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BLDG (0104-004)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty o .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 #. Lic. Class Exp. Date 511457 Date ° �^ ..../ Signature of Contractor —�' OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). () I am exempt under Section B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I' hereby .affirm under penalty of perjury one of the following declarations: (.) I 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. 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 & policy no. are: Cartier Policy No. STATE F0110,D) (This section need not be completed if the permit valuation is for $100.00 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,,�ssubject to the workers' compensation laws of California, and agree that if/!�fiould become subject to the workers' compensation -provisions of Secj�3700 of the Labor Code, I shall forthwith comply with those provisions. ,vim Date: v/ z,.•z,- i Applicant Warning: Failure to secure Wo`kers' Co�mpeion coverage is unlawful and shall subject an employer to criminal penalties. and civil fines up to $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. IMPORTANT. Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his 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 applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and 'void if work 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 is correct. I agree to comply with all City, and State laws,r",elating to the building construction, •and hereby authorize representativesQf/his City to enter upon the above mentionec,propertyfor=inspection purposrs. - ;i t , k" ;ivy Date Signature (Owner/Agent)��'—��--��`• r+ ; , , BUILDING PERMIT DATE VALUATION LOT PERMIT # Q104.. TRACT 'JOB SITE APN ADDRESS I OWNER CONTRACTOR/DESIGNER/ENGINEER LA QUA-4fA CA 92253 MUM PR.IN'GS to 922-62 (760)325-6-/10 MU61 4611 :CLASS Ld��x.AR'6ry��jj�i'p�9�,to,Y+.�e•��ip�{.��1�.•.y I - VALUX-FIr.O'1N s19,GD 1.8 ..ffsMQUD COST O COPM.U' O4s=29,00 i�.%idBS�Y LIME ME-RAWNFEW $0.00 FAPR 3 2001 CITY OF TA l FINANCECE DEPT RECEIPT D BY DTE FINAL INSP TO INSPECTION RECORD OPERATION DATE INSPECTOR BUILDING APPROVALS Set Backs Forms & Footings Slab Grade Steel Roof Deck O.K. to Wrap Framing Insulation Fireplace P.L. Fireplace T.O. Party Wall Insulation Party Wall Firewall Exterior Lath Drvwall - Int. Lath BLOCKWALL APPROVALS Set Backs Footings Bond Beam Final OPERATION DATE- INSPECTOR MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Exhaust Fans F.A.U. Compressor Vents Grills Fans & Controls Condensate Lines Final Steel Electric Bond Main Drain Approval to Cover Equipment Location Underground Electric Underground Plbg. Test r:ac Pining POOLS - SPAS PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final water aping Plumbing Final I Plumbing Top Out Equipment Enclosure I Shower Pans O.K. for Finish Plaster I Sewer Lateral Pool Cover I Sewer Connection Fncamt latinn I Final I COMMENTS: I Final I ELECTRICAL APPROVALS I Temp. Power Pole I Underaround Conduit I Fixtures I Main Service 1 Sub Panels I Exterior Receptacles 1 G. F.I. Smoke Detectors ►Temp. Use of Power R�� P.O. BOX 1504 f No. 11002 Building78-105 CALLE ESTADO Address 77-845 Monterey LA QUINTA, CALIFORNIA 92253 � c� Owner d/ Robe -rt Undyke BUILDING: TYPE CONST. OCC: GRP. Mailing Address 74577 Azurite Circle A.P. Number ' City i m. Desert Zip 3226 Tel. P�.as� Legal Description Contractor Project Description RVS Plumbing/Rick Stevenson Address Serer Hook Up P. 0. Box 692 City JZip Tel.: Rancho Mira(ye 92270 3416546 State Lic. City '� Class iS 602396 Lic. # 1914 Sq. Ft. No. No. Dw. Arch., .Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # ICENSED CO TRACTOR'S DECLARATION I herebyy affirm that I, liceltsed ndegprovisions of Chapter 9 (commencing with Sect 7000), t o* ision 33"oflt /e(^B"sin'ess and Rrofesslons Code, and my license is in fu11Aforce an SIGNATURE PT !I �lv L7i f j. I DAT L. OWI ERaBUILDEFi DECLA•i1A eN 'I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation 900.00 reason: (Sec. 7031.5,8ur�(�siness and Professions Code: Any city or county which requires a 9 0 `• ' 0 0 permit to construct, atter, 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 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 for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. subjectstheapplicant toe civil penalty of not more than rive hundred dollars ($500). ' 0 I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 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, Mech. provided that'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 Electrical , 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- Plumbing 30.00 slruct 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.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading • ❑ I am exempt under Sec. B. S P.C. for this reason Driveway Enc. Date Owner Infrastructure 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 certifiedcopy thereof. (Sec. 3800, Labor Code.) Policy No. Company �( '51 1p ' T'� 5-- .-92 _, 10 ❑ Copy is filed with the city. O Certified copy is hereby furnished. � ��;P d0 "r° 1 �d •% 27 TOTAL 30.00 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundie dollars ($100) valuation or less.) �^a �-1 }, I certify that in the perfo mance oJ�bg�kuork for wMe this�p�i it is issued, I shall not employ any person in any manners as to becom sub) t o th Nkelrs' Compensation Laws of California. { Date Ownert� AVA NOTICE TO APPLICANT: 1, aft f s -C R�cateifo tion yo uld become ZONE: BY: subject to the Workers' Compensation p visions 1 th r Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked.' Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR 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 certify that I have read this application and state that the above information is correct. Issued by: Date Permit 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. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. FOR. SO. FT. ® GAR. SQ. FT. ® CARP. SQ. FT. WALL SQ. FT. ® 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 HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER DUCTWORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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. SQ. FT. ® c BATH TUB BOND BEAM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® V4c HOUSE SEWER FINAL INSP. ROOFING GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBLTOTAL 1 FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE 1 , SMI FEE PLUMB. FEE I I STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR - SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER ?/X2 H WIRING. DUCTWORK ROCKSTORAGE 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. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION- NSPECTION CERT. CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL COACHELLA VALLEY -WATER DISTRICT CASH RECEIPT'DETAIL !� /},Received From: Address L Date: 4— �f Account No. li 'Lot(s) 1�y Service Address Tract ElMeter(s) _ - / el G.A. Code - ❑ Service(s) $ '0, Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge ~ . V ma�cc.✓, 'XSanitationCapacity Charge ❑ W.S.B.F.C. ❑ +Temporary Construction Meter ❑ Turn on Charge. ❑ Uncollected Account- Name ❑ Inspection -Fee - Tract - Fee - ❑ Plan Check Fees Water ! Sewer - , Tract - ❑ .Bond Payment - A.D. -. Bond Assmt. r - ❑ Customer Deposit J " • ❑-Other r ... Remarks: ♦.._ TOTAL . $ . / /.. ' c ❑Copy to: ' Water Service -71C- f�.i� Ceshler CVWD-438(11/89) Building Address 77-845 MI Owner Mailing . Address Same City La -Ouinta Contractor ?�aT>•rtF+ Address, Zip QUM& TAhf P.O. BOX 1504 N O.' 003493 78105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC: GRP.