08622 (SFD)r
Building
Addressi_Ran
Owner
Mailing
3 r saw t
Address
City Zip
Contractor
Wr, n$nr haer+�s 1 rttrrn
Address `
City Zlp
•414 Q
��
P.O. BOX 1504 N o .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253f��
BUILDING: TYPE CONST. OCC: GRP.;
Tel.
dime valla 92210
State Lic. tuict�
& Classif.
Arch., Engr.,
Designer
Y .
Address I Tel.
w
City P Zi State
Qredan€>� �39ATs� Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that Iam 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. _ _-.q tkf lx- A/
DATE
J OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031. S,Buslness and Pro/essions 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) Div
Division 3 o/ 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 o/ 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 o/ 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.)
O 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.)
O 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. 0 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 Certifica!e 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 1 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
£8822
P. Number w '*
Description i
Project Description _8V
Sq. Ft. No. No. Dw. '
Size 1522 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
PERMIT
AMOUNT
Plan Chk. Dep. "
150.00
Plan Chk. Bal.
245-43
Const.
572.00
Mech.
5.
Electrical
126,49
Plumbing
163,
S.M.I.
5-95
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1868.12
?reel" plan
TOTAL
3077.41.,
REMARKS
j�`•�q� „ {,y
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. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
VENTILATION
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
SETBACKIdl
G D GIgX
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE %
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
FOUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING / 9
f
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHINGf o
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL :d
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 10/1/90
No, 10176
Owner Name William O. Wilkinson
Type of Permit I La uinta
Permit ii
Log #
No. street See Below
City La Quints Zip 92253 Study Area
APN # I I Tract N 1 Lot N Square Footage 112,448
Type of Development I Single Family Residence INo. of units
Comments -ri1-94.ri Ramirp7 AA -19.0 R„1kin 59_9R0 1V onrinv,n 9;9_UAn Noir JZtQQn
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 ofFl—.5-8--1 X 112.448 1 or$ 19,667.84 have been paid to D.&U.&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 William O. Wilkinson Telephone
Name on the check
:3
Richard M. Beck
Director, Facilities Planning & Development
Fee collected /exempted by Shelley D. Bennett
Signature ANYi
Pair ent,F.ecf:iNed
Creck No. 019694
Collector: Attach a copy of County or City plan check application form to Dicti:ct copy.
Embossed Original- Building DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
Cn
X
Ln
Name r
Street
Address
City &
state L_
r
Name
Street
Address
City &
State L_
,,e 0 -7-.
RECORDING REQUESTED BY
UNION LAND TITLE COMPANY
AND WHEN REGORDED MAIL TO
MR WILLIAM 0. WILKINSON'
NAT -30 (5-87)
MAIL TAX STATEMENTS TO
same as above
J
t
~ 2C
1n.a a�IE8
J
JI
SPACE ABOVE THIS LINE FOR RECORDER'S USE
Individual Grant Deed
The undersigned grantor(s) declare )�,
J z Docupentary transfer tax is $ ,
a (L ( ) computed on full value of property conveyed, or
( ) computed on full value less value of lien, and el) cumbrances remaining at time of sale.
( ) _Unincorporated area: ( City of !�J , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
Robert E. Haas and Mercedes J. Haas
hereby GRANT(S) to William 0. Wilkinson and Barbara L. Wilkinson, husband and wife
as joint tenants as to an undivided one-half interest and John L. Hart, an unmarried
man as to an undivided one-half interest, as tenants in common
the following described real property in the
County of Riverside , State of California:
Lot 19 Block 32 Santa Carmelita at Vale LaQuinta, Unit No 2, as per
map recorded in book 18 page 55 of maps, in the office of the county
recorder of said county.
Dated: February 7. 1989 '
Robert E. Haas
STATE OF CALIF NIA
COUNTY OF LC9 i.?�sw�s.Gi�aJ� >SS.
On�. /p before
me, the undersigned,
__1�gtRy, b 'c in and said State, Merc des J. Haas
personally appcare�d �{I`��/ J C- ,/J_
personally known to me or proved�/td me on the basis of sat-
isfactory evidence to be the person � whose name S
subscrib d to the within instrument and acknowledged
tha executed the same.
WITNE my hand and official seal.
Signature (.
Title Order
(This area for official notarial seal)
Escrow or Loan No.
MAIL TAX STATEMENTS AS DIRECTED ABOVE
f ". ": <:•
OFFICIAL SEAL
JOANNE C. BEMIS
41a�
y '
NOTARY PUBLIC•CALIFORNIA
SAN
BERNARDINO COUNTY
My Commission Expires Mar. 6, 1992
(This area for official notarial seal)
Escrow or Loan No.
MAIL TAX STATEMENTS AS DIRECTED ABOVE
RECEIPT NO. 67 Issued By( A�eDate
DISTRICT: ❑ Riverside, ❑ Hemet O Perris ❑ Rancho Calif.,' ❑ Blythe /
r
DOH -SAN -122 (Rev. 3/90) DISTRIBUTION: WHITE . Office file YELLOW • Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Ae"iOf P11111,011111 Film
E V�VIRONMENTAL SERVICES DIVISION - -
-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 IIsL
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.
