12366 (SFD)78-105 CALOLE ESTADO
AddresP.O. 1504
s 78-749 Sagebrush LA QUINTA, CALIFORNIA 92253
Owner Bob Grimes
Mailing
Address 78-605 Sagebrush
City
Zip
-
i2 Quinta,CA
92253
T
Contractor
Appollos Construction
Address
P.O. Box 977
Cil Quinta, CA
Zip 92253
Te1564-1.$8
State Lic.
City
& Classif. 619680
Lic. # 2231
Arch., Engr.,
Designer
Address
Tel.
City I Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) df'Division 3 of the Business na d Professions Code, and my license is in full force and
1ffwffarf.. .� }; I I
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 rile 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 thathe 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
PrFfesosions Code: The Contractor's License Law does not apply to an owner of property who
bwlds r 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 or 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 �Plfipensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy, 90. 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.)
1 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.
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 617-381--025
12366
Legal Description Lot 25 Desert Club Manor
Project Description
Sq. Ft. 1030 No. No. Dw.
Size Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
IPermit includes 220 1.f. of block gardei
wall. Retaining walls and/or pool permits
to be obtained separately.
Estimated Valuation
$112f564.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
332.30
Const.
685.00
Mech.
55..50"
Electrical
1.36.07
Plumbing
178.50
S.M.I.
11..30
Grading
11.0.00
Driveway Enc.
.00
Infrastructure
2,331.73
reciseFl—an
25.00
Arts in Public
Places
31.41
TOTAL
#,J! •8
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 IN
Issued by: Date_
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES''
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE Q
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
A _
FORMS
i
MOBILEHOME SVC.
BAR SINK
POR. S0. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.IV
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. @
GROUT
WATER HEATER
DRINKING FOUNTAIN.
WALL SO. FT.
FINAL INSP.
BOND BEAM �� C
WATER SYSTEM
URINAL
SO. FT. ®
GRADING
CU. yd.
plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP._3
FLOOR DRAIN
MECHANICAL FEES
q (�
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
INSULATION/SOUND
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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 Q
NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE Q
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
A _
FORMS
i
Sf M-Q9—SEPTIC TANK
ROUGH WIRING
Ea
DUCT WORK
ROCK STORAGE
FOUND. REINF.IV
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE o•
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM �� C
WATER SYSTEM
$
GRADING
CU. yd.
plus x$
=$
LUMBER GR.
FINAL INSP. _U
(
FRAMING 1•-7--1 4P
FINAL INSP._3
ROOFING (z _3•.p13 40
q (�
Lr—
O
A(J J N
I
yy�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING j? G.io
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
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 619-775-3500
Date 10/28/93
No. 112504
Owner Name Bob Grimes
Type of Permit I La Quinta
Permit #
Log
No. 78749 Street Sagebrush
City La Quinta Zip 92253 Study Area 123
APN # 617-381-025 Tract # I J Lot # 25 Square Footage 11830
Type of Development 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 1.65 x 1830 or $ 3,019.50 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
By
Bob Grimes
Name on the check
Dolores A. Ballesteros
Superintendent
Telephone
Fee collected /exempted by Vickie J. Durrett
Payment Received
Signature Zia Check No. 1457
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
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`-L L COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY Assessors Parcel No.
DEPARTMENT OF ENVIRONMENTAL HEALTH 6/% — 01
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..
ur--7-9�� 10:18C003
r}
LOG # a (Y VERIFY ITEMS IN SECTION A FROM A NON -FEE BUILDING 8 SAFETY (goldenrdd)�APPLICATION $15,
Agent, Contriaor,"Contact Person
Phone
Address City State 11No Zip
�,i•A' , ;,/ /L/x7,,)i
CHECK 1!53 o I
Owner
'A�<) le 7e�����-'���C
Phone
Address City State Zip/ f
/k �l'r �? ir���i� Z/—'i�(Lfr7i ( !7
Job Property Address
City
State
Zip
Legal Description Prop. (PM, Tract, Lot) ; r
/ � 60 (l /"' /-�f-
r� /�
%'
LoT a?S Fs�r,T �6er� �1q�✓ve 7�11�
Lot Size'
titer Agency W
Use of Permit PIP, CU, etc.