- A.P. Number 774x-0.9:1-0.13 Tel. H . ' TM Legal Description-' Project Description patio Par a city T. r REMARKS'.tm...�,k.;» .,x ., Zip Tela .. State Lia & Classif. City Lic. # Sq. Ft. Size• - '• No. No. Dw. Stories ..Units Arch.; Engr.; .. .. w. .. Designer New ❑ Add ❑ Alter ❑ <. Repair ❑' -Demolition ❑ Address Tel. Rear Setback from Rear Prop. Line Side Street Setback from Center Line. ' City Zip State Lic. # Issued by: Date 11%16%07ermit LICENSED CONTRACTOR'S DECLARATION.. 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. Validation: .-,: ,•...,,_ „_ ,. . V 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 ($500). " — ' 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 anowner of property who biAds or improves "thereon and who does such work himself or•lhrough his own employees,_ provided. thatauch improvements are not intended or, offered for sale.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 corn 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.)• ' O.I am exempt under Sec. B. & P.C. for this reason Estimated Valuation 501 --PERMIT- •• AMOUNT :•r� • Plan Chk.. Dep.' •. ... . Plan. Chk. Bal.$127-.22. . Const. . . r - Medh .If, .. Electrical" Plumbing S.M.I.' Grading Driveway Enc. jr • Date Owner � �a,ry`' r3- Infrastructure WORKERS' COMPENSATION DECLARATION" - hereby'affirm that -I have a certificate of consentto self -insure; of 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 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: 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 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. 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 stale 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 T. r REMARKS'.tm...�,k.;» .,x ., .0"," o`�.�'ff I 'TOTAL » . ZONE: BY: Minimum Setback Distances: Front Setback.fTom. 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 11%16%07ermit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FFbS 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL. SO. FT. 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 SO. FT. DRINKING FOUNTAIN SO. FT. ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ plus x$ LAUNDRY TRAY 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 FIREPLACE SO.FT.GAR ® 3/ac HOUSE SEWER SPARK ARRESTOR 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 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 APP.IEOUIP. 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. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH I NSULATIONISOUN D FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS_ GARDEN WALL FINAL - �l Er�'ON 'OJ N3�2J."11CJ 3N3`Jfla -T i} L_� �#_:_; fl � - F' I 1 i:Cr. �I�I-}.} ! � I.1 I �: p� �; { ., I �; �•, I I - -I 1 -t- I -t7Zi _�-c •� I I r ` __ ,. ! _� I -i__. J i___ r I i } I r 1 i- -, a.D �'1 ; z .fit•.1: t bI_ _ ! 1, z.;l 1.1 L_ pa j 1 1 r i 1r- t11-I1i- � 1 � .� J i 1 !_ J_1 . ,_ : � . . ;_; � ' � j •� � ' . � 11 + � � ,-t , � ; � -; ► -� I-1.1_ } ' � I �, ;• -I, ,b= `� .1?f t rl.,i.l�.i.I1 - i , F ` +-' Y_: , 1-, -L {_}1-��-,_ '1t{,-;-rI�� i-•�--r!:i ::��i�.T � I t:�-1� �I-' � __ I � r��t �� ;_L_1.�_1_ 1 11 t i Ij ' t} 1._J!_ �_1_�� _ t�.._:-�. J-;-. ! _ .+. ,. +. 1. ,'\ J i. j I. i ! , �L. t-; l ..lt jr . _1_I. j_.1 1 -- ±T- i i-Yt-' '- i .p�� •a..;l. , �, '� � ;. v,, � r r I r � '' Z:_l._ ID fa ! _ -t l t-r; 44�;.i .. � �� i � • i-, ' ! �_' �. ..I � . ;_ ,. J .� (� � _L ; 1 I.. e} - t f i = I 1 .. � � j '�E-t T4 1 i I. f_}.. 1 .. . d i.,} .i PJ r. ir{� 1.. .L ;_. I i•4 .1. `3_�r�� 1: .i ' I` i� F i..•.�-t r-- �I-7_ f^j 07 �, �� 1.1 '_L�. .t -i{ iy 1.,.1_i �_� �t � _� 11 ...{.I :�' «.1 fn� •�.� '_ i-.. : }._: _.. 1 _ t 1�_! � ,r ;�_ .t.l.�i�� i �—'' :�—` i r ,_ ,�'_�.i � � r—f � �I � 1 G_i ,• t _ _ _, ( � �j � — �� 1 � .