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9511-011 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm 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. SS347:i B1/31/97 License # Lia Class / A Exp. Date Date �l 1 (./ A Signatureof Contractor OWNER -BUILDER DECORATION I hereby affirm 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 r' 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 permlt is issued. . ( ) I have and will maintain workers' compensation insUiance, 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: Carrier„,,, , Policy No.' o. n sn .os nan�rn, (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 subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with triose`provisions. Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to :criminal penalties and civil fines up to $100,600, 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 application agrees to, & shall, indemnify -& hold harmless the City of Indian Wells, its officers, agents and employees:'4 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 relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for, inspection purposes. V! t V IADate %gnature (Owner/Agent k S ALCM,? BUIL' DING PERMIT�� .PERMIT DATE 12/ VALUATION .rbYsyma3ti,� LOT 26 TRACT 2667 .1195 JOB SITE ADDRESS ti 46-3801<rR(S>C1;b' ELL LAN APN "9_05" 03 OWNER CONTRACTOR '(.7RES, NMAND VETS MI -LAND 1,F:i'4iiURES 43-365TVASAYE.. 43-3165 `E AS AVE. _ t PALM DESERT CA 92211 PA1.,M: DESIMT CA 02.211 (619)345-33133 CII.L#r ('619)11513383 ” DESIGNEWENGINEER d USE OF PERMI1yI4ICJ..LE FAMILY AT 13NV`f3 ,LR -4G PfERMIT DOHS 'N(.)T 1NC IAZE KOCK WALL OR POOL_ FEE DESCRIPTION FEES `CRACrCONaT'RUCTION 1,857.00 at PORCUY.1>Nno - -216.00 SF - - 0ARAGEDIC•ARl'C)RT 597.0 SF E'SI MATED C,'OST CDS' COiNS'fR l('TI N 115,409.10 PERMIT F E•E 4tJKti9:A RY PLAINC.RFCKFE.N 101-000-43 •318 $5116,27 CONSTRUCTION FEE 141-000-418-0130 $095.50 IVIECHANIC L FEE 101430©421 -ON $53.50 0,ECTRICAL FEE* lUi-{30(1-4i(t-130{) $140.44 PLUMBING TEE. 101-000-4.19-000 $162,00 31WtcYrt0I4 FES - RESID 100 -0W -241-0W.$11,54 c P.AD113C FEE 101-000-423-000 iNFTd.ASi`RUC:1'URF FIEF 225-M-443-342 52,.532.07 'PRECISE P1.:A.N 1.01.4XI0441-345 $2.5.00 ART DT PUBLIC 1`%.:4 US u R. SM 701 -MO -255-400 $38.52 SUB -TOTAL. CONgrf1UC1' ON AND PLANT UMCK $4,264.84 LESS VRE-PAID EE $0.00 D`SE1L Prt,RAUTYEES DUE, NOW ';4,,264.14 AAA Fln Q C 01 199 ' RECEIPT DATf�� BV DATE FINAILED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air SteelCombustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing(-71Compressor InsulationVents Fireplace P.L. Grills Fireplace T.O. L Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final BLOCKWALL P ROVALS Final steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out in Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances I 'Zi bun Final Final Utility Notice (Gas) ELECTRICAL P OVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: ------ Q . V i Notice: Document Cannot Be Duplicated Date 11/28/95 Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE No 13909 Jurisdiction Owner Name Nu -land Ventures No. 46380 Street Roudel Lane City La Quinta zip 92253 APN # 649-052-003-5 La Quinta Permit # Log # Study Area 231 Tract # Lot # Square Footage 1857 Type of Development. Single Family Residence No. of Units 1 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 1.72 x 1,857 or $3,194.04 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 Nu -land Ventures Name on the check By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson •n43'45 7360 -'Telephorie ,s r ^� r Payment Receive'd$31;94':04 �.,5: f . Check No. 2028` ` Signature Ij..rl. Lk=MJ Al n A &V\ - Collector: Attach a copy of county or city plan check application form to district copy for all wai-ers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting Order No. Escrow No. 2-18453 Loan No. I V\A V 4 -�• lUo C cc Cn LUN w :gV G id IUj ILLcc DOCUMENTARY TRANSFER TAX $......O...z�.......................:......... SPACE ABOVE THIS LINE FOR RECORDER'S USE J .... Computed on the, consideration or v me -& property conveyed; OR _ / Computed on the consideration or value less liens or encumbrancesI�,Q GV' rem min at time of Signature of Declarant or Agent terminitax — Firm Name al s� --� GRANT DEED FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, RICHARD L. STUFFLER AND SONIA H. STUFFLER, TRUSTEES OF THE RICHAP-D L. AND SONIA H. STUFFLER TRUST hereby GRANT(S) to \ NU—LAND VENTURES, INC., a California'.corporation the real property in the City of �cJrh f4' County of Riverside State of California, described.as Lot 26 of Tract 2667, as per map recorded .in Book 50, Page 64 of Maps, Records of Riverside County,, California. Dated October 31, 1994 t STATE OF CALIFORNIA- }ss. COUNTY OF ki JAZ -0-S 1,0 jr On a - T before me, 1/,J rf q J9ud,Li 4�., personally appeared ,el c1ch4rW L , S? -.e4 personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) Ware subscribed to the within instrument and acknowledged to me that WsOre/they executed the same in W%64their authorized capacity(ies), and that by Ktstt /their signa- ture(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand fficial seal. Signature MAIL TAX STATEMENTS TO: chard L. Stuffler, Trustee Son -fa -H. Stuffler, Trustee PATRICIA A WHITTLE NOTARY PUBLIC -CALIFORNIA° COMM. No. 1023070 . RIVERSIDE COUNTY MY COMM. Ems. JUN 20, 1998 I (chis area for offizial notarial seal) 1002 (1/94) WHEN RECORDED MAIL TO: NU—LAND VENTURES 43365 Texas Street Palm Desert, Ca. 92260 ( 4 -�• lUo C cc Cn LUN w :gV G id IUj ILLcc DOCUMENTARY TRANSFER TAX $......O...z�.......................:......... SPACE ABOVE THIS LINE FOR RECORDER'S USE J .... Computed on the, consideration or v me -& property conveyed; OR _ / Computed on the consideration or value less liens or encumbrancesI�,Q GV' rem min at time of Signature of Declarant or Agent terminitax — Firm Name al s� --� GRANT DEED FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, RICHARD L. STUFFLER AND SONIA H. STUFFLER, TRUSTEES OF THE RICHAP-D L. AND SONIA H. STUFFLER TRUST hereby GRANT(S) to \ NU—LAND VENTURES, INC., a California'.corporation the real property in the City of �cJrh f4' County of Riverside State of California, described.as Lot 26 of Tract 2667, as per map recorded .in Book 50, Page 64 of Maps, Records of Riverside County,, California. Dated October 31, 1994 t STATE OF CALIFORNIA- }ss. COUNTY OF ki JAZ -0-S 1,0 jr On a - T before me, 1/,J rf q J9ud,Li 4�., personally appeared ,el c1ch4rW L , S? -.e4 personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) Ware subscribed to the within instrument and acknowledged to me that WsOre/they executed the same in W%64their authorized capacity(ies), and that by Ktstt /their signa- ture(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand fficial seal. Signature MAIL TAX STATEMENTS TO: chard L. Stuffler, Trustee Son -fa -H. Stuffler, Trustee PATRICIA A WHITTLE NOTARY PUBLIC -CALIFORNIA° COMM. No. 1023070 . RIVERSIDE COUNTY MY COMM. Ems. JUN 20, 1998 I (chis area for offizial notarial seal) 1002 (1/94) ASSESSOR'S PARCEL NUMBER COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY 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 specifications as indicated on the attached check list. A non-refundable filing fee Is required when the application is submitted. Check must be made payable to the County of Riverside. Approval of this appl'Ica- lion shall remain valid for a period not to exceed one year from date of Payment. i it 2'_.q5 08%4'�'COOI `�� / L238 $162.01 LOG # CHK $162- 00 Agent, Contractor, Contact Person �� P Address `City State Zip ?:? `�� �F ��?�I( Telephone ­> -? X11 I F �` T =k I JF. �� ?4S Owner Address City State ZIP Telephone Z Job Property Address City Zip U Lot Size Water Agancy/Well Use of Permit, P/P, SUP, PUP, etc. Legal Description W U7 Dwelling, MH Site Prop.. etc. Signature of Applicant �l i Date CHECK BOX IF REOUIREDi Q Holding Tank Agreements Completed ❑Detailed Contour Plot Plans Required (1 to 5 foot interval) ❑ Certification of Existing S.D. System Required ❑ Grading Handout Provided ro ❑ WQCB Clearance Required ❑ Staff Specialist Lot Inspection Required Z O (Attach For DOH -SAN -007, Santa Ana Region Only ❑ Lot Inspection U ❑ Soils Percolation Report Required ❑ Date Lot Inspection Completed: Initials w U) ❑ Special Feasibility Boring Report Required Remarks: ❑ Maintenance Booklet Provided Initials Date ❑ Final Inspection by Department of Environmental Health is required. e CJ42 /Soils Percolation Boring Report by UgPro)ect # Date T 1 r Soils Map Page Soil Type Approved By Date No of Systems Type of System(s) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Sand O Holding Tank O Replacement IdNew O Addition Bedrooms, Fixture Units ) C r 'Z Grease Intcp/Lint Trap O Existing /!' tt 00 Gal. Gal. P Sq. i t. Bottc..n Area Total Linear Ft. 9 Sidewall Allowance - Leach Bed sq. ft. of Bottom Area tt. rock/ sq. ft. running ft. Install Line(s) ft. long..�tt. wide with Inlet Tested Depth '�❑ NA min. -inches, rock bel w dkainlines or tJ • Proposed Bottom Tested Depth Z Leach lines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Pit Maximum Other: Oj Applicable r Total Depth Allowable Depth W N/A Overburden Factor L] 5, 6' v l P TD "fl 20 N Well Review Approved: Date: Well Drilling 'ermit # SIGNATURE Grading Plan Approved: Date: SIGNATURE Sewer Verification Approved: Date: REMARKS: r This application isjAi ROVED/D�NIED for the category checked in SECTION B FOR OFFICE USE ONLY above, regarding the deslg"1140 subsurface disposal system as Indicated on the acomoanted plot plan using the requirements set forth In SECTION C above. A build- ing permit is necessary for the Installation of the above -designed system. No construct Revenue code ! Fee $ / �✓ tion is permitted in the required reserved 100% expansion area () eptic Tank must be 100' minimum from any wells. Check # (2) Leach lines must be 100' minimum from any we!ls, including expansion area. Date 0 IVS- Initia . C] (3) Sewer lines must be 50' minimum from any wells. ' /l / j Z O_ C(4)9eepage pits must be 150' minim m from any wells. Including expansion area. U W 2'��%7^�iF Signature of Health Official J v Jdz 5A Date' r ^+ ^ • « 1^— ar»r 1JI.JUIUMIUn. vvni I c--vnice rim, T CLLV W—Applicam; r•ir4m-uiog. wept.; GOLDENHOL—Plans/Hecords