SFD (10323)54225 Avenida Martinez
10323
m
Building
44
P.O. BOX 1504 No. 10323/""-.
54--225 Martine LA QUINTACCALIFORNIA 92253
f !
Airs and Ifs. Ricky Van
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 40975 Sandy Gale Ln #C A.P. Number
City ___JZip JTel.
Palm Desert 92260 345-5973 Legal Description
Contractor SFD
Owner/Builder
Project Description
Address
Zip I Tel.:
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I he affirm that I am licensed under provisions of Chapter 9 (commencing with Section
ffect
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
e.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or Nat. 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 rive hundred dollars ($500).
❑ 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 of 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. ff, 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 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. 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, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O 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 ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: ff, after making this Certificate or Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I car Illy that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant —Date—
Mailing
ateMailing Address
City, State, Zip
ZONE: BY: .r.
Minimum Setback Distances: 1. I l f.s•` JII 'L 101 HL t A,
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
i
Sq. Ft.
Size 1726
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
Permit does
not include any
block wails
or pool
Estimated Valuation
99,025.30
PERMIT
AMOUNT
Plan Chk.'Dep.
250.00
Plan Chk. Bal.
253.66
Const.
639.50
Mech.
55.50
Electrical
133.13
Plumbing
141.00
S.M.I.
10.00
Grading
20.00
Driveway Enc.
20.00
Infrastructure
TOTAL
3:40.61
349$.61
REMARKS
('
ZONE: BY: .r.
Minimum Setback Distances: 1. I l f.s•` JII 'L 101 HL t A,
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:
i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING PEES
IST FL. SQ. FT. ® $
w
2ND FL. SQ. FT.
POR` SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SEWER OR SEPTIC TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® 3/4c
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
(UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
r
ROUGH 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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
plus x$
=$Iv�
LUMBER GR.
FINAL INSP. hx a?—
FRAMING 2 L
FINAL INSP.
ROOFING
aJ
•�J %-'Iy
so, � Guy ��d�s l/ 3l9 � i✓1 �l
CST it/Ja�V-cr — /(1271421L,
�// /$
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
<1
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 11/25/91 11 Type of Permit I La uinta
No. 111012 Permit #
Owner Name g #
Ricky Van
No. 54225 street Martinez
city La Quinta zip 92253 Study Area 110
APN # I Tract # I Lot # Square Footage 11726
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:
This certifies that school facility fees imposed pursuant to Government Code 5.3080
in the amount ofFl—.58--1 X 11.726 or $ 2,727.08 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 Leslie Van
Name on the check
By James E. Lively
Assistant Superintendent, Business Services
Fee collected /exempted by Vickie J. Durrett
Telephone 345-M3
Signature Z - _check No. 1,01
i, : y
Collector: Attach a copy of county or city Plan check application form to district c'opyfor. iaffwaivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
Payment Rteceived
g
Signature Z - _check No. 1,01
i, : y
Collector: Attach a copy of county or city Plan check application form to district c'opyfor. iaffwaivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
=
RECORDING REQUESTED BY
0
Ct
-- C01ifomia
RIVERse- t.OUNTY
My COMM. ExpirMs AUG 19,1994
AND WHEN RECORDED MAIL TO
Name MR- AND MRS. RICK VAN
Street 1248
Buena Vista
Address Palm
Springs, Ca 92262
City &
state L
J
MAIL TAX STATEMENTS TO
r
Name
S!re.^.t
Address
City &
state L
ABOVE ADDRESS
CAT. NO. NNO0502
TO 1923 CA (2-83)
® 8
0
O.y l t a)
C
tc
o , d,
0 Q m W O • J t'y
4 J 3 La iid
_j
SPACE ABOVE THIS LINE FOR RECORDER'S USE
Individual Grant Deed
THIS FORM FURNISHED BY TICOR TITLE INSURERS
iThe undersigned grantor(s) declare(s):
z Documentary transfer tax is $ 21-e l
a a (XX ) 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 _ T.a Quinta , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
Rn WILLIAM R. RILEY, an unmarried man
N
G hereby GRANT(S) to
RICK VAN AND LESLIE VAN, husband and wife, as JOinbt Tenants
N the following described real property in the City of La Quinta
County of Riverside , State of California:
Lot 11, Block 297, Santa Carmelita Vale at La Quinta,. Unit #27,
l` as per map recorded in Book 19, Page 02 of Maps, in the office
of the County recorder of said county.
t
Dated: May 31st, 1991
STATE OF CALIFORNIA
COUN7yappeared
Riverside }SS.
