0204-187 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
� Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp, Date
F
oZ ti Date Signature of Contractor
CD 0 ri
J U 0 OWNER -BUILDER DECLARATION
LU aW r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
to License Law for the following reason:
Z_ ( ) 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).
co () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
OM
Q WORKER'S COMPENSATION DECLARATION
p 1 hereby affirm under penalty of perjury one of the following declarations:
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( ) 1 have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
a Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No. �t;.1y�,h:,
cb 5
�O
Q (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'L'abor
Code, I shall forthwith comply with those provisions.
Date: Applivani
Warning: Failure to secure Workers' Compensation coverage"i's.unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, 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 tb
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
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;
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT V
JOB SITE
ADDRESS 46 r ;i] AV.s`.hMA Y.RN"Ztl"O
APN
OWNER
CONTRACTOR / DESIGNER /EN61NEER
ALL. />sW14u:tc'► N l.iOME DT.]I4~r1a1• OS
A.!.1 1S.kAb1ti1('AN) ii k%AEb 1: Jii -.1
77-5f�1 l:i?iTN3`1z Y 1.'•L [].(} l�Wl�is. E.+t ;. ,
76,5195 A-10 i IDA AVPNUr
(`760)204-0277
USE OF PERMIT
Olt 4CUr 7 r-AINI11.Y ]=" IT-L12Al,
,, .i ;" PODL OR
1]1tlill?WnY I;I�PItCaht`1.1
EF
i'C►I?t;;}•111=�'i'IO ¢4�.fla ;:1+
OAR ft{1Y•{,RUQRT Tip 00'4N
"F1?Mr11b'VK SMAMAky
CY3?1;i'iFdUCTION 1-1?F 10) C3L.► _41t1 _Qo() 1,.t4 .Vtl
PLAN CPIFCK VFK 1f)1-(k0-439--31X $1,A!A.'�`
YEE:i.A..P031S ]fJ] 00{1•�p3q..il;t �2�U.1:,
"VC:I iA.i!3ICAL )r'F1 1 CS 1-I'7iT{j a 3 -0Lf{1 $? .OU
MY-CTRICAl.1qT, 101-OM-470,00 1 V] 41 C.4
PLIiMB1140 FYZ- 1011-000.4) P-M1 $2011.23
STRON110 Waz V)0 RE • i FAD 101-00,(t.241 WK30 3:I9141
GRAD . )140 PFF )01-{yW-421-(WK) $10.w
E]WO0Pi!R IMPACT NEE $111WT00
I nIr I PLI91AC P1_�.OP.r • RM311- 270•b 6.445-(J00 3226-o
:;,.! ��•']•r_]'1'J�,l. ('i]N�'J`�Trt°I'Cf3�i A� 1'i,l+�is {�1�1�:c•�:
D 9"YVAL. 'N
4_0 KIRM1' it'F.1 DAfK IN OW
C13Y0FL gIJ1N-rA f
FINAi&-c n1_-_
RECEIP E
_.
BY •
_ 7
DATE F ALED
/7 /
INSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall insulation
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U. !
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
POOLS - SPAS
BLOCKWALL APPROVALS
steel
1
Set Backs
Electric Bond
Footings
j
Main Drain
Bona Bea7t
npuruVdi to CuVer
Equipment Location
Underground Electric
Underground Plbg. Test
Final _ _
PLUMBING APPROVALS
Gas Piping
]
Gas Test
Electric Final
_
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaste.
I
sewer Lateral
Pool Covc!r
Sever Connection
Encapsulation
T
Gas Piping
�r
Gas Test
I
±
Final
COMMENTS,
Final
Utility Nr-41ca (Gas)
ELECTRICAL APPROVALS
T amp. Power Pole
Ur dErground Conduit
—Rcugh Wiring -
Lmv Voltage Wiring
Fixtures
Plain service �I
Sub Panels
Exterior Receptacles I
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utilitv Notice
CERTIFICATE OF COMPLIANCE v��Fsc
Desert Sands Unified School District z4eERM 0 .
