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12129 (SFD)Building 51-270 Ramirez P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Owner I Mu mbil . Inc. Mailing Address P.O. 501% 1555 City Zip Tel. La Quanta, Cly 92253 1 564-1338 Contractor Numbi.1, Inc.. Address Same City Zip Tela State Lic. City & Classif. B~537333 Lic. # 2526 Arch., Engr., Designer Greg Bugler Address Tel. P.O. Box 6 564-0518 City Zip State La Quinta, CA, 92253 Lic. # 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. 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). ❑ 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 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. & 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. ❑ 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: 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 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 No. 12129 BUILDING: TYPE CONST. OCC. GRP. A.P. Number 773-083-002 Legal Description Lot 23 Plock 66 Project Description SFD r, Sq. Ft.1729 Size No. No. Dw. Stories Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Permit does not include any block walla or pool. Estimated Valuation $99,849.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 565.€10 Const. 639.50 Mech. 55.50 Electrical 129.42 Plumbing 166.50 S.M.I. 10.01 Grading 20.00 Driveway Eno. —0— Infrastructure 2,231.30 1112 iF12 110 6973.. it-�',..yx TOTAL 3?i %,sta l l x 1111"3,19T. Tr,„ : 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE Y ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SQ. FT. @ STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® ROCK STORAGE FOUND. REINF. POWER OUTLET ROOF DRAINS GAR. SO. FT. ® OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. SO. FT. ® GROUT WALL SQ. FT. WATER HEATER DRINKING FOUNTAIN. FINAL INSP. URINAL SO FT ® WATER SYSTEM ESTIMATED CONSTRUCTION VALUATION $ _$ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING �^ FLOOR DRAIN MECHANICAL FEES 7n .�'� WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRYTRAY AIR HANDLING UNIT CFM FIREPLACE 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 SO.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT 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 GROUND PLUMBING�a (� UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS -MT7EMM'SEPTIC TANKb-fO 3L OUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) / TEMP. POLE S� 3%43 uj III GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. plus x$ _$ LUMBER GR. FINAL INSP. --q-- j r4 FRAMING �^ FINAL INSP.823^ 3/p$ ROOFING , LYi 7n .�'� gG(7 TQ. ^ o 71 �O I C ° dx� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING 6 -75 S LSD MESH INSULATION/SOUND -� 3 FINISH GRADING FINAL INSPECTION 7 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 4/30/93 Type of Permit I La Quinta No. 112178 Permit # Owner Name Mumbil, Inc. Log No. 51270 Street Ramirez City La Quinta zip 92253 Study Area 113 APN # 773-083-002 Tract # I J Lot # 0 Square Footage 11729 Type of Development I Single Family Residence I 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.58 x 1729 or $ 2,731.82 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 Mumbil, Inc. Telephone 564-1338 Name on the check By Tames E. Lively . Assistant Superintendent, Business Services Fee collected /exempted by Signature Tomi Doebereiner Payment Received Check No. 5502 Collector. Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/ Receipt Copy - Accounting .l`1ECon0INc r-FQUESTED 13Y 1.116 Wn[q 0[COPUtO RAI( TWO DTfl) 40 1111I.P11 DIH[AW10[ SNOW" Alt OW qNl 1rU 91A1(W(N1 10: --HUMBIL, INC. /M. Marnhall S •eel 42135 COBALT WAY r:l.a PALM DESERT si,,l4 CA 92260 HATt TAY $ttj[Mr.Nr- to ;I•rPl A •:. •ii ��1!I mit nnntnPin 1.975662 (srnnwNn. 2-15093, 'V'1 cardod -1) S Y SPACE ABOVE THIS LINE FOR RECORDER'S USE GRANT DEED 11 Ir UNDERSIGNED GnAN'Ton(S) DECI_.AnE(S) DOCUMENJARY14"JANSFER 1'AX IS $ 22.55 LN'Ornputrad on 11.111 vnlurt of propel ty conveyrid, r:n L_l collipul"d on full VRII'Ie less value Of liens or erlc:umbrarlce5 terrlaining at limp of sale. U unincorporated area C:ily of LA QUINTA AND Fon A VAI_UABI.. CONSIDEPA-T'ION, receipt of which Is hereby acknowledged, JILT.. I,T;SLI? WORTH, a ninoIn woman humby GRANT(s) to flut'itub TNC. , n California Corporation lim following descrilled le"ll propnity in it]() City of LA. QUTNTA County of RIVERSIDE , State of California: LOT 23 OF BLOCK 66 OF SANTA CARMELITA AT VALE LA QUINTA UNIT NO. 6 AS PET MAP RECORDED IN BOOK 18 PAGE 67 OF MAPS IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY. STATE OF CALIFORNIA ) County of J Q -_ • 4.0 P R Q. E nn$'�_C�S_L�4 ._.p_L�� _.,.,... bebre me, tho undersigned, n Notary Public, inCj and for said State, personally a i eared _ TL ---- �_ ® .mona►lly known to me or proved to me on the basis of satisfactory evidence to be the person(g) whasp F« a nan,e(s) inlarr► PLJbscribod to thn within instrurri®nt and acknowledged to me that he/sheAhey executed G , the samAInhisthetRheirauthorized capncity(ies),andthat byhis/herJthpirsignaturT�(s}onit>einstriu7�ntUiep�rrson(s),�.'