On AV 7 / before
me, trsigned, a Notary Public in and for said State,
personWilliam R. Riley
personally known to me or proved to me on the basis of sat-
isfactory evidence to be the person whose name is
subscribed to the within instrument and acknowledged
that he executed the same.
WITNESS my hand and official seal
Signat P_t
Frances Bridges
Title Order No.
("Phis area for official notarial seal)
Escrow or Loan No.
MAIL TAX STATEMENTS AS DIRECTED ABOVE
OFFIC!AL NC)TARY SEAL
FRANCES BRIDGES
Nota DGES
rY Puolir.
Ct
-- C01ifomia
RIVERse- t.OUNTY
My COMM. ExpirMs AUG 19,1994
("Phis area for official notarial seal)
Escrow or Loan No.
MAIL TAX STATEMENTS AS DIRECTED ABOVE
CALVIN C. KAMINSKAS
Assistant Commissioner
(714) 275.3000
OFFICE OF
AGRICULTURAL COMMISSIONER
JAMES O. WALLACE, Commissioner
83-612 Avenue 45 Suite 7
Indio, CA 92201
(619) 342-8291
DAN RILEY
Sealer, Weights & Moos ures
(714) 275-3030
DATE 4(! I CASE NO. PC I _C' L L L)4
t-
DEVELOPER'S NAME:
ADDRESS : ^ Z J W 1` 'Y Vl ,7Q J`.4 Z
2A
TELEPHONE:ZZ
Lt
Dear Developer:
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ from plant material listed, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
2
Agri ltural Commissioner's Office
cc= Indio and Riverside
4080 LEMON STREET, ROOM 19, RIVERSIDE, CALIFORNIA 92501 — FAX (714) 275-3012
` r.+.^►.. _ i"'^.v+H `+.r'y 'i"' '"'' „d'1+ ...*M+J.'" y+,..s.-.A"."r`.rwl..rw-. 're .++s*J+r+-l..•+r'Nl1n .'^,.'r +-r. , nrr,.'.rT.'ie'+.+-L-.v+`-.f.+'.,-.. .- „i,-,.
s
Buena Engineers, Inc. 79-811 B Country Club Drive • Bermuda Dunes, CA 92201 • (619) 345-1588 / 328-9131
AN EARTH SYSTEMS, INC. COMPANY
SB/R.S. CO. GOV.
Building Permit No. /O OSA Application No.:
Project Name: \IcAnc T ,-eSI
Project Address: ';-4- ' c;ZA'
Architect: -- J— f i IK k k,-- S
General Contractor:
TYPE OF INSPECTION:
Unit Placement
TITLE 21/24 OTHER
Date of Inspection: ag 'rpt S - t
Job No.: 37' 374 S - P9
ral Engineer: d Io" 61e,,, &"
Contractor:
er—
Grouting Other
Description of Work InspectFd--/Ir'rivO-,P /d it, -3
44 re , ;,•e®
ro« l .e r s rl e r /arm G. , , Ac` so4 :.
1A J
r
to i.rAef S7 C (,r, c1 4-zn, y, -.c 14,r St.,r
a. h {
e_. , ;ice L• l1-kel ,11 re e , Qn f 1!
Al S,a" Ke J\ L,,i'C5 L I.^IAL-> C, I, T 1 C11 el 6 /
Ilrre4e
ij,
I.J f ,ey--e •_. : V-+.. G .1)fl t,,. d I 2 t, GW^G.4a JO ( } re, ,J3 t -,i 7myF
1,05 o er , F A — 1 A2 -14
OOF
Unresolved Items:
Descriptive Location of Samples: --)est ,,3" S 1 , o....... -5 1, L
Slump: A s t t Grout Temp: *75 Time in Mixer: a ' 3 S Supplier: &L,7,74, Admixture:
Water Added: Air Temp.: ft Type Gement: -1 Mix Design: Oa v1 I.D. Mark:
C.M.U. Unit Sizes & Colors: _ FAA C.eAS J l/Z kc,J po, ,-, a
Mortar Type:
I hereby certify that I have all of the above
plans, specifications, & applicable building
Contractor's Representative ;P//,//
iii'/ .r
All inspections based on a minimum of 4 hours; over 4 hours
In addition, any inspection extending past 12p '`will be an 8
Copy 1 Buena Labs
7 Bond Pattern:
dse noted; and to the best of my ability I have found this work to comply with the approved.
roje t;4mpletio
Inspector's Signature4 ; ,' _ `
8 hour minimum. ,9
num Inspector's Name/No. '111/4 ,-, " J'c lG, /CSS ' ,) 9v 0
Copy 2 Project Superintendent Copy 3 Governing Agency Sfrice a ov ,l