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BLCK (05-0067)Ti4f 4 4 a" BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . 05-0000"0"0-6'7 Date 1/06/05 Property Address 2280-AVE�TID MENDOZA. APN: 773-273-005-18 -000000- Application description . . . WALL/FENCE Property Zoning . . . . . . . COVE RESIDENTIAL Application valuation . . . . 5075 'Owner ----------------------------------- Contractor HERRERA ELIZABETH --------------------------------- Owner 52280 AVENIDA MENDOZA LA QUINTA, CA 92253 ---------------------------------------------------------------------------- P.O. Box 1504 78-495 CALL$ TAMPICD LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: 05 - D O zS i Applicant: Applicant's Mailing Address: Architect or Erigineer: a- VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architect or Engineer's Address: Lic. No.: 13UILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division.3 of the Business and Professionals Code, and my License is in full force and effect. License Class License No. Date Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she 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 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, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that the 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 or she did not build or improve for the puipose of sale.). (--) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' 'State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U 1 am e � mpI under Sec. , B.8 P.C. for th /eason ' I k 11 L-_ WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Cartier Policy Number. I certify that, in the performance of the work for ich 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, and agree t t, if I should become sZ'ect the workers' compensation provisions of Section 3700 of the Labor Code, I shall for comply with those provisi s. 1 scant WARNING: FAILURE TO SECURE WORKERO SATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSA OLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address r APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if wok is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information i I agree to ply ' all city and county ordinances and state laws relating to building constriction aLo- ate y authorize representatives of this county to enter u above -men rty for inspection purposes. 1 L ignature (Applicant or Agent): 1. - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - -"- - - - - - - - --- - - - - - - - - - „ Application Number . . . . . 05-00000067 ---------------------------------------------------------------------------- - - - - - - - --- - - - - - - - - - - - - Permit . . . . . . WALL/FENCE PERMIT Additional desc Permit Fee . . . . 81.00 Plan Check Fee .00 Issue Date . . . . Valuation 5075 Qty Unit Charge Per Extension BASE FEE 45.00 4.00 9.0000 THOU BLDG 2,001-25,000 ---------------------------------------------------------------------------- 36.00 Special Notes and Comments DEMOLISH 133 L.F EXISTING RETAINING WALL. ADD 203 L.F. COMBO WALL, 32" RETAINING, 6' GARDEN & 4' TRASH ENCLOSURE WALL, ALL CITY STANDARD . Fee summary Charged Paid Credited ----------------- Due ------------------------------ Permit Fee Total 81.00 .00 ---------- .00 81.00 Plan Check Total .00 .00 .00 .00 Grand Total 81.00 .00 .00 81.00 11 CITY OF LA QUINTA BUILDING & SAFElY DEPT, P p SOV BION Cl ST --S ARPPI STRUanoN DA dl Arl ►b --77. xg ib il y -1 ?-V)Y I -zj p�d IL OWNERBUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer and you are subject to several obligations include State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contracts are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 FAX: (760) 7 7 7011 LL= O ' SIGNATURE/DATE PROPERTY ADDRESS 0.1-- oos-7 PERMIT NUMBER(S) Building Address 52-280 Mendo Owner Joist L. Hart Mailing Address City Contractor Address Zip Tela State Lic.I City & Classif. _ _ Lic. # Arch., Engr., Designer Address City ZIp. State Lic. # 4 P.O. BOX 1504 N o . 