07539 (SFD)P.O. BOX 1504 N o . 07539,
Building 51-720 Rubio 78-105 CALLE ESTADO "
Address LA QUINTA, CALIFORNIA 92253•
Owner
Mailing`,
Address 2 ` ale ,Mire
City Zip Tel, -
Contractor
%Mid
Address .. =rte • -_,
City Zip Tel.:
State Lic:`;`; City
&'Classif. Lic. #
' Arch., Engr.,._.
• Designer
Address `• "' Tel. -
r.,:
City "' z. Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE - - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that.l 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).
❑ 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 propertywho
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 of completion, the owner -builder will have the burden
of proving. that he did not build or improve for the purpose of sale.)
❑ 1, 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
A
Date 41 aCJwner v _
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 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.
1 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' 6
BUILDING:. TYPE CONST. OCC: GRP.
A.P. Number 773-022-008
j
Legal Description
Project Description Single Family DwZ; i»g "
..I: V
TOTAL -.7 S3.436.44 53.186..44 >
REMARKS
torr
AY c 6 s�1sr7W_4_
ZONE: BY:
Minimum Setback Distances:
Front Setback,f.rom Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
4/13190
Issued by: Date Permit
Validated by: y'
Validation:
Sq. Ft. 1624',,
Size
No. No. Dw.
Stories Units
New ❑ Add ❑ .
Alter ❑ Repair ❑ Demolition ❑
Does -not include pool or btod Wall.
t e
Estimated Valuation
$88,563.20
.PERMIT '.; ,
AMOUNT
Plan Chk: Dep. ,
250.00
Plan Chk. Bal.
256.64
Const.
690.00
Mech.
55.550
Electrical
126 M-
Plumbing-,
157,50-
5 ,50-
S.M.I.
S.M.I.
ji. 23...
Grading
--20.00-',
Driveway Enc.
20.E
Infrastructure
t` 1,954.43
..I: V
TOTAL -.7 S3.436.44 53.186..44 >
REMARKS
torr
AY c 6 s�1sr7W_4_
ZONE: BY:
Minimum Setback Distances:
Front Setback,f.rom Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
4/13190
Issued by: Date Permit
Validated by: y'
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTF.M
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) /_ /Gp METER LOOP
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQU1P.
LAUNDRY TRAY
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
�)
FINAL INSP. j
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
REMARKS:
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK ;57/-9/
9/�
p� M UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 'rK
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER ROUGH WIRING
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH) /_ /Gp METER LOOP
HEATING (FINAL)
OTHER APPJEQU1P.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$,,P
LUMBER GR.
�)
FINAL INSP. j
FRAMING
FINAL IN�SP.
ROOFINGrf0rQ
'000'
/
O
Q
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LAT HINGt !Q/N
MESH
INSULATIONISOUND6
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
C�
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253 NOTICE: THIS �3®.CUV' EST CANNOT
NOTICE: BE DUPLICATED,
This is to certify t at
developer of which is
located at , within
this District, has paid school facility fees imposed pursuant to the
authority enerate by Government Code Section 53080 in the amount f�,
Sa53 ( ) AD
covering a total of square feet of'(J ) residential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
96 -
for DESERT SANDS•UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL THIS DEED AND UNLESS OTHERWISE SHOWN BELOW
MAIL T4X STATEMENT TO:
Name GARY J. SEMERAD :111i
,treat OD
Tress 12 Toledo Dr. C"
ty& Rancho Mirage, CA 92270
RT ;late
MAIL TAX STATEMENTS TO C)
1-4
C=r
Ime
L F_ 8
X
,eet SAME AS ABOVE
r ass
Ci7a&
State
TITLEORDERNO. 8925301-21 ESCROWN0. 2-10274
SPACE ABOVE THIS LINE FOR RECORDER'S USE
GRANT DEED
Wo
773-122-008-4
THE UNDERSIGNED GRANTOR(S) DECLARE(S)
DOCUMENTARY TRANSFER TAX IS$ 17.05
jopomputed on full value of property conveyk, or
0 computed on full value less value of liens or encumbrances remaining at time of sale.
'A4
mp rgtedW_A=,4,,_4q�,�
>60Y Of La Quinta
AM - 77, T-777re,
FOR AVALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
LISA MARIEICARREIRO, a single woman
hereby GRANT(s) to
GARY J. SEMERAD and SHIRLEY A. SEMERAD, Husband and Wife as Community
Property
the following described real property in the
-City of Lauinta
County of Riverside State 05 California:
THE SOUTH 1/2 OF LOT 8, IN BLOCK 22 OF SANTA CARMELITA AT VALE LA QUI.N4f
UNIT NO. 2, AS SHOWN BY MAP ON FILE IN BOOK 18, PAGES 55 AND 56 OF MAPSf"'
RECORDS OF RIVERSIDE COUNTY, CALIFORNIA
Dated Oct. 2
LISA MARIE,CARREIRO
STATE OF CALIF A
COUNT
On this OF
of in the year 19
before me, the undersi a Ncrtary�fic in and for said Stale,
pe;apnally appeared
personally known to me
(or proved to me on the,basis of satisfactory evidence) to be the
person — whose,name subscribed to the within OFFICIAL SEAL
instrument, and acknowledged to me that he executed it. DIANA C. THUNEY
IFO
RINIA
NOTARY PUBLIC - CALIFORNIA
WITNESS my hand and official seal. RIVERSIDE COUNTY
My Comm. Expires Aug. 31, 1991
Signature
NOTARY PUBLIC IN AND FOR SAID STATE (This area for official notarial seal)
CO -441 (REV 4185) MAIL TAX STATEMENTS AS DIRECTED ABOVE.