47950 Dune Palms Road
Date 9/17/02 La Quinta f CA 92253 RANCHO MIRAGE d
' INDIAN WELLSDESERT
No. 23624 (760) 771-8515 `�,y, FALM LAQUINTA �V
IQ INDIO y�
O
Owner All American APN # 658-310-006
Address 77-564 Country Club Drive Suite 137 Jurisdiction La Quinta
City Palm Desert Zip 92253 Permit # 0204-187
Tract # Study Area
Type Single Family Residence No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 67 48770 Avenida Fernando 3430 Unit 6
Unit 2 '48-60 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments Single family dwelling
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patioshmalkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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
Education Code Section 17620 and Government Code 66995 Et Seq.
in the amount of $2.14 X 3,430 S.F. or $7,340.20 have been paid 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 CC/1st Bank - Mark Tuvell Check No. 65361
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $7,340.20 So.00
Payment Recd Over/Under
Signature G
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90-day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
Southland Title
RECORDING REQUESTED BY
fy J
AND WHEN RECORDED MAIL TO:
All American Home Builders, Inc.
76995 Florida. Ave.
Palm Desert, CA 92211
A.P.N.: 631-322-001 TRA #: DO;710
DOC IS 200 2-406069
08/22/2001 08:00A Fee:9.00
Page 1 of 2 Doc T Tax Paid
Recorded in Official Records
County of Riverside
Gary L. Orso
/ Assessor, County Clerk 8 Recorder
�'��vR f����� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIII
M s u PAGE SRE DA PCOR/ NOCOR I SMF MISC.
✓ CI
A R L COPY LONG REFUND NCH..41
Order No.: 21530855 Escrow No.: 2-33810 -J
GRANT DEED
THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $115.50 MC
X ] computed on full value of p roperty conveyed, or
] unincorporated area; [ X f City of La Oumta , and
FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged,
Louis Clinton Burr and Fiduciary Services of Washington, Co -Trustees of The Henry Burr Grandchildren's Trust
created U/T/A dated February 1953, as amended
hereby GRANTS) to All American Home'Builders, Inc., a,California Corporation
the following described property in the City of La Quinta, County of Riverside State of California;
Lot 67 of La Quinta Golf Estates, Unit No. 1, in the City of La Quinta, County of Riverside, as per map recorded in
Book 37, Page(s) 96 through 98, inclusive of Maps,,in the Office of the County Recorder of said County.
Louis Clinton -Buff and Fiduciary
Services of Washington, Co -Trustees of
The Henry Burr Grandchildren's Trust
created U/T/A dated February 1953, as
-, !amended
t
Louis Clinton Burr, Co -Trustee
By:
Fi lary Services ashington
-lCo-Trustee
Document Date: May 30, 2001 _•
STATE OF CALIFORNIA)SS)SS
COUNTY OF .!� i I/ EIQ,S i.bg • ) /
On �-'TUA/ e- o 3oc / before me, / / / ` 6_)/ 1'^' o4yl G
personally appeared LDw j S l l-&N "&f./'a'e '—
ersonall k own tome (or p on asts of sa s actorya to be the person( whose name) is/alb subscribed to the within instrument
an ac nowled.. to me that h�httce/ft executed the same in his/ftek/thhr authorized capacity(tak) and that byhiher/tRvir signature on the instrument
the personNkor the entity upon behalf of which the personXacted, executed the instrument.
WITNESS my, hand and official seal. �INIIUUIIIIIIIUUIIIIIIIWUIIIIIIUIIIUUIIIIIIIIIIWIIIIIIIUUWIIIIIUU
Signature a MARI LEE CONRAD R
Conmi lart k 1281689
NoiQy Ac- Caffomio
JNy l°lv�
s iuiPo71 ZOo.—
�111IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIHIIIIIIIIIIIIIIIIIIIIIIIIIIIIf�
Mail Tax Statements to: SAME AS ABOVE or Address Noted Below
J
COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY ASSESSOR'S PARCEL NUMBER
DEPARTMENT OF ENVIRONMENTAL HEALTH
APPLICATION FOR WASTE WATER DISPOSAL APPROVAL
APPLICANT: Submit this form with four copies of a SCALED plot plan (1"=20' to 1"=40' 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
application shall remain valid for a period not to exceed one year from date of payment.