Other
H S' a Prep, eta
=Iling
„Date ;!
Signature of Applicant
CATEGORY REV CODE FEE
CATEGORY REV CODE FEE
SUBSURFACE DISPOSAL (per system) 1238 $153.00
❑ SITE EVALUATION,'Ll 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
❑ SITE EVALUATION Lot Less than 10,000 Sq. Ft. 7347 $172.00
❑ GRADING PLAN REVIEW DETAILED 1238 $104.00
❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00
❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00
❑ COPIES (LAND USE) 7786-81 $ .50
INITIAL DATE
�
Holding Tank Agreements Completed ❑Yes O!'No Pi- ! /� ` 2 74 3
9/o
Certification of Existing S.D. System Required ❑ Yes /
WQCB Clearance Required ❑ Yes P No
. (Attach Form DOH SAN 007, Santa Ana Region Only)
Required ❑ Yes
Soils Percolation Report Nom
Special Feasibility Boring Report Required ❑ Yes elillo
j,21
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes �,`N/o,
o
Grading Handout Provided ❑ Yes PNo
Staff Specialist Lot Inspection Required ❑ Yes m
Maintenance Booklet Provided ❑ Yes El"'N o Lot Inspectio4Dts_ Initial
C/42 / Soils Percolation Boring Report by Lic/PP/roject # Date
Soils Map Page//W/ Soil Type ( - Approved By l4�2 Date �' 9
/
No. of Systems
Type of System(s)
No. Dwelling Units (t)
(1) Septic Tank
Soil Rate
Grease/Sand
❑ Hojdiftg Tank ❑ Replacement
Bedrooms, Rxture-Unfts
G easeIntcp/UntTrap
grN'ew ❑ Addition
3 J�� �, , 1pi ,
Gal.
�� -v
Gal.
❑ Existing
Sq. Ft.
ttom Area
Total Linear
Ft.
`\
\
Sidewall Allowance
ft. rock/ sq. ft. per running ft.
Inlet Tested Depth 1619A_
Instali�� un s ft. Ion ft. wide with
'O+�) 9
Min' Inches rocralnlines or
Leach Bed sq. ft.
of.Bottom Area
Proposed Bottom Tasted Depth
Leaenlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
Seepage Pit Total Depth
(TD) --4 �y
Other:
Applicable
Inlet (BI)
Max. Allowable Depth
V-31 -
NIA t� Overburden Factor
. 6'
/
�O
Well Review Approved: Signature Date Well Drilling Permit #
Grading Plan Approved: Signature Date
REMARKS: _-4 P
Gcl A A&A—Ale.f�� -�Gr H-Gu�-�. / .►� !! u�,.�
ED , E(Jjl`D fi�he cats o checked in SSE O�'B a�`'ove re a in the desi n of'a subsu'fface'is sal
aPP 9 ry 9� 9 d 9 po system as indicated
This �IC�ati& is 'PPRg�a
on the accompani o usin the require a is set gn S.E. ON above A building permit is necessary for the installation of the above -designed
syste
(1 Septic tank must be 1f ' minimum from any wells cJ /U >`�-G✓ N lir Gr'.•�..
(2) Leach lines must be 100' minimum from any wells, includin expansion area `J' /J,c
ESeepage pits must be15500', minimmu�m�fromm�Jany wells, Including expansion area u lol&& �'` � V
Signature of Health Official-�7/�r(�', ( l Cf (/ Date
U'11 SH ❑_ CHECK NO.ZZIS'
RECEIPT NO. ifl& Issued By AAA Data 1-2 7 93
/4 O
DISTRICT: ❑ Riverside Er'Indio- ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
DOH-SAN-122(Rev1/92) DISTRIBUTION: WHITE—Office file YELLOW --Applicant PINK—Bldg. Dept. GOLDENROD—Plans/Records
516
.00
10
L
ORDER #
W r
I
Name
Sued
aw,=
cava
Sale L_
U
RECORDING REQUESTED BY
G
61
'
Bj
rxnipa'
�m
�j s,1`071r..an Ido Irisin ante
It
Jr _j
rn
,.:. .,
WHEN RECORDED DAl11L TO
50. p
to
W m
a
.