-� I • , r i t i l` � i i I i t� I -f , , r �- I 1 t I �T i I j- t_ .r.. - ,�'.i ; - ' ' r '} -i I , � i v 04 Z O F_ U W U) N. Z O F_ U W CO U) Y W Q 2 W W U Z O F_ U W a • COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM R Applicant: Submit this form with four copies of a scaled plot plan (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. Building Department Application Log # Name (Owner, Agent, Contractor Etc.) Mild r/ `/ > � Mail' Address A"- - ? 2 j 5r./_ -f .f�C , { City ? — / ��'� State / Zip Cade 17 e, 3 Telephone ls�, Job Property Addres0f,/1 W, Jij /17AaF2u "i !'City or Community' Legal Description of Property. (Lot, PM, TR) SHIA A Xrx 'Assessor's Parcel No. VVater.Agenc''r.VJell. �° - of Permit / C/fir•Planning Case # Lot Size 7741 —0 _420,0,'� C Es MH Site Preparation Etc. Signature of Applicant 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 0 -No WOCB Clearance required` ❑ Yes. P'No 1 , Soils feasibility report required. ❑ Yes El No. 1. 1 i Detailed boring report required. ❑ Yes I]'No I + "Detailed contour plot plans required. ❑ Yes 0 No �� f Staff Specialist approval required. ❑ Yes ❑•No Lot Inspection Date Soils/boring report by / Project # Date Soils Map Paget/ Soil Type( )61Approved byr .-// Date r� Type of System: i' No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing ❑`New ❑ Additional ❑ Replacement 3 rn a & Gals. (2) Leach line sq. ft. Sidewall allowance Install Ft. Long, Leaac`h' bed Sq. m (eottotrench area) ft. rock/ Sq. FL �Line(s) Ft. wide`wit min. inches Ft. of'bottom per running ft. O-N%A rock below drain lines area Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth Applicable__-• N/A t*r' 6verburden factor '�5 ©'`6'� H� Max. allowable depth Q, 0 ��7./t .•7 �'1, ./!' r ,�%!.-I.-r>,. ,/i�`'.i%}r. �""l; ! �/1Cf� t� �a�f,Lati'�i�2h�- This application is;apr�ovedrd nied�for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B above. A building permit is necessary for the installation of the above -designed system.. OD) Septic tank and sewer lines must be 50' from any wells 116 , �' S l�-./�r' (2) Leach lines must be 100' min. from any wells including expanslon,area 1.17 4, (3 Seepage pits must be 150' min. from any wells including expansion area Signature of Health Official Date RECEIPT NO. '1 Issued by District: ❑ Riverside ❑<`Indlo ❑ Hemet ❑ Perris ❑ Rancho Calif. Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. DOH -SAN -122 (Rev. 6/86) Date 6,111 / ❑ Blythe GOLDENROD—Pending File %If:a V-1-490 l� ESCROW INSTRUCTIONS TO wxs',['Lwi Mu'ruAL Lsalow SERVICES WESTERN MUTUAL ESCRUW SERVICES Office 74 133 EL PASEO SUITE H, PALM DESERT, CA 92260 PHONE: 619-340-6979 ESCROW OFFICER: NANCY MARSHALL For the consideration hereinafter stated the undersigned buyer is acquiring the land herein set forth from Date JUNE 1st, 1987 Escrow No. 2352 FRANK LOPEZ & PATRICIA ANN LOPEZ, HUSBAND AND WIFE AS -JOINT TENANTS Title to be vested in RICK E. JOHNSON & LAURIE S. JOHNSON, HUSBAND AND WIFE AS JOINT TENANTS/ Real Property in the State of California, County of RIVERSIDE City of LA QUINTA Lot-4—in Block 181 -of Santa Carmelita at Vale La Quints. Unit No. 18 as per map recorded in Book 19 pages 30-31 of maps.in the office of the County Recorder of Said County. -�(D !_F_ tsC r-® LA"') You will record any instruments called for in this escrow when you can obtain Policy of Title Insurance on said property with liability limited to the total sales price showing title vested as above, Subject Only to: 1tAll general and special real and personal property taxes for the fiscal year 1987-88. 