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC: GRP. '--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. r, SIGNATURE ! DATE OWNER -BUILDER DECLARATION I hereby affirm 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 file 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 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 civil penalty of not more than five hundred dollars (8500). O 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. If, however, the building or improvement is sold within one year or completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose or sale.) O 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 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. O 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 (8100) 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 or 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. 3 09 7, 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 .P. Number ©8619 e Legal Description i Project Description Sq. Ft. No. Size 1522 Stories New ❑ Add ❑ Alter ❑ uatlon No. Dw. Units Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. 250,00 Plan Chk. Bal. Const. 572-00 Mech. Electrical Plumbing 163-50 S.M.I. Grading 20.00 Driveway Enc. Infrastructure ftec, me plan TOTAL REMARKS A4 x: 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. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. SQ. FT. WALL SQ. Ff. SQ. 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 FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROUGH WIRING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FOUND. REINF. LAUNDRYTRAY AIR HANDLING UNIT CFM METER LOOP 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 SERVICE SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL WATER SYSTEM INSP. SO.FT.GAR ® V4c HOUSE SEWER GRADING -CU. yd. $ -plus-x$_=$ 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 PLUMBIN ERGROUND AE A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS ( 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 INSP. FINAL INSP. GRADING -CU. yd. $ -plus-x$_=$ LUMBER GR. FRAMING / / 90FINAL ROOFIN v ��L� V 4 / L, 0 7 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING /yt/rVA �d94k MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION i CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL 4 4 Qum& P.O. BOX 1504 APPLICATION ONLY I 0 7&105 CALLE ESTADO Address✓�en (7 Building S - LA OUINTA, CALIFORNIA 92253 _� MZa Mailing Address a o Naw b r CityZip Tel. 80 5 hl'. r�ha l l 913 1 asg9 a95 Contractor wA I 8 Class'i-LA j 'Z r) '1 ;:::7 1 Lic. # Designer Address Tel. ZipI State 10 n r1% "a= Lic. # CONTRACTOR'S DECLARATION I hereby V=gT�! under provision of Chapter 9 (commencing with Section 7MMof Dand Professioode, ander license is in full force and ffect. NA DATE OWNERII DER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the following reason: (Sec. 7031.5.Busbass and Professions Code: Any city or county which requires a permit to construct. ager, improve, demolish. or repair any structure, prior to its issuance also requires the appicant for such pemrf to file a slpned statement that he is licensed pursuant to Me provisions of the Contractors License law. Chapter 9 (commencing with Section 7000) of DkWslon 3 of the Business and Professions Code, or Mat. he Is exempt therefrom, and the basis for the alleged exemption. Any vtola0on of Section 7031.5 by 'any applicant for a permit sLtWJs the applicant to a civil penally 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, aulsness and Professions Code: The Contractors License Lew does not apply to an owner of property who brills or hv'oves thereon and who does such work himself or through his own employees, provided that such hpmvements are not intended or offered for sale. H, however, the building or Improvement is sold w&m one year of completion, the owner -builder will have the burden of proving that he did not build or krprove for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con• struct the project (Sec. 7044, dress aid Professions Code: The Contractor's Lkense Lew does not apply to an owner of property who builds or brproves thereon, and who contracts for such prtyects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under SeG R d P.C. for this reason Date Owner WORKERS! COMPENSATION DECLARATION 1 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. 3900, 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 is for one hundred dollars (S100) valuatlon or less.) I certify that in the perf thg work for which this pe it is Issued, I shall not employ any ppeerson in arty as to become subj th orkers' Compensation laws of California Date Owner'1201 08 N077CE TO APPLICANT: b, e/ making this Certificate o/ 6cemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply w(M such provisions or this permit shail 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.) Lenders Name Lenders Address This is abuilding =when properly filled out, signed and validated, and is subject to 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. 