Q
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
t Contrarctor, Con Person ' `
er ►ere o e Znc,
Phone Ad res & Firm
345b0 T71 C aro eeTnd` ae ► 15
n
\
W
l 1
o L. Hart,
Phorie8(� Mailing Add ress
LU
State
Zip
13Stale
J rope rty dress
c,ae�
Legal Description •. (PM, Tract, Lot)
L t3 3a -u its
Lot Size,to
Use of Perrn\P/P, CU, etc. c Gt t,. fjL
i.
Other
�/ j� ^
5 O /� ' v vM
'
V.Ki� 0
Dwelli H e raP, etc.
Signature of Applicant
Date
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
l3)�SUBSURFACE DISPOSAL/SITE
EVALUATION UPON REQUEST 7349 $ 43.00
07
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00
O
0
a. 1 at 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year)
b. Each Parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
W
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
U)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $ 47.00
.-Critical Area 7348 $111.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
❑ Site Evaluation Lot Less ithan
SYSTEM
'O,000 Sqr F..t:;: ; , f�, . -.��, �,: -'7347 $ 87.00
DATE
Holding Tank Agreements Completed❑Yes PJ��No'� — �e - 0
Certification of Existing S.D. System Required ❑ Yes ITNoi0e'
WOCB Clearance required. (Attach Form ❑ Yes R No
DOH SAN 007, Santa Ana Region Only)
I�
Soils Percolation Report Required. ❑Yes -///���
Special Feasibility Boring Report Required. ❑ Yes 00
Detailed Contour Plot Plans Required (1 to 5 it interval) ❑ Yes
lid 'fid
i ❑ Yes
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection Date
Soils boring report by r - #/� Date
�U•.
c
Soils Map` Page 'I' Soli Type ��� Approved by P�*`�" pffie-1�—
Z
No. of Syatenrs
T of System(s)
No. Dwelling Unite f
(1) Septk: Tank
Soil Rate
feese/Sand
O
ng Tank ❑ Existing
9. Now ❑ Replacement
Bedrooms, P
_J_
.r
'm.
(N: x
'P _""
Gal
U)
Q Leach Line Sq. FL
Sidewall allowance
Irretel Line(s) R long ff wide with
Bed eq. fl
trench area
�•-
h
ft rock/ sq. R
per running K
min. irx'Idd, dralnl'mes or
o1 bottom a►ee
! .
Leachlines/bed special design for slope:
Applicable
3) Pit Diameter j
No. Pits
Pk Below
Inlet (BI)
�D) Seepa� H Tgtal�ptti
p! �j
N/A Overburden factor'
6'
(�(/
Max. Albw�bl@ �epth
`f (J
No. 2 System
REMARKS:
�.
This hpplicat' ;APPROVED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanp using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Z
0
above -designed system. No construction is permitted in the required reserved 10096 exp"ion area. i
Septic tank and sewer lines must be 50' minimum from any wells %Q '� � F^►^F,Y'R.+'�
Leach lines must be 100' minimum from any wells, including expans' rar��atW Seepage
must 150' minimum from including
pitsany wells, expans' n aQ��
AWDateSignature of Health Officia W /C a -�a - 9 ►_
RECEIPT NO. 67 Issued By( A�eDate
DISTRICT: ❑ Riverside, ❑ Hemet O Perris ❑ Rancho Calif.,' ❑ Blythe /
r
DOH -SAN -122 (Rev. 3/90) DISTRIBUTION: WHITE . Office file YELLOW • Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
in
'e� °� '�►,� OFFICE OF
s
AGRICULTURAL COMMISSIONER
AND
�.�,�z;; WEIGHTS & MEASURES CALVIN C. KAMINSKAS
4000 LEMON S1REE1ROOM 10 Militant COmmlt710net
.
JAMES O. WALLACE CLEMENT 6ENVENISIE
Aufle-Arot Commlt)lonel RIVERSIDE, CALIFORNIA 92501, Seote,
OBealot d welohh a Meame► (7 14) 767.2561
49613 Ilighway 86, . Suite 812 ;
Coachella, Ca. 92236
) C� (619) 342-8291
DA'T'E ! 0// / C? CASE NO. -C` D
Dl;VEWPER' S `NIWIEt l�'1 ev c_; e ��v fo , • • �� •�
ADURESS t' 7-7-7 D
'lELEpi IONS t (��(�i) 3(4
Dear Developert
After reviewing your landscaping plans, all plant material listed is not in ,
violation of quarantine- laws governing the Coachella Valley. If substitutions
do occur and they differ from plant material listed, this office must be notified! '
immediately.
lbank you for protecting and preserving the Coachella Valley's pest-free.environment.
C.��`-�-�Go� lC t•�r
Agricultural Can ss one "s Office e
'i: