08688 (BLCK)C&hf
414ag
W
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address c;A_d?rs rA 3 1,64 Aga l l(�tT �t LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 53,-885 Calle Paloma
City lZip ITel.
Contractor
Address
City jZip . Tel.
State Lic.I City
& Classif. Lic. #
Designer Drafting Services
Address Tel.
74-x183 Kerle Far.
City Zip State
Palin Desert 92260 Lic. #
'Ta ' 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).
0 1, 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.)
❑ 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
DateZ�'
Ownerfi
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 copythereof. (Sec..3900, Labor Code.)
Policy No. _) I"-- C,., c pany a.1 - '�' i+r r 1 C, �f_, e
❑ ; py is filed with the city. �ICertifled 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 o/�ff�Calrf�yo�rn�/ia. -Al
Date �Qwner >- i,'i.;l..a . 1 ��^ -+) rte• yt w V\.�
NOTICE TO APPLhCANT: If, i`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 conslruction'lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name r. •t /`
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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 cityto enter the above-
mentioned property for inspection purrposes. //���//}} / {_
Signature of applicant r%fst!.�?fiR-. /"/11 /4G 'C ate ! f t 7 �T
Mailing Address
City, State, Zip
BUILDING: TYPE CONST
No.
OCC. GRP.:
M14,
.. 1
• *T.1.1f
A.P. Number 7"441...1 Al _A1 1
Legal Description trxyp - 1 AC; nxac0pX'i" W tib ePran+k
Project Description "
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:
Sq. Ft.
Size 2603
No. No. Dw.
Stories 1 Units 1
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
Block tell
included in permit
3srr:nl7 >ncsf^ �
x�rtt n,r3r�+r3 � n *��s>E �-
Estimated Valuation
�'r �tit1p00 • 4 p
�i�� �V�i7
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal. '
448.57
Const.
814.50
Mech.
96.00
Electrical
166.29
Plumbing
202.50
S.M.I.
10.50
Grading
20.00
Driveway Enc.
20.00
Infrastructure
3085.42
Precise Plan
25.00
TOTAL
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
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
D SEWER OR SEPTIC TANFv
ROUGH WIRING.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF. 12
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SQ. FT.
HEATING (FINAL)
OTHER APPJEQUIP.
WALL SQ. FT.
GAS (FINAL)
DRINKING FOUNTAIN.
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
`
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFING q �h / L
LAUNDRYTRAY
AIR HANDLING UNIT CFM
1
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.
SQ. FT. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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 d
V UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
D SEWER OR SEPTIC TANFv
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. 12
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL r�
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
(/
WATER SYSTEM
GRADING
cu. yd.
$ plus—x$_=$
LUMBER GR.
FINAL INSP.
`
/
FRAMING 2 2Yl {�
�7 /f
FINAL INSP.'-7 3'0lc / go
(/
ROOFING q �h / L
/``
f3 at4a��
rNnfi
i 1 -7 %� 1 L�
�l l
1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
1
TG L
HIN
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION 36(c
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED :SCHOOL DISTRICT
82 Hg'i�
�Way.
111.
NOTICE: Indio . C �X 92201
Document =Cannot Be Dupliqated
(619
W--8631
Date] 11/29/90. Type of Permit La: ` uinta
No. 10290.. Permit #
Log # I I
Owner Name Michael G. Mitchell
No. 51425 Street Calk Paloma'..;
'.
city L,"uinto, klo:, 92253, Study Area
APN # 1769-14.1-01Tract Square Footage M
Type ofDevelopment 1.jrSingle 'Family R Residence si. ence No. of units
Comments
At the present. time; the Desert Sands Unified- School. District does not collect fees on
ar alk'
garages/c. . _pdrts,'�,�clovered p;;Aios/W'_- W__"a'y§, residential addifions under 500 square feet,
deta6he'd accessory tr ctures or replacement n6bileho
me -s -. ''It h4sibeen determ'ned,
the.,ab6ve-named
6wner.is,-exeihpt from pay1rigs-6ihool feesat this time due to the
following reason:
EXEMPTION NOT `"PLICAIBLE
This certifies that- h Ifacility fees 10.,
mposempursuant .Government Code,53080
in the 4nount-of .,%03
_or$ -&j12.`74 have .1eenpwdtoD.S.U.S.D. for
the lsthd-abovp�a�.i6i�pi01ty
pernuts and/or teittficates .-of Occupano for
this square footage hi this, p*vposed-
project may now issued
Fees Paid by 'Michael Mitchell
Telephone 564-3418
Name on the "cii- check''
By Richard M.