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 FINANCE BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. 4 Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure ets e d 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 Permit Validated by: Validation: DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 10/1/90 1 Type of Permit I La Quinta No. 110176 Permit #I Log ii Owner Name William O. Wilkinson No. street See Below City La Quints Zip 92253 Study Area 0 APN #1 Tract #1 Lot #i Square Footage 112,448 Type of Development Single Family Residence No. of unite Comments r%1 _AAA% Rnmira,7 9A_190 R„}.;.. c1 013n 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: EXEMPTION NOT APPLICABLE Ibis certifies that school facility fees imposed pursuant to Government Code 53080 in the amount ofFl—.58--1 X 112.448 1 or$ 19,667.84 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 William O. Wilkinson Name on the check By Richard M. Beck Director, Facilities Planning & Development Fee collected /exempted by Shelley D. Bennett Signature Telephone 3454M Pa;�rient 'ci eck No. 019694 Collector: Attach a copy of County or City plan check application form tG Dich ict copy. Embossed Original- Building DeptJApplicant Copy - Applicant/Receipt Copy - Accounting 0 City & State L_ NAT -30 (5-87) RECORDING REQUESTED BY A' !UNION LAND TITLE COWANY DA AND WHEN RECORDED MAIL TO r � Name MR & MRS WILLIAM WILKINSON Street 38344 Poppett Canyon Address Palm Desert, Calif. 92260 City a State L J MAIL TAX STATEMENTS TO same as above Name Street Address City & State L_ NAT -30 (5-87) J � -17 SPACE ABOVE THIS LINE FOR RECORDER'S USE Individual Grant Deed The undersigned grantor(s) declare(s). 90 J z Doc xmentary transfer tax is $ , Q a ( ) 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: ( City of 1-4 0491A)74 , and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Roy Duane Hulbert hereby GRANT(S) to William 0. Wilkinson and Barbara L. Wilkinson, husband and wife as joint tenants as to an undivided one-half interest and John L. Hart, an unmarried man, as to an undivided one-half interest, as tenants in common the following described real property in the County of Riverside , State of California: Lot 18 Block 101 Santa Carmelita at Vale LaQuinta Unit No 11, as per . map recorded in book 18 page 99 of maps, in the office of the county • recorder of said county. Dated: February 16, 1989 STATE OF CALIFORNIA COUNTY OF Riverside }SS. On Marr•h 17� 1989 before me, the undersigned, a Notary Public in and f%said State, personally appeared Roy Duane Hulbert personally known to me or proved to me on the basis ppf sat- isfactory evidence to be the person_whose name /J subscn'bpo to the within instrument and acknowledged that executed the same. WITNESS my han"nd official seal. Signature 407 IVzct� Roy Duane Hulbert OFFICIAL SEAL ~� -DEBRA J. UIvOERWOOD m� NOTARY PUBLIC—CALIFORNIA PRINCIPAL OFFICE IN ' u RIVERSIDE COUNTY ` 8 My Commission Expires Oct. 4, 1991 (This area for official notarial seal) Title Order No. Escrow or Loan No. I MAIL TAX STATEMENTS AS DIRECTED ABOVE DA J � -17 SPACE ABOVE THIS LINE FOR RECORDER'S USE Individual Grant Deed The undersigned grantor(s) declare(s). 90 J z Doc xmentary transfer tax is $ , Q a ( ) 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: ( City of 1-4 0491A)74 , and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Roy Duane Hulbert hereby GRANT(S) to William 0. Wilkinson and Barbara L. Wilkinson, husband and wife as joint tenants as to an undivided one-half interest and John L. Hart, an unmarried man, as to an undivided one-half interest, as tenants in common the following described real property in the County of Riverside , State of California: Lot 18 Block 101 Santa Carmelita at Vale LaQuinta Unit No 11, as per . map recorded in book 18 page 99 of maps, in the office of the county • recorder of said county. Dated: February 16, 1989 STATE OF CALIFORNIA COUNTY OF Riverside }SS. On Marr•h 17� 1989 before me, the undersigned, a Notary Public in and f%said State, personally appeared Roy Duane Hulbert personally known to me or proved to me on the