06694 (SFD)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 7 Ei8E3 TAss im LA QUINTA, CALIFORNIA 92253
Owner
No. 06694
a & isWMZrIactio 2
BUILDING-. TYPE CONST. OCC: GRP.
Mailing
Address 6
A.P. Number
769-077-008
CityZip
Tel.
La Quinta
192253
564-4832
Legal Description
Contractor
SWIM
Project Description
y
SFA
Address.
City
Zip
Tel.'
State Lic.
& Classif. 487584
City
Lic. # , ..
Sq. Ft. 2300
4
.No. a No. Dw.
Arch., Engr.,
Size
Stories Units
Designer
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
NO IWAM
City
Zip
State
1
Lic. #
DCENSED CONTRACTOR'S DECLARATION
I hereby affirm that I an licensed under provisions of Chapter 9 (commencing with Section
7(100) of Division 3 of 016 Business and Professlo`ns`Code, and my license is in full force and
effect. ,V�.�";�..�"+°►'z -
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SIGNATURE A DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
Estimated Valuation
$325,5.26
reason: (Sec. 7031.5,Bus-mess and Professions Code: Any city or county which requires a
permit to construct, after, Improve. demolish, or repair any structure, pdor to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
PERMIT
AMOUNT
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
Plan Chk. Dep.
5230•,00
subjects the applicant to a chd penalty of not more than rive hundred dollars ($500).
❑ I, the
Plan Chk. Bal.
359.79
as owner of 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
Const.
•
builds or approves thereon and who does such work himself or through his own employees,
that anprovements intended
Mech.
r33• SU
Provided such are not or offered for sale. If, however, the building
or improvement is said within one year of completion, the owner -builder wig have the burden
Electrical
1 t��
of proving that he did not build or approve for the purpose of sale.)
C3
.8
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
�57 50
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
S.M.I.
8.83
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
❑ I am exempt under Sec B. & P.C. for this reason
20.00
Driveway Enc.
20.00
Date Owner
Infrastructure
2.673,53
It �-
WORKERS' COMPENSATION DECLARATION
I hereby -affirm that I have a certifi4tefof cogsen`t�tn elfin u?e, or a certificate of
Workers Compensation Insurance, or a certified^copyhe
treof. (Sec. 3800, Labor Code.)
Policy No company t
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
44*4 1Z •Yu -
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE(This section section need not be completed if the permit is for one hundred dollars ($100) valuation
.1 � �'E'• .� `*+ kyr i+ttt' �`' Y'" ' 'i L '" '"��` .s
• or less.)
1 certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: 8, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such Provisions of this Permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
1 hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civilcode.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
I PECTOR
9
" This is a building permit when properly filled out, signed and validated, and is subject tog/$n
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.
'
Issued by:
Date Permit
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING,FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEWER OR SEPTIC TAN_
,/ WIRING
!�
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
I
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT.
=$
LUMBER GR.
FINAL INSP.
FRAMING i
URINAL
SOFT ®
_ y
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
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
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® IY4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Ac
HOUSE SEWER
FENCE FINAL
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 GOND. SOLAR
SETBACK
LUMBING860
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TAN_
,/ WIRING
!�
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING i
FINAL INSP. S 9UQ
ROOFING 1-2,�, �
VENTILATION
_ y
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
I
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 11/9/95 Type of Permit I La Quinta
No. 113863 Permit #
Log
Owner Name Janet Diemen
No. 78680 Street Tampico
City La Quinta _ Zip 92253 Study Area 118
APN # Tract # I I Lot # 0 Square Footage 1168
Type of Development Residential Addition No. of units 0
Comments Addition of 12 x 14 bedroom and installation of gas piTg to kitchen
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:
Residential Addition 500 Sq Feet or Less
. EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 0.00 x 168 or $ 0.00 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 N/A Telephone
Name on the check
By Dolores A. Ballesteros =l
Superintendent
Fee collected /exempted by Pauline Pearson
Signature 0—a,, i 2-j -AIAA pM $0.00 Check No. N/A
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./A-pplicant Copy - Applicant/Receipt Copy - Accounting
Order No. 156436
Escrow No.