Director, Facilities Planning,&Development
Fee collected /exempted. by Shelley D. Bennett
Payment Reccve
l
Signature I Check Nc:'202:326/1592
Collector:. Attach a c
opy ofCounty or City plancheckapplication form to,District copy.,.
Embossed Original- Building Dept./Applicant Copy'- Applicant/Receipt Copy - Acc6iinting
T C�iKao� e •
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GRANT DEED
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TW UNDERS ONEd.ORANVA(9) DECLAN(S)
DOVA M W TAAMSM:rAx IS! 57.30
C*o" vtnd on MR vrk"A d propMr m rVv
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VZMCUT A. MARIU M ane JVLIA A: MARE M, Rusband and Wife
h KoW ORANTIs) W
MIC18L 0. MITCHELL, a single man
ew b1m6ko dsfor!brd.rW prop". lel ft City of LA -UZMTA
COL"Y o RIVSRSIDS,81at�61cebmw.
tuft 185 OF VX8nT CLVD TRACT UNIT No. S AS PER KAP RECORDED IN BOOR 21,
PAGXS 61 AND 62 OP KAPS, RECORDS OF RZVERSIDB C60XTY, CALZrOPMZA.
DOW June iS. 1990
stmOFCrkPOVE" RIVERSIDE
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7777777.777��
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Asse"Ors ftraw NIX
ENVIRONMENTAL SERVICES DIVISION 17 69 Iq
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 me attached check Ila
Anon -refundable filing fee (sea below) is required when'the application Is submitted. Check must be made payable to the County of"
Riverside. Approval of this application Phall remain valid for a Period not to exceed one year from date of approval.
VERIFY ITEMS IN SECTION A FROM BUILDING &'SAFETY. APPLICATION BUILDING DEPARTMENT APPLICATION LOG # =V�Z?
Ad
Agent Contractor, tact Person Phone dress&'Firm 0 C7 ro & - , V
t 151, <
LU owner Phone Mailing Address
) W
citytA 1 V'cA State Zip Job Property Address Legal Description Prop. (PM, Tract. Lot)
4
I
Lot Size 0 Use ofParmi'P/P,CU, etc. 44 (99,Wrq
Other
Dwells , f�H Site Prep, PC
7/
Signature of Applicant
Data
CATEGORY:,; "_' REV CODE FEE CATEGORY: REV,CObE' FEE
81105URFACE DISPOSAL 1238 W5_7=4�74 0 SITE EVALUATION UPON REQUEST 7349 $ 43.00
CD 0 MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN)
LAND DMS40N 0 SEWER/SEPTIC VERIFICATION 7348 $ 17.00
OZ
a. 1 at 4 Parcels (Each) 1238 $ 57.00 (Loss than 1 year)
b. - Each Parcel after 4- 7344 $ 24.00 0 PRELIMINARY ELECTIVE 7352 $ 23.00
Ui 0 Rereview (2nd review same parcel) 7344 $ 24.00- EVALUATION (Attach DOH SAN.53),.
0 Site Evaluation in Conjunction with 0. HOLDING TANK .7351 $ 47.00
Critical Area 7346 $111.00 0 ALTERNATIVE/EXPERIMENTAL -,7345. -$222.00
0 Site Evaluation Lot Less than SYSTEM
10,000 Sq. Ft. a 7347 $ 87.00
00r INIT7L DATE
Holding Tank Agreements Completed 0 Yes /N_9 0 0
Certification of Exlatlng S.D. System Required 0 Yes7NoO/
7
No
WOCEI Ciearanoe required. -(Attach Form 11 Yes • N
DOH SAN 007, Santa Ana Region Only)
soils Percolation Report Required. 0 Yes 7NV'
Special Fli3asiblilly Boring Report Required. 0 Yes 94�2/
Detailed Contour Plot Plans Required (1 to 5 ft. interval) 0 Yes 01 N,
Other 0 Yes (?; NN
Staff Specialist Lot Inspection Required 0 Yes 00`No Lot Inspection Date
Soils boring report by Project 0 Data
Soils Map Page SON Type Approved by 'Dda
No. or System TyJV of No. Dwelling Un I) SON P"s I N.Gresea/Sand
Z 0 OcringTank 0 Existft Bedmoms. PUTU ��, Imp
0 B'New 0 Repboarntint
49DA*k ?eAr# .no /I IV
UJ N.