ROBERT N. GRIMES AND
W
g
$B
BETTY A. GRIMES
()
78-545 SAGEBRUSH
W
cc
LA QUINTA, CA 92253
I
J
'
SPACE ABOVE THIS LINE FOR RECORDERS
USE -
Quitclaim
Deed' .
The undersigned grantor(s) declare (s):
Documentary transfer tax is $ -0-
( ) 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 LA QUINTA
( XX) Realty not sold.
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
WARD HOWARD AND CINDY HOWARD, HUSBAND AND WIFE
hereby REMISE(S), RELEASE(S)'AND FOREVER QUITCLAIMS) to
ROBERT N..GRIMES AND BETTY A. GRIMES, HUSBAND AND WIFE
the property in THE CITY OF LA QUINTA, RIVERSIDE
as:
County, State of California, described
LOT 25 OF DESERT CLUB MANOR, UNIT N0.' 1, AS PER MAP RECORDED IN BOOK 22,
PAGE _5•3, OF MAPS, IN TUE OFFICE OF THE. CMINTY RECORDFR OF SATT) COUNTY_
First American Title Company has recorded this
instrument. by request es. an accommodation
ordy'and has not examined it for regularity and
sufficiency'or, as to its effect upon the title to
ariy real property that riiaybe described herein.
Mail tax statements to SAME AS AB
Date APRIL 27, 1993
STATE OF CALIFORNIA C
COUNTY,'OF.`' Santa' Cruz:_ s SS.
On April 1330, 1�91I93 d Sbefore.me,theundersigned,
a Notar aY' �rlowartl lansda'L7n`�y�owarla appeared,
personally known to me (or proved to me on the:basis of
satisfactory evidence) to be the person 'S whose name
subscribed to the; within instrument and acknowledged that
theY_ executed the same. Witness my hand and official seal.
Signaturre-1340 :Af
rri' ; LODes'
AG -19
Name (Typed or Printed)
WARD ((HO Wt
\ pA kk
CINDY-HOWAiRD-
a
iJ
•+ ...ice.
MAIL TAX STATEMENTS AS DIRECTED ABOVE
Y
'z Rojo go. 1961160 i.......2-14450
SPACE ABOVE THIS LINE FOR RECORDER'S USE
11
GRANT DEED'
... . ....... - -------
17 381_0.25'•`.
THE UNDERSIGNED GRANTOR(S) DECLARE(S)
yi DOCUMENTARY TRANSFER TAX Is S 35.75
rtorr(pZiled,onfull value 61 property conveyed. or
C] computed
ad onluli;va'lue less value'of lions or encumbrances remaining at time of sale.
0 Unincorporated ar a'.
XI city of La : Qu i'n t a AND
F0 'A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged.
JAMES D. HOWARD,,'M.D;, Trustee of thp James D. Howard,,M.D., Inc., Mom
` *
Purchase Plan T rust
hereby GRANT(s) to
WARD HOWARD end CINDY HOWARD, HusbAnd and Wife an Joint Tenants
yr
a
t -following described real propert . y in the City of Lar Quintshe
'.'County of RiVersidle State 61 California:
LOT 25 OFDESERT.CLUB MANOR_UNIT NO. 1. AS PER MAP RECORDED IN BOOK 2:
PAGE '53 OF,MAPS, IN,THE 'OFFICE OF THE COUNTY'RECORDER OF SAID COUNTY.
q
4r,.—ti�
CALVIN G. KAMINSKAS +� P� DAN RILEY
V
Soolor. WOIp
Aftlflonl Commissioner
(7414)
Moon❑n.