LMS #
Agent, Contractor, Contact Person
Address City ' f-1L t `/ State / Zip
liad
Telephhone7 ,
Owner ,= -a
'Qgdress �a "" City State Zip
Telephone
O
Job Property Address v
City _
Zip
-.2
Lv'%r) /�✓�,r>/LEI /-t��/c',i
G-✓l Cam
IULot
U)
Size
Water Agency/Well
Use of Permit, P/P, SUP, PUP, etc. {
±
Legal Description b r� w
%
B` I
Z
r
Jd � Ul '
' L
Dwelling, MH Site Prep., etc.
Signature of Applicant
Date,/ / ( -7
,[,
11�
FOR OFFICE
USE ONLY
CHECK BOX IF REQUIRED
If any box is checked, this application shall be considered rejected until the
❑ Detailed Contour Plot Plans Required (1 to 5 foot interval)
information is provided and the fee paid. Resubmittals later than 90 days
after date noted below may require repayment of fees.
❑ Other
❑ Staff Specialist Lot Inspection Required
Z❑
Holding Tank Agreements Completed
0
Cl Certification of Existing S.D. System Required
Thomas Bros. Page Grid
WC]WQCB
Clearance Required
❑ Date Lot Inspection Completed: Initials
fn
(Attach for DOH-SAN-007, Santa Ana Region Only)
Remarks:
❑ Soils Percolation Report Required
❑ Maintenance Booklet Provided
❑ Special Feasibility Boring Report Required
❑ Final Inspection by Department of Environmental Health is required.
❑ Rereview Required Initials Date
Please call 24 hours PRIOR to inspection.
C/42 / Soils Percolation Boring Report By �� ,(� Lic/Project # C 'a A Date
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
❑ Holding Tank ❑ Replacement
Bedrooms, Fixture Units
Grease Intcp/Lint Trap
.New ❑ Addition
3-&04a" h
Ad00
/•S-.10
❑ Existing ❑ Connect to Sewer
Gal.
Gal.
Sq. Ft.
Total Linear
Sidewall Allowance
Leach Bed sq. ft.
Bottom Area
Ft.
ft. rock/ sq. ft. running ft.
Install Line(s) ft. long ft. wide
of Bottom Area
Inlet Tested Depth Cl N/A
with min. inches rock below drainlines
U
Proposed Bottom Tested Depth
or
Z
Leach lines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit B"eTow I V (131'Seepage
Pit
Maximum
Other:
0
Applicable
Total Depth
Allowable
P
C)
(
r
L
De th
p
N/A Overburden Factor
❑ 5'
% v
TD 7d
y0•
U)
Well Review Approved: Date: Well Drilling Permit#
SIGNATURE
Grading Plan Approved: Date: ;
SIGNATURE 3,7
Plan Check Only Approved: Date: �
/���
f
6
REMARKS: .. ✓..4c. / *-V /
This application i5 APPROVED/pENIED for the category checked in
SECTION B above, regarding the/ esign of a disposal system as indicated
on the accompanied plot p a�ing the requirements set forth in SECTION
C above. A building permit is necessary for the installation of the above-
Revenue Code Sr f a Fee $ �•
designed system. No construction is permitted in the required reserved
,
100% expansion area.
Check #
Do)eptic Tank must be 100' minimum from any wells.
0
Z
(2) Leach lines must be 100' minimum from any wells, including expansion
Date L Initial
'
O
area.
y
(~j
(3) Sewer lines must. be 50' minimum from any wells.
LU
0(4)..eepage pits must be 150' minimum from any wells, including expansion
RIVERSIDE: 909-955-8980
area.
INDIO: 760-863-7000
Signature
SOUTHWEST. 909-600-6180
(/+
Date
DEH-SAN-122 (Rev 8/01) Distribution: WHITE -Office File; YELLOW -Applicant; PINK -Bldg. Dept.; GOLDENROD-Plans/Records
Certificate of Occupancy
.�
4
I VATM
C OF Buildin & Safet Department
9► Y p
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying -that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 48-670 AVENIDA FERNANDO
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0211-014
Occupancy Group: R-3 Type of Construction: V-N Land Use Zone: RL
Owner of Building: ALL AMERICAN HOME BUILDERS Address: 76995 FLORIDA AVENUE
City, ST, ZIP: PALM DESERT CA.92211
By: GARY SHOWALTER
_mob'
Date: 08-06-03
Building Official
POST IN A CONSPICUOUS PLACE