2. Covenants, conditions, restrictions, easements, rights and rights of way of record. INSTRUCTIONS: (A) The close of escrow is subject to the buyers approval of the preliminary title report within 3 days of receipt of same from escrow holder. Silence shall be deemed approval. (B) Seller herein to net $9,000.00 less'any tax proration. (C) Escrow holder is hereby authorized and instructed to release to the seller the sum of $1,000.00 from funds deposited by buyer herein. Escrow holder is hereby relieved of all liability for such release of funds prior to the closing of escrow and to any recovery thereof in the event this escrow is not consummated. Said funds to be released upon receipt of these signed instructions by buyer and seller. MEMO: BETWEEN BUYER AND SELLER ONLY WHICH ESCROW HOLDER HAS NO DUTY OR PERFORMANCE: Seller is aware that buyer herein is a California Real Estate Licensee. CONSIDERATION Paid Outside of Escrow To $ Deposit to be made $ 11000.00 Deposit to be made $ 8,000.00 First Trust Deed $ Second Trust Deed $ Total Sales Price $ PRORATIONS AND ADJUSTMENTS to be made on basis of 30 day month on items marked "X" below as oFLOSE OF ESCROW TAXES -49- 86 _ (If amount unavailable for current year. base upon 2nd hall of last fiscal year) INSURANCE on basis of premiums shown on policies handed you. INTEREST on Trust Deed Note RENTS on the basis of rental statement IMPOUNDS to be replaced by the buyer BERSTRt CTIONS: Time is of the essence of this agreement. If, for any reason, this escrow cannot be closed by WP%'M1987 you shall nevertheless close it as soon as possible thereafter unless notice of cancellation is given by either parry. Any notice of cancellation affecting this escrow, for whatever reason and whenever given, may be given only in writing, delivered to you in duplicate. On receipt of such notice you -shall within three days mail one copy to the other party. Unless written objection thereto from such other party shall be received by you within ten days after such mailing, you are authorized to comply with any instructions in such notice and to cancel theescrow upon payment of your cancellation charges. In the event written objection is received within the time stated or in the event conflicting claims are made upon you in this escrow, you may refuse to take any further action hereunder or you may interplead the parties in any court of competent jurisdiction, in which case you shall be entitled to your costs including reasonable attorney's fees, incurred therein. If you become a party to any civil action by reason of this escrow, you shall be entitled to recover your attorney's fees and costs, as may be allowed by the court. You are hereby authorized to deposit any funds or documents handed you under these escrow instructions, or cause the same to be deposited, with any sub -escrow agent, subject to your order at or prior to close of escrow, in the event such deposit shall be necessary or convenient for the consummation of this escrow. From the buyer's funds, you are authorized to pay, upon presentation, invoices for new or additional insurance. Seller warrants that premiums on existing insurance have been paid. Prepare the Deed providing for the Tax Bills being forwarded to the buyers at Ci Address of property a nuinta_ rA Q?)S'l I agree to deposit funds and deliver documents as called for herein and pay buyer's usual charges BUYER R1CK E. JOHNSON Address P.O. BOX 329, La Quints. Ca 92253 i jOHNSON Phone (Res.) Phone (Bus.) The undersigned SELLERS hereby approve the above instructions in their entirety, specifically including the incorporation of the printed general instructions, and will hand you deed for said property to be used when you hold for my/our account the total sales price as above set forth less any amount paid outside of escrow and less the unpaid balance of any encumbrance listed above. Commission, if any, to be paid Broker is provided in separate instructions. From funds held for my/our account pay You are authorized to pay any other encumbrances necessary to place title in condition called for an I/we will hand you any funds or instruments required for such purpose. I agree to pay seller's usual charges. SELLER FRANK LOPEZ .PATRICIA ANN LOPEZ 21.9001 6183 Address P.O. Box 1218, La Quints, CA 92253 Phone (Res.) 564-4624 Phone (Bus.)