CD
Leech Line Sq. Ft Sidewall albwaniS6 Irl s) ft.- ft wide with Bed s% fl•
trench as
tL rock/_ sq. It.of
min. incFail-,rock below drainlines or bottom area
per running It.
LeachlinesA)ed special design for slope: (3) Ph Diameter No. Pits Belpw, x (TD) See Ph Total Depth
/ Other
Applica;�� Max. Alple _5Z 4-th A7
N/A Overburden factor lowePep
r,
No., 2 System . (As- I
rT,
REMARKS: m/7
__0
0 A.
disposal sys
This application APPROVED. 414D for th,c,tjry the ked in SECTION_B above, regarding the design of a subsurface Ad
on the accompanied p Pis
I ( -
.9E1 APPROVED
the requirements set forth in SECT6i'C above. -A building permit is 'necessary for. the installation of
the
Z above -designed system. No construction is permitted in the. required reserved 100% expansion area.
0 1 Septic tank and -sewer lines must be 50' 'minimum from any wells/
2)
Leach lines must be 100' minimum from any wells, including expionrrea
I
seepage Pits must be/��' minimum from an wells; including 91pansion
LU ar
V,
CO
Signature of Health Official 7, A_A_ Date.��
,n . RECEIPT NO. - 0Issued By .40 6-411-
Rate
DISTRICT: .0 Riverside, M<W-191 0 Hemet 0 Perris 0 Rancho Calif. 0 Blythe
DOH -SAN -122 (Rev. 3190) DISTRIBUTION: WHITE - Office file YELLOW - Applicant' PINK - Bldg. Dept GOLDENROD Plans/RecorC6
9
✓�i��e1 �3�1` J
®/
t u utnta
s.' This Certificate issued pu►uant to the requirements of -Section 306 of the Uniform. Bulldin�g
Code certifying„that at the tlme,of;issuance .this -structure was yin compliance. -with the'various,
ordinances of the Cityureguldfing wbuild ng nstruction, or use. For the following: r
r `BUILDING 'AOORESS 51 425 . CallePaloma i
Use Clo`ssificotion x SFDBldg. Permit'No. 086.88
G.oup ` }f3 Type Construction.. VN Fire* Zone Uie Zone SR
Owner of Building_ Mi`chael".G.• Mitchell: �4eeress '51-265 Calle-Paloma t= '
City. La Qaint&” AmYiY%`
By; Lonnie Day
Dote. 8/28/91
Bui inq'• Official. .
'POST IM A 0ONe7I000W GLACE - •,
•
�k
y .l
� i
p°
I;'�
r:
;
f
I
io1�
r
9
✓�i��e1 �3�1` J
®/
t u utnta
s.' This Certificate issued pu►uant to the requirements of -Section 306 of the Uniform. Bulldin�g
Code certifying„that at the tlme,of;issuance .this -structure was yin compliance. -with the'various,
ordinances of the Cityureguldfing wbuild ng nstruction, or use. For the following: r
r `BUILDING 'AOORESS 51 425 . CallePaloma i
Use Clo`ssificotion x SFDBldg. Permit'No. 086.88
G.oup ` }f3 Type Construction.. VN Fire* Zone Uie Zone SR
Owner of Building_ Mi`chael".G.• Mitchell: �4eeress '51-265 Calle-Paloma t= '
City. La Qaint&” AmYiY%`
By; Lonnie Day
Dote. 8/28/91
Bui inq'• Official. .
'POST IM A 0ONe7I000W GLACE - •,