05053 (SFD)•t�t 4 4 "
-7 -7 -:2 DO CAL LE Cl+ 1 L- LO 0P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address e LA QUINTA, CALIFORNIA 92253
Owner
Address P. 0. Box 1379
City Zip Tel.
La Quints 92253 564-7411
Contractor t�
Address
City Tela
1000 Palmas � 6 346-0408
State Lic. City
& Classif. Lic. # �
Arch., Engr.,
Designer ,yy✓ �� 30
Address /�_5 Tel.
CityI Zip I State
Lic. #
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. � f
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,18usiness 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 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 rive hundred dollars ($500).
O I, as owner of the pfoperty, 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 knproves 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
or 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 of property who builds or improves thereon, and who contracts for
such projects with a contractors) 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
bXCopy is filed with the city. O 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 (S100) 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 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
ateMailing Address
City, State, Zip
No. 05053
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 774-142-012
Legal Description
Project Description S.F.D.
Sq. Ft. 1441 No. No. Dw.
Size - Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
stimated Valuation
$88,482
Minimum Setback
PERMIT
AMOUNT
Plan Chk. Dep.
$250,00
Plan Chk. Bal.
72.96
Const.
FINAL DATE
376.00
Mech.
12/27/98
36.00
Electrical
Validated by:
75.10
Plumbing
106.00
S.M.I.
5.64
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1,772.61
TOTAL
S2.733.21
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
12/27/98
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
#
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SD. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
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
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH 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
GRADING
cu. yd.
$ plus x$
x$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC,
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
I
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 11/8/90 1 Type of Permit I La Quinta
No. 110254 Permit #
Owner Name B & K Land Company Log #
7 7. Za) No. 62-980 Street eurt,;z (ALLC C14IL Onl
city La Quinta zip 92253 Study Area 111
APN # 774-142-012 I Tract # 1 Lot # Square Footage 11441
Type of Development Single Family Residence No. of units
Comments Sebnnl fees were Haid on this home nn 12/29/99_ The owner was charged for
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
5u- o.ba-W eY p la,/nal-I'M
This certifies that school fatality fees imposed pursuant to Government Code 53080
in the amount of 0 X11.441 or $$99 513.00 have been paid to D.S.0 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 Desert Vintage Development
Name on the check
Telephone
By Richard M. Beck
Director, Facilities Planning & Development
Fee collected /exempted by Shelley D. Bennett -
Payment~ Received '
Signature :- :
`�� ��' CFS_®ck No. 2087
Collector: Attach a copy of County or City plan check application form to District -
'copy -Embossed Original- Building DeptJApplicant Copy - ApplicanUReceipt Copy - Accounting
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COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors Parcel No.
1
ENVIRONMENTAL HEALTH SERVICES 774 — 142 — 012
1
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 checklist.
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.
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG''*
Agent, Contractor, Contact Person
P O Box 1379, La Quinta, CA 92253
Owner
Phone
Mailing Address
WESTERN AMERICAN CONSTRUCTION CO
a CA 4225"1
City
State
Zip
Job Property Address
Legal Description Prop. (PM, Tract, Lot)
La Quints
CA
92253
53-980 Cortez
Lot 13, Blk 197, U 19
Lot Size
Water Agency/Well
Use of Permit P/P, CU, etc.
Other
50 X 100
CVWD
SFR
Dwellin MH Site Prep, etc.
WESTERN AMERICAN CONSTRUCTION CO
December 15. 1988
4-',-Signatureof'Applic6nt-'V"' ' PrPrt-.qitr1An
Date
CATEGORY: REV CODE FEE
- CATEGORY: REV CODE FEE
j7 SUBSURFACE DISPOSAL 1238 "$45.00
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation In Conjunction with
❑ HOLDING TANK 7351 $45.00
Critical Area 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
INITIAL DATE
Holding Tank Agreements Completed = ❑ Yes 1 No
f
Certification of Existing S.D. System Required ❑ Yes No
WQCB Clearance required. (Attach Form ❑ Yes 11 No
DOH SAN 007, Santa Ana Region Only)
Soils Percolatlon Report Required. ❑ Yes ,I I No
_
Special Feasibility Boring Report Required. ❑ Yes No
r
Detailed Contour Plot Plans Required (1 to 5 It. interval) ❑ Yes I I No
Other ❑ Yes I I No
Staff Specialist Lot Inspection Required K ❑ Yea No
Lot Inspection Date
Soils boring report by Project Date
Soils Map Page Soil Type Approved by l f �'^a v �U✓ Date
No. of Systema
Type of Systems)
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand
O�ing Tank Existing
Bedrooms, Flxture Units
�E^ /�_
n__._
Grease IMt��
/
❑❑
�m
3
/�j
.G7fr IU��
�
Gal
(2) Leach Line Sq F,
Sidewall alb
Install Une(s) R longt wide with
Mach Bed sq. It.
R sq. R
aper running it
min. inches rainlines or
ti ���
"
of bottom
❑ NA
Leachlines/bed special desig orswpe:.
(3) Pit Diameter
No. Pits
Pit Below
Seepage P j Toll
Other.
Applicable
/
/
Inlet (BI)6
jj
Max. Allowab� Depth
N/Ov�� factor `
C35 6
1
J%
St
/
2a
No. 2 System - rx
REMARKS:
I
This application is PPROVED ENIED for the category checked in SECTION B above, egarding the design of a subsurface disposal system as indicated
on the acx ompani p o plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
above -designed system. No construction is permitted in the required reserved 100% expansion area.
1) Septic tank and sewer lines must be 50' minimum'frofi any wells
g(2 Leach lines must be 100' minimum from -any wells, including expansion area
(3 Seepage pits must be 150' minimum from any wells, including expar s on area
J�, 'j/ //
h �OYy
Si nature of HealthOfficial 'f'ii ! Date [ (
RECEIPT NO. Sa " r Issued % Date
DISTRICT: ❑ Riverside, Indio ❑'i Hemet ❑ Perris ❑ Rancho Calif. ❑• Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD-.Plans/Records
til
T-iht 4 4a "
78-105 CALLE ESTADO - LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
March 28, 1991
Riverside County Assessor
46-209 Oasis Street
Indio, CA 92201
RE: Parcel #774-142-012
To Whom It May Concern:
In reference to the above mentioned parcel, please be advised
that the address of this parcel has been reassigned. It was
previously addressed as 53-980 Avenida Cortez and is currently
addressed as 77-200 Calle Chillon. This is due to a change in
the position of the dwelling.
Please adjust your records to show the correct address of 77-200
Calle.Chillon at your earliest convenience.
Your prompt attention to this matter is appreciated.
Sincerely,
BUILDING AND SAFETY DEPARTMENT
Tom Hartung
Director of Building and Safety
TH/lc
cc: Desert Vintage Realty
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253