basis ppf sat- isfactory evidence to be the person_whose name /J subscn'bpo to the within instrument and acknowledged that executed the same. WITNESS my han"nd official seal. Signature 407 IVzct� Roy Duane Hulbert OFFICIAL SEAL ~� -DEBRA J. UIvOERWOOD m� NOTARY PUBLIC—CALIFORNIA PRINCIPAL OFFICE IN ' u RIVERSIDE COUNTY ` 8 My Commission Expires Oct. 4, 1991 (This area for official notarial seal) Title Order No. Escrow or Loan No. I MAIL TAX STATEMENTS AS DIRECTED ABOVE Q r Z O 5 W i co Z O 8 W U) e U Z _O b W U) 0 Z O 8 U) COUNTY OF RIVERSIDE DEPARTMENT -OF HEALTH Asemem ftf W No. *6 ENVIRONMENTAL SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE. SEWAGE DISPOSAL SYSTEM 4plicant: '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 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. 1 t,f VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG Agent. Contractor, Contact Person =NC, Phone Address & Firm V e 3 5 095, 41-7,11) r e Owner 7Sn'kn Lr Phone 5 Mailing Address 20' 5Q5000 .aLv hY I State CA �Zip� Job P rty Add Description P. (PM, Tract Lot) r L lu e_ Q a ' , Lot Si 1 Water Agency . ell Use of Permit P/P, CU,�tc.q o X) a O P Dwelling S ra Lt,R•t f (c Signature of Applicantter- Date -'SUBSURFACE CATEGORY: REV CODE E� CATEGORY: �, REVCODE"-_FEE %)0 - 9, DISPOSALS1238 .5s a, © E�l SITE EVALUATION UPON REQUEST 7349 $ 43.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00 a. 1 at 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) ❑ She Evaluation in Conjunction with " ❑ HOLDING TANK 7351 $ 47.00 CrhicW Area 7346 $111.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00 (O She Evaluation Lot Less than SYSTEM t 10,000 Sq. Ft. 734T. $ 87.00 ' INITIAL DATE Holding Tank Agreements Completed ❑ Yes of !/ /' _ / Certification of ExistingS.D. S System Required ❑Yes + N� WQCB Clearance required. (Attach Form ❑ Yes N_ r DOH SAN.007, Santa Ana Region Only) Sons Percolation Report Required. ❑ Yes No� ° X0 Special Feasibility BZ;r g Report Required. ❑ Yes ND_ Detalled Contour Plot Plans Required (1 to 5 fL interval) ❑ Yes Other ❑ Yes No Staff Specialist Lot Inspection Required ❑ Yes ;dNo }f Lot Insnection Date Soils boring report by Project if*� Date `!It J Soils Map Page Sol Type ft [ _ ,�_ Approved by ti"(�"' Dale No. of Systems vyrm, of Systems) '61 Holding Tank ❑ Existing No. Dwelling Un () (1) Septic Tank Soil Rate,, . Greaae/Sand 11 (,'� Nsw O Replacement Bedroorna„Fa +sw�[ 3isWQi , 4114W' � � / V#i y ! ! f Intcp Gd \2) Leach Line Sq. FL Bottom trench area Sidewall allowance - A Lines) R long a wide with Leach Bed 94 ft. �d "-. , , . ��►� ,i•"� 1t rock/ sq. R per running It min. inches rock below draMiines or t�ltom area Leachfinse/bed'special design for slope: "(3) Pil Diameter No. Pits Pit Below Seepage Pit Total Depth Other: .Applicable - ( ! Inlet (BI) (TD) > N/A � e! Ovbu errden factor -(=5 6 ( Max. Allowable Depth No. 2 System A1/A r REMARKS: This application is ' PPROVED ENIEWfor the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompanied plot p n, 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.AA ( Septic tank and sewer lines must be 50' minimumfrom.any wells0'^`ems (2 Leach lines must be 100' minimum from any wells, including expansion ea i r f () Seepage pits must be 155 minimum from any wells, including expansion area ► Lf/t kr^ j // Signature of Health Official RECEIPT NO. / / Issued By �.W (k-- Date + 1 t� DISTRICT: ❑ Riverside, ❑VI 102 ❑ . Hemet O Perris ❑ Rancho Calif. ❑ Blythe DOH=SAN-122 (Rev. 3190) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK -Bldg; Dept GOLDENROD - Plans/Records r+►, OFFICE OF r AGRICULIURAL COMMISSIONER AND WEIGHTS & MEASURES CALVIN C. KAMINSKAS •, 4000 LEMON SIREEI. ROOM 19 LEMENNIS JAMES o. WALLACE CLEMENT BENVEISIE Apok-Aheol Comm19+10"e+ nIVERSIUE. CAI•IFOnNIA 72501• Seal" Dhealo of welghle of (114) 167.2661 49613 Ilighway 86, . Suite B12. Coachella, Ca. 92236 l (619) 342-8291 VATE / A70 CAW. i MNEWPER' S NMI 04 £ t/ c i E AwuREssf 7 -7 CJT � ol�� Dear Developed After reviewing your latxlscaping plans, all plant material listed is not in violation ofantine-laws governingthe Coachella Valley. If substitutions do occur stK1 tl� ey differ fra plant material listed, this office Illus t be notified' inv ediately. ' 1111ank you for protecting and preserving the Coachella Valley's pest -free .envirolnlent. Agricultural Can ss one s Office . ca, Indio and Riverside Office I IN