��: or the entity Upon bnhnif of which the person(s) acted, �;� G=FI �rL SE''L r+xr+culed the instrument. `I ' DON"Ili M. tL"' t NOTAAY;PUBUC—C aLIFORNIA CA1NCIpAL G' HOE IN • . AIVE11910E ;OUNTY 'd� LJ? rPi�fl9n Cx9+011 ATIG, 24. 199fi eC WITNESS my hand and official seal. 1 ......,... Signature- _ _.... _._..._..._.__.._._____........ ............_..... Assessors Parcel No. COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY 7 %j -U�3 -O0�•- DEPARTMENT OF ENVIRONMENTAL HEALTH 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 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� lia_-1•��....93 l.v:nnf, D1 ..LOG # S�(GNc/f� VERIFY ITEMS IN SECTION AFROM ANON -FEE BUILDING &SAFETY (goldenrod) APPLICATION A ent, Contract 9%rContact..Person Phone.. x(0_1-133 - Address City238 State Zip dij LL Yro( � .f o 1 ktr#c CIA - 0 ie 71 �P-h/o�ne (1ki Address G� City State Ij+}p Zip 11� 0, 2, CHECK Job Property AddressAt#-A0,4 City L StateZip Legal Description Prop. (PM, Tract, Lot) s,� Cne s -Z Bann\Vet:.. \ u -I on2s31:dT zZ Lot Size Af iter Agenc �/Vell Use of Permit P/P, CU, etc. Other AT (RIE Lq j�ur,% ��_� MH Site Prep, etc.. belling, i Date Signature of Applicant CATEGORY REV CODE FEE CATEGORY REV CODE FEE 911SUBSURFACE DISPOSAL (per system) 1238 153.00 ❑ SITE EVALUATION UPON REQUEST 7349 $120.00 ❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION (NO PLOT PLAN) ❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00 a. 1st 4 Parcels (Each) 1238 $153.00 ❑ PRELIMINARY ELECTIVE EVALUATION b. Each Parcel after 4 7344 $ 55.00 (Attach DOH -SAN -53) 7352 $ 69.00 ❑ REREVIEW (2nd review same parcel) 7344 $ 55.00 ❑ HOLDING TANK 7351 $119.00 ❑ SITE EVALUATION in Conjuction with Critical Area 7346 $197.00 ❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00 ❑GRADING PLAN REVIEW DETAILED 1238 $104.00 ❑ SITE EVALUATION Lot Less than 10,000 Sq. Ft. 7347 $172.00 ❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00 ❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00 [I COPIES (LAND USE) 7786-81 $ 50 INITIAL DATE u ? Holding Tank Agreements Completed El Yes fG(,r�� �/No Certification of Existing S.D. System Required ❑ Yes No I WQCB Clearance Required ❑ Yes No (Attach Form DOH SAN 007, Santa Ana Region Only) ' Soils Percolation Report Required ❑ YesNo Special Feasibility Boring Report Required ❑ Yes Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes �Zo Grading Handout Provided ❑ Yes � o Staff Specialist Lot Inspection Required ❑ Yes N" Maintenance Booklet Provided ❑ Yes p No Lot Inspection Date Initials C/42 / Soils Percolation Boring Report by Lic/Project # Date Soils Map Page +� Soil Type /�a� Approved By �>� Date S f'z 43 No. of Systems Type of System(s) No. Dwelling Units (1 } (1) Septic Tank Soil Rate Grease/Sand ❑ Holding Tank ❑ Replacement O'Aew ❑ Addition Bedrooms, f ixtttcesUnits• .Aovd t ?% �V �• 3 !�� Grease lntcp/LintTrap ❑ Existing Gal. Gal. , S Ft. Sq Area Total Linear t. Sidewall Allowance �IGF,IT Leach Bed sq. ft. Ottom h. rock/ sq. ft. per running ft. Inlet Tested Depth OFNA Install_ Line(s) ft. long ft. wide with min. ches rock below drainlines or of BottomArea �,. Proposed Bottom Tested Depth - Leachlines/bed special design for slope: (3) Pit Diameter N0. Pits Pit 8910W Seepage Pit Total Depth (TD) ".r / Other: Applicable I�5 _r_Inlet — ( BI - - - N/A Overburden Factor Well Review Approved: Signature Date Well Drilling Permit # Grading Plan Approved: Signature Date REMARKS: This application i�. PPR,OVEDD%D fVIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompanied plot R an, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed syste o (1 Septic tank must be 100' minimum from any wellsd /U son Leach lines must be 100' minimum from any wells, inclu Ing a pa�f area 63�Seepage pits must be,150' minimum from any wells, includind expansion area cY /0//, 11 GI Signature of Health Official r"�! w `� Gam' i[- C �(i' 1 Date `d 3 RECEIPT NO. DISTRICT ❑ Riverside DOH -SAN -122 (Rev 1/92) . ❑ CASH Z'CHECK NO. <S1 S' Issued By U. �� GJ�^' ' Date 5 //an / Indlor) ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe DISTRIBUTION: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Plans/Records , ....: tib 00 Remarks: F ❑Copy to: ` COACHELLA VALLEY WATER DISTRICT i `CASH RECEIPT DETAIL. NO 4 .r Order J Date: / .!... Received From: Address:, �.. � Ir � � (> Account No. LI), � � 1..J 1 � 1 �__- Lolls) Tract - y __-- 15A i = ; f1' 1 1 . t v't-i Service AddressG.A.'Code ❑�SerVicelsl � — Backflow(s) -- c ❑ House Lateral(s) — ❑ DetectorCheck(s) - ❑ Meter Surcharge — ❑ Sanitation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter _ ❑ Turn on Charge ---- ❑ Uncollected Account - Name-- ❑ Inspection Fee - Tract - Fee - — FJ Plan Plan Check Fees Water I Sewer - Tract - ----. — ❑ Bond Payment - A.D. - Bond Assmt. -- ----- ❑ Customer Deposit — ❑ Other — TOTAL $ Remarks: — ❑Copy to: Cash Check Money Order Water Service Cashier - 438 (11189).