06480 (SFD)4 4 "
P.O. BOX 1504 No. 06480
Address 53--350 Obregon LA QUINTA, CAL FORNIA 92253
Owner
RP
ai
maffing
Address 34-116 Date Palm 06
City Zip Tel
Cathedral Cit 92234 324-7767
Contractor
same
State Lic. 556181 (City 1457
& Classif. Lic. #
Arch., Engr.,
Designer
Address
City IZip I State
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.
DATE
=SIGNATURE
y OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,11siness and Professions Code: Any city or county which requires a
permit to construct, after, improve, demofth, or repair any structure, prior to its issuance also
requires the applicant for such permit to lire a signed statement that he is licensed pursuant to
the provisions of the Conbactor's License taw, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and. the basis
4for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a cuW peraily of rnot owe Own five hundred dollars (5500).
f❑ 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 Contractors 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,
providedthat such improvements are not Intended or offered for sale. If, however, the building
or improvement is sok/ wMb one year of completion, the owner -builder will have the burden
of 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 of property who builds or improves thereon, and who contracts for
such projects with a contractors) icensed pursuant to the Contractor's License Law.)
,❑ 1 am exempt under Sem R & 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
Workers 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 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: f1, 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 peri* shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (sec- 3097, Chd Code.)
Lenders Name
Lenders Address
- This is a building permit when property filled out, signed and.validated, and is subject to
expiration if work thereunder is suspended for 100 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
11LDING: TYPE CONST. OCC: GRP.
P. Number 774-075-006
Legal Description
Project Description S1D
Sq. Ft. No. No. Dw.
Size 1348 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 074,155
PERMIT
AMOUNT
Plan Chk. Dep.
$250.00
Plan Chk. Bal.
Const.
L •
Mech.
49.0U
Electrical
Plumbing
139.50
S.M.I.
5. 25
Grading
20.00
Driveway Enc.
02.00
Infrastructures
•
TOTAL
REMARKS
t;tA�a4 :? t.t:e,9
4112 ii
1V vt"1f>i
1 iC7tt'an.. .., Y: k'.8 'Y FYI.,
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 I ISSP€4CJ89
Issued by: —Date—Permit
Permit
Validated by:
Signature of applicant Date
Mailing' Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FIL SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE ! `
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ, FT. ®
ROUGH WIRING.
DUCT WORK
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN.
GROUT
URINAL
SQ FT ®
SERVICE
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
4iA ®`i/�/�Q
/L
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 nz/
UND PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ! `
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
i OR SEPTIC TAN ,�
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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. 0912 0/9
FRAMING / /
FINAL INSP.
,�1„ / �3
ROOFING��Y�'!/
4iA ®`i/�/�Q
/L
/f/ /J�
D
!�
d
A.
Q
ll
e
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHINGfOYVAI Ay 90
MESH
INSULATION/SOUND /
FINISH GRADING
FINAL INSPECTION-
NSPECTION
CERT.
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES (�,p
(CJR
TO: City of La Quinta DATE: C�
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253 NOTICE: THIS DOCUMENT CANNOT
eW
i!P ICATED�
This is to certify that
developer of 3 A �D which is
located atM� i , within
this District, has p id s ool faci ity fees imposedpursuan to the
authority generated by government Code Section 5308 n the amoft/of
covering a total of square feet of ( ) residential or
( ) industrial/commercial development and that buil ing permits for
this footage in this development may now be issued by your jurisdiction.
,A f_
for DESERT SANDS•UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
NO COR F'II:Ei)
Ll RECORDING REQUESTED BY X
Olt 8 U1
AND WHEN rRECORDED .MAIL TO: r :W. <-j.
ce
- oce m0
�{t
Q y V 8 Q CqUJI
'�
cW� `Q ROCt�
Name Charles W. Caldwell :�� a cg -, >: �. � •� - M
Street 46370 Ocotillo -.D±.'., W <"
AddressJ C,) -
Cl,yg Palm Desert, Ca.' 92260 -' 1U.O
state
L f
MAIL TAX STATEMENTS TO:
F
Street, address above
Address _ -
City &
State e - -
LSPACE ABOVE THIS LINE FOR RECORDER'S USE
Grant-DWe
The undersigned grantor(s) declare(s):
Documentary transfer tax is .$ ICI -9r; "
X) computed on full value of property conveyed, or
( ). computed on full value less value, of liens and encumbrances remaining of time of sale.
( X ) Unincorporated area: ( )'City of _ , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, :>
Mary Elizabeth Hield,• C." Richard Hield` and Rober'At.R. Hield, Co -Trustee
UTD 3/14/88, FBO of Mary .Elizabeth Hield
hereby GRANT(s), T = ,
Charles W. Caldwell,-ari unmarried man -
--- - ih`e following escri a ^eat property in the
County of Riverside State of California:
Lot 6 of Block•1,87 of Santa Carmelites At Vale L.a Qunta #18 as per
Maps recorded in Book 19, ,Pages' 30, & '31 ''of Maps;, REcords of said
County.
Dated: June 5,- 198-9.'
a _ ,
Marfy El zabeth• Hie'rd, Trustee
STATE OF CALIFORNIA SS
COUNTY OF ,,v .
On
before me, CYNTHTA .T, KARSTFN ' a Notary Public
in and for said, State, personallyappeared
**#MARV FT-IZABETH-HIEL,n***
{known to me) (or,'
_ proved tome�on.the basis of satisfactory.evidence) to beTtli'e person
whose name 14 subscribed to the
within instrument and acknowledged that aha
executed the same. Aff{ilAl t(EAL. ,
ITNIA.1 [ANITIN
WITNESS my hand and official seal. J4 Notory PublipCcWittornip
r. . PRINCIPAL OFFICE IN
Signature �` - =AM IEINANIINi CANMTI
My Commmion EXp. 9-13-9
CYNTHIA d KARSTEN ;: r
Name (Typed or Printed) (This srea'for official notarial seal)
Title Order No. Escrow or Loan No.
UL -4 MAIL TAX STATEMENTS AS DIRECTED ABOVE: M
"�1. .
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COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
ENVIRONMENTAL HEALTH SERVICES —
PERMIT APPLICATION 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 checklist.
A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of
Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval.
VERIFY ITEMS IN SECTION A FROM BUILDING 8 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
Agent Co��Gtact Person
Phone
-Ir -77,0
dd & Phone
Z J 6
Owner 104
Phone
Mailing Add
/dity. State'Z
ip
Job erty P opAddress
Le al Desc/riptipn Prop. Tlv, Tract, ot)�%
Lot Size / Water�Agency' ,ell
50 l I U
Use of Permit P/P, CU, etc.44VOW 0A V-7
Dwelling, W site Prep, e �F
*, Other
if r•kv v b �p�v�
Signature of Applicant
Date
CATEGORY: y REV CODE FEE
00"SUBSURFACE DISPOSAL 1238 55;50° 4
CATEGORY: REV CODE FEE
j ❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
/ (NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1 st 4 Parcels (Each) 1238 $45.00
b. Each Parcel after 4 7344 $16.00
(Less than 1 year)
❑ PRELIMINARY ELECTIVE 7352 $45.00
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $45.00
Critical Area 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
INITIAL
Com? )DATE
Holding Tank Agreements Completed ❑ Yes fe
Certification of Existing S.D. System Required ❑ Yes O” Nq� 1
WQCB Clearance required. (Attach Form ❑ Yes 80No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes N f
Special Feasibility Boring Report Required. ❑ Yes , N
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes
Other _ D'Yes IRI No'
?
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection Date
s
Soils boring report by j /{Project # Date �p
Soils Map Page /i 0' 1 Soil Type i Approved by '�� Date" �L► f
No. of Systemsype
of System(s)
❑ Holding Tank ❑ Existing
CSINew ❑Replacement
No. Dwelling Units('
Bedrooms, Fixture• n s
(1) Septic Tank
Gal/
Soil Rate
°7
Grease/Sand
�" 6�e�awse,I_n't�cp.�
Gal
(2) Leach Line Sq. Ft.
Bolt m trench area
Sidewall allowance
ft. rock/ sq. ft.
per running ft.
BfNA
Install Line(s) ft. long ft wide with
min. ux hes,r k below drainlines or
�,Lea�ch_Bed sq. ft.
of bottom area_
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage yit/Total Depth
her:
Applicable
N/A Overburden factor
Inlet (BI)
MaxAllowable Depth
No. 2 System A/4
t✓y� b 1 gyp%
REMARKS:61,
./.L�' �-tI'1�s;.<. s,9...•_ '�' ., �Cc.-C:.ly 6'Z' ...Yl"F' ...C•e•.�..�z�.X�X �� .r^,C'.� Cra.,. �,�i' •Gff°i/ /'..-P
This application i PROVED BENIEEY'for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied" plot" plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
above -designed system. No construction is permitted in the required reserved 100% expansion area.
Septic tank and sewer lines must be 50' minimum any wells
.from
Ph Leach lines must be 100' minimum from any wells, including expansior�,.rea,'
Seepage pits must be 150' minimum from any wells, including expansion areal
—Signature of Health Official Date
RECEIPT NO. � 0 �. Issued By Date
DISTRICT: ❑ Riverside, Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records
f .: Dry;`D�ens ty
Moisture Content
`' R e4tive
'Tesf
Test
Test
Soil
Test
(. t)
(percent).
C P.�tion
`f�eki"
Max
Fuld
Opt.
No.
pate
Looati.on
Ti pp'
Eiev./Depth
(pvroQn#)
`1`989
1
11/3
Building Pad
A
F:G.
1.17.1
13.0 .
4.2
8.0
90
2
1,13:5
6.1
87
3
111=. 2.
5.8
86
4
>;_111 ,2
5.7
86
5
1..09.4
5:.8.
84 .
2A
11/8
1.21:;5'.
10.5
93
3A
I
-
122.7
10.2
94
4A
.1-22.-.-,l-'
10.9
94
5A
120.7.
"
' 10.0`
93
I
I
FtELD DENSITY TEST METHOD':;. -ASTM D292'2 78
• F. G. _ Finish Grade
MAXQM DEPISIT,Y AND OPT"UM MOISTURE TEST METFfOD; ASTM. D1557-78
"Pro}�o# No' 689;1.'934-01..
RE:L•AT I VE COPI'IPACT' 1 F1I =A Q
Pro jeot Mnw B'e r
LULnj
• TES . RE`Sl1LTS Date 11 8 89 Figure No.
3064 788
I
i
ION
00
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cxIsTv� Nws�
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