City
Stat e�d
Zip Code
z /,
Telephone
Job Property Address I
"`City. or comrnvr*y.
Legal Description of Property. (Lot, PM, TR) f ekt
'Assessor's Parcel No.
'`WaleoWelh,,.-
JLot
Use of PermiD A_P/ 0111JIC,(..t.�lr•f-14 Plannrtig Case N
Size
SFD, MH Site Preparation Etc.Ad%
/-.,- - </- /.Fez
Signature of, App i ant /J Date
The above information must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
Initial Date
Certification of Existing S.D. System required. ❑ Yes END f 7
WQCB Clearance required. ❑ Yes
�r
Soils feasibility report required. ❑ Yes ®,Nrro €
Detailed boring ❑
report required. Yes r2o-"
Detailed contour plot plans required. ❑ Yes ® No- 1
r
Staff Specialist approval required. ❑ Yes No Lot Inspection Date
Soils/boring report by Project # Date
Soils Map Page//W/ I Soil Type 'WC, Approved by � � /• ,L 6 T
- DateIV-
Type of System: U
No. of Bedrooms
(1) Septic Tank
Soil Rate Required
El Existing 'New ❑ Additional ❑ Replacement
W� •
Gals.
(2) ,Leach line sq. ft.
trench
Sidewall allowance
ft. Sq. Ft.
Install*. Lines) FL Long,
i Ftp. 'wide
%Leach bed Sq.
of ttiotto
(Botta : area)
rock/
<r `
ft. (9yN%A
with min. inches
-
below drain lines
Ft.
per running
rock
area
Leach lines/bed-special design for slope:
Applicable_
(3) Pit Diameter %
No. Pits
Pit BI
f
Seepage Pit total depthf !
r
N/A Overburden factor
97,6;1, ® 6'
/EL
T
Max. allowable depth y�
/i
This application is app_ve.ro_vedenied-for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
set forth in Sectiori B aboA building permit isnecessary for the installation of the above -designed system.
Septic tank and sewer lines must b�50' from any wells('/10
2) Leach lines must be 100' min. from any wells including expan'sionvare a
�Seepage must be 150° min, from any well, including expansion area/,
-Signature
RECEIPT NO. Issued by Date
District: ❑ Riverside ZI d ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 6/86)
RECORINNG. REQUESTED: BY
AND WN EN R[COROED MAIL .TO
c �
Coachella Valley .Land" -Co.
NAM[ .
"Daggs 247 E. Tahquitz. W.ay, Suite :2
Palm Springs, Ca. ..92262
CIT. •
STAT[-
SPACE,ABOVE THIS LINE FOR RECORDER'S VISE
PAIL TAX ST UK TO'
.. Documentar,} trap fer tax -S.8.25',............:.:..... .
NAME Com wteci on': full ,value 'of . ro ert conveyed, or
®. I. N p > y ;
gee C6rn'puted on Bill value le lienc:8'"encumhrances
Aoollt�. 1,
remaining thereon vt, ime of'ale.,
CITY 'W
STAT[ I '. ..............................
J
i
S ¢nature of -der
larant of spent. determining tax firm name
'a
Escrow \o.
207784 �] 'Ii,nrorj;v*rnicu area illyoi:............:.....................
Title Order No. 78589—L
.Grant �Dee�d _ ' i
L -t _ THIS FORM FURy.ISHED. 8V STEWART'TITLE COMPANY Off. RIVERSIDE C06044T.Y
I
FOR A VALUABLE CONSIDERATION, receipt -of :which is hereby' acknowledged;
RALPH A.. FOX,. LACHLAND,'.S.:. CAMPBELL, ROBERT F': DRYDEN and• ;CLI.NTOM,.DOU.GHERTY,
each to an undivided. interest,.' }. I
hereby GRANT(S) to
COACHELLA VALLEY LAND'. COMPANY, A. Califorrii-a Limited•Par.tnership
I
the following described real property in the
county of Riverside°i
state of California: I
Lot 6 Block 175, 'San ta-'Carmeli,ta ata Vale,- La ;Qui,nfa, Unit No. -,18' as per Map
recorded in -.-Boo 19,'.:pages 30 and 31 of Maps; r.e"cords of`Riverside County;
California. '
Dated ' September 1, 1987
fj(aYph,A. Yox
(Individual)
0.
STATE OF CALIFORNIAaC an Abell
SS.. Vf
_C!1211NTY Ot "VC',�llT[//Q�,
- 1 _
On :S �0 9g. befor .me the unders a%a hotar rib 'c il5 and for'said. State, personauy appeared
Q`.;
noun •tome or:(proved to me on' Ahe basis of satisfactory evidence) to be the
person S whose names — subscn ed to the within instrument,and acknowledged that T6+ fzx
executed the same. A
FOR NOTARY:SEAL OR STAMP'.
r. ; .
WITNESS my hand official 1'.
.. ,.... , OFFICIAL SEAL ,
MICHELE HARAN
Signature NOTARY PUBLIC CALIFORNIA
PRINCIPAL OFFICE IN '
A//VENTURA COUNTY
C y�f 77`iQiQ/��t/ � ri
Name (Typed or'Rnnted) Mh Com"usseen Er B:. Dec. 4, H89
FORM '72.19
. MAIL TAX STATEMENTS, AS DIRECTED:.ABOVE