-------------------------------------------------------------------------------------------------
. � a � � - r. ' . _ _, � y „" }� � . Y y. .`•?-�'�!'sY �� � r -La R. ' � . r �, y w Y• '.Zr .. '. ` i. .. T
Asseum Parcel Nm
COUNTY OF RIVERSIDE ENVIRONMENTAL.'
r HEALTH; SERVICES DIVISION
PERMIT; APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM.
Applicant: Submitthis form with four copies of a scaled plot plan (1�-20 scale) drawn to County speculations as,indicated.on the attached check list
Anon refundable filing fee (see below).is required when the application Is submitted. Check must be made payable to the County of
Riverside.,. of this application shall remain valid for a period not exceed one year from date of approval.
iiJJr^Approval
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
'.Agent, Contractor, Contact Person
Phone
Address & Firm o1?A,,<{00 /�►i/Z/+GS
O a
Owner
Phone
Mailing Address
G ,
City
State
Zip
Job Property Address
Legal Description Prop. (PM, Tract, Lot)
CIi/e LCrALK
Lot Size
er Agency
Use of Parmft P/P, CU, etc. �a ( u�,,, f s
Other)
—71
SO /PJO
welling, rep, etc.
Signature of Applicant
Date
CATEGORY: REV CODE FEE
CATEGORY: REV CODE -` FEE
UBSURFACE DISPOSAL 1238 $ 57.00
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
_
❑ . MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00
a_ lot 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year) _
b.. Each Parcel after 4 7344 4$ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $ 47.00
Critical Area 7348 $111.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
H �/ NfTI DATE
Holding Tank Agreements Completed ❑YestJo .
Certification of Existing S.D. System Required ❑ Yes
WOCB Clearance required. (Attach Form ❑ Yes ❑��
DOH SAN 007, Santa Ana Region Only)
Solis Percolation Report Required. ❑ Yes
Special Feasibility Boring Report Required. ❑ Yes
6No
Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes N
'
Other ❑ Yes
Staff Specialist lot Inspection Required ❑ Yes i7 No
Lot Inspection Date
Soils boring report by Project/ Drta
C7
Soils, MapPage 1141 Sol Type Approved by Date r
No. of Systema
T of System(.)
❑ Hoiding Tank ❑ Existing
❑ Replacement
No. Dwelling Unb(i
Bedrooms, due.Q
(1) Septic Tank
Soil Rate
Grease/Sand
Ir p
1
F1�1�'i
&3�,l
1(2 Leech Line Sq. Ft
Sidewall allowanceInstal
Lne(s) fL long n wide with
Leach Bed sq. ft
trench ams fttWft
rock/ sq. R
min. below dralnlines or
area
per running ft
NA
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
Applicable i
f
Inlet (BI)
1
(TD)
N/A � Overburden factor
"`
Max. Allowable Depth
No. 2 System IIIA—
REMARKS:
—
This application i,APPROVED .E.NIED, for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied plot pia�r , 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 from any wells q//per
Leach lines
(2) must be 100' minimum from any wells, including expans' area
Seepage pits must be 150' minimum from any wells, including expansion a ea 1
Signature of Heattli Official Date
RECEIPT NO.r2!Kg Issued By Date
DISTRICT:. ❑ Riverside,? 7) ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
M
i
�• °'�.� OFFICE OF
AGRICULTURAL COMMISSIONER
AND
WEIGHTS & MEASURES CALVIN C. KAMINSKAS
JAMES 0., WALLACE 4080.LEMON STREET, ROOM 19 AsslstanlCommissloner
Agrlculhnal CommIssloner RIVERSIDE. CALIFORNIA 92501 CLEMENT BENVENISTE
j grector of Welghls a Measures (714) 781-2561 Seoler
49613 Highway 86, Suite B12
Coachella, Ca. 9223.6
ATE ;
E
L V 619) 342
D -CASINO.
DEVELOPER'S N11ME3 E- vTAt d\*\d
ADDRESS:
LA
2A'ri 14A�, -0i
TELEPHONE:
Dear Developers.
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 fran plant material listed, this office must be.notified
immediately.
Thank you for protecting and preserving the Coachella Valley'.s pest -free environment.
Agric ural Cam,nissioner s' f ice
ccs Indio and Riverside Office