(714) 275-3000 ? , 11 � ' 1714) 2753030
OFFICE OF
AGIRICULIURAL COMMISSIONER
JAMES O. WALLACE, Commissioner
83-612 Avenue 45 Suite 7
I�idi.o,` CA 92201
(619) 342-8291
'DATE / /2 7/1_3? CASE NO: •'f � Cry D 927 `l3 >�
DEVELOPER'S NAME1 {Xp� Z/ cn,-,d-Le t
ADDRESSs 7p toOs 50.4 F Ca•✓�S� %4q%af
TELEPIIONEs (
Dear Developers
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing We Coachella Valley. if substitutions
do occur and they differ from plant material listed, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment
' l
Agr cultural Commissioner'' ffice
ccs Indio and Riverside
I
4080 LEMON STREET, ROOM 19. RIVERSIDE, CALIFORNIA 92501 — FAX (714) 275.3012
COACHELLA VALLEY FRINGE -TOED LIZARD
SECTION 10A MITIGATION FORM
FROM:
APPLICATION
DATE:
APPLICATION.FOR
GRADING OR BUILDING
PERMIT NUMBER
CITY OF LA QUINTA
ASSESSOR'S PARCEL NO (S) . 7 - 3d° / - Z r
ADDRESS
(Name of Developer) has applied for a
building/grading permit affecting zea,B
G
4t.7
This proposal will require the payment of $ ��—
($600.00 X acres).
We have received mitigation in the amount of $
($600.00 X �G 7_L in the form of cash on
from 1-m,& n., j
BJ/FORM.006
Name of Developer
DQ_�DOCT 14 1993 D
By
SOUTHWEST COF;STRUCTION
X Qc*rfificate Of Comp [lance: Flesideniial
D*6--Gf# A -a
q
-Let- -,'Wu er."
6197781385 P.02
(Page 1 of 2) CF -IR
I 0-ziee -'0'6 'Rev. �-lfqj
to -
SMOV Pa #
778 0"057 m
uea.nCho& / Woo
50WROM Uoftd Imacup, int §;Rwn or
C-SHERAL INFORMATION
Total OonMlonad Am Area:
RSC ft2
BuAding Type, JX ale Family Addit.lon
(etc W* or ftsam) MUW-Famlly C-Xl
Front 0dontatfon: NoAh / Fast /,Sowh /West V
(4t4 6w in dwoft and ewde w,
I
NURVWr Of Dw011lng UnOs:
Fbwr WW Type: 616 1 Pulsed Floor Gird® am* or both)
Comstrudon
Cb"V6000 IrWWOn i}y LowiWOommms
U -V lue (atticto eta.)
all .............. A�
Wdu ... M J LL
........... . as II)y TI&I-YSTY
�P�l
RWI
.............
Slib Sd"..
$hadlng Doyloes
F§rfttNWp,- Ayeao Exterior
St. (.j-Y;1qq blind,
1,y pe
roNr new. "Mill
Fmilp
NONEL
Roar.. A)
Rom...%
VISAMAL MASS
Aw ThIcimss
Point System Summa `
J ry�' riate zone 1® P -2R
Oa y
®UILUINU DATA
C®nditioned Floor Area ! Number of Stories I
SlablRakied Fbor
Check all aiicable Unit iypac condition(a):
I I Single Family Detached (SFQ) t D Addhion Alone
14 S111916 Family AttXhgd (SFA) j ] Exleting Building
! 9csNi-Feratiiy (MF)I) E.xtstir g fts-Addition
SR -E CARO
Area %
North —7–sr—
Z.15
East .1 5
West- q
skyllo °at o
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1"
Calling Insulae on
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2.
Wall insulation
W� 30l..
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3"
RAWed Floor Inscalatictt
C%
or
�.
ala aYq& Insulation
"'RaI4��"
0,
or
v� 10�v�03
West
aaluA 0
or
tra 10,75
5.
ii l8t $3
Any Ducts in U ndiib ed Space? Y / N) M
H08tb Loco
rf4J
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1170% ns 6.81
T. F@n8a$ration HOW In
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Installation Certificate: Residential CF -61
U54i of this form to satlsty the requirements of the Administrative Code Is optional, but the Information mu at be provided and posts
78-749 Sag.ebrush 12366
Site Address Permit Number
An installation certificate is required to be posted at the -building site prior to the issuance of the occupancy permit. This form
may be used to most these requirements. All appliance categories listed below are the actual equipment installed. Note that
the efficiency and type of the appliance installed must be equivalent or better than the appliance specified on the Certificate of
Compliance (CF -1R). This certificate (or its equnralerd) shall be prepared and signed by the person(s) assuming overall
responsibility for the appliance installation.
I, the undersigned, verily that the equipment listed in the category above my signature is the actual equipment installed and
that the equipment.meets or exceeds the requirements of the Appliance Efficiency Standards. In addition, I have verified that
the equipment is equivalent to or more efficient than the equipment specified on the Certificate of Compliance submitted to
demonstrate compliance with the Energy Efficiency Standards for residential buildings.
HVAC SYSTEMS
Note: Hydronic boiler information is entered here. Other hydronic or combined hydronic equipment is listed under
Water Heating Systems.
Heating Equip. CEC Certified Actual Distribution Duct or Heating Load Heating
Type (furnace, Manuf. Make 3 ENlclency Type and Piping. Before Over- Equipm
heat pump, etc.) Model Number (AFUE, etc.) Location R -Value Sizing (Btuh) Capaett
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CEC Certified
Cooling Equip. Compressor Unit
Type (air pond., Manuf. Make 6
heat pump, etc.) Model Number
Actual Distribution
Etticlency Type -and
(SEER) Location
6 vv G
Duct or
Piping
R -Value
- - - - - - IOU
The building design heat loss and design heat gain rate have been determined using a method specified in Section 150(h) of
th. Energy,.Eff IRIS ncy ndards, and are two of the criteria used for equipment sizing and selection.
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Sig re Date HVAC Subontratxor (Co. Name) or General Contractor or6�ner
WATER HEATING SYSTEMS
Energy' External
Water Heating CEC Certaled Rated' Tank Factor or Tank
System Type Manuf. Make 3 Input (kW capacity Recovery StandbyInsulation
(storage gas, etc.) Model Number or Btuh) (gallons) Etilclancy Loss (%) R -Value
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.9-16,7
1. For small gas storage (rated input s 75.000 Btu.'hr). electric resistance and heat pump water heaters fat Energy Factor.
For large gas storage water heaters (rated input >75,000 Btufttr), list Rated Input. Recovery Efficiency and Sunday Lass.
For Instantaneous gas water heaters. fist Rated Input and Recovery Effiaency.
For Instantaneous electric water heaters, list Rated Input. .
FAUCETS 3 �� OWER HE S/�
All taut a d/ owe
inst�t'ed e feted. in the Commission's Directory of Certified Faucets and Showerheads,
pure n to i ` 24, Part , Subcfiaptdr. . Section 111.
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Sgra:�re Date Plumbing Subcontractor (Co. Name) or Genera! Contractor or dwner
Revised January 1ett2
joint Property Agreement
November 5, 1993
.This agreement between the property owners of lot 25 on
Sagebrush and lot 26,on Bottlebrush, to install a blockwall
fence on the. adjoining rear, yard of 55 feet.
Said wall .and -:-fPotin(4,`tP--.be centered on, the property
line.
A -copy of this agrebment.to be signed by both property
owners and to beforwarded to the City of La Quinta.
Wall to be.constructed by the owner's contractor of lot
26 and the owner. of lot 25--;Ll'to�pay the maximum amount of
$6'00.00 toward 'the cost of.-i-n;stallation and materials.
Wall to be.5 foot from grade of lot 25.
The owner of lot 25 to -be -provided a.lien release on
labor and material's prior to payment of the $600.00.
Date
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This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building!
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Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use: For the following:
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78-749 Sagebrush Ave.
BUILDING ADDRESS rusve.
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Single Family Dwelling '12366
Use Classification Bldg. Permit No.
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Group Type Construction Fre Zone Use Zone SR
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Bob Grimes 78-605 Sagebrush
Owner of Building Address
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By; Lonnie Day
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�Date; March 15, 1994
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Building Official
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