Loan No. A M Lot 120 f
WHEN RECORDED "MAIL TO:.
Palm Desert National "Bank.
P.O. Box 1717 '
Palm Desert, CA 92261
Att R b
n. o ert M. Cross, SVP
SPACE ABOVE THIS LINE FOR RECORDER'S USE
MAIL TAX STATEMENTS TO:
A & M Construction,. DOCUIVENTARY TRANSFER TAX S..»
P . 0 . Box 366 .. Computed on the considers'
tlon or value of property, cowveyed; OF
La Quinta, CA 92253 •••••• Computed anthe Consideration Orvalue IMlions orencumbrance
remaining at time of gale.
Signature o Declarant Or ANnt detuminlne tare —Flim Name-
-GRANT. DEED
FOR A VALUABLE CONSIDEI �IATION,'treceipt of which Is hereby acknowledged,
John P. Ginsbach and Maria C. Ginsbach, husband and wife as joint tenants
hereby GRANTIS) to
A & M Construction,.aCalifornia General.Partnership
the real property in the City of.' La Quinta
County of Riverside
o
Lot 120 -of Desert Club Tract Unit 5,. as shown by Map on file. in Booke2lf California, des:ribed as
Pages -61 and 62, of Maps, Records of Riverside County, California.
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Dated October 24 1989
STATE OF CALIFORNIA
GCUNTrOF Riverside.
On October 24, 1989
before me, the undersigned a Notary Public In and for said State, per.
sonanyappear ed—John P. Ginsbach and Maria
C. Ginsbach
Personally known to me (or proved to me on the baNi of satiatectory
evidence) to bathe person(g) whose nams(si ls7ve iubet dbed to the
within Inetfumellt and ecktgwledotad tome Ihet hWetw/they executed
the same. F
WITNESS my hand and official seal
Form 3195
ohn P'. -G!ns ac 1.
Maria, U. GiLIOUCLU11
-OFFICIAL SEAL
LESLIE JEAN N100SAVI
NOTARY PUBLIC- CALIFORNIA
RIVERSIDE COUNTY
Mr comm. explrea JAN 21, 1992
(Thea area for official notarial seal)
. E.lEptl51'�1tr,Y
IIII1t,EUt to+�'�oln+;•tn '
V;nE1 ACT.
�^ AGIUCUL l Ullnl. ICU'%' U 1v1�lEtt )A. ILS << ,
M.0 LLEMENI UOVE"S'E '.
b. hIEASUIIIiS
s�••uh
t+q -GIJ IIvY IIG+ Ilalte II -12
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to 2-0191
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Vl;YG1Al'L•"Il' g 1 W11js Ti
'1r:LL1�11�11Cs i 1 .SCO _ 4
Dear Uevelvherl
11a1m till 1111u1t I1Valer lal 115tec1 in ItltutllUlls
Atter >reviewlliy your lullcisct!IlllltI 1 et1 tills vCElce nluut be 11orlEied
lull vl: uarantlnp 1u',�g titrveEll)ny llln Cvaclt`lla Valley-* it suUs
violat y
do occur wid they �11E[er [tun 1+1u11t u�:lterlul i g ,
�nl�dlatety .
`�1J tteselrvllty ills Coachella Valley 's l.�esl
110& you LUK 11CU
-[]Lee ellvllrvinel�`-•
'lectLly
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nyKlcuLfural
CCI llldiv allcl Itivetelcle U11 ice
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COUNTY OF RIVERSIDE ENVIRONMENTAL, AsfNeorsPOMW NO'HEALTH
�1bf- o? -J- OD
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 # (X& 004 04tAlw
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Agent, Contractor, Contact Pe //]/� "" `
�np Address & Pn
Owner
W
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Phone Mailing Addre"PO
3 (o 41 ,/t%%/�
U)
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City
State
7,io_
(��ZJ�3
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I Desc 'pt• Prop. (PM, Trect Lot)
�*s ICT
C
r'cv
G
Lot Size
Water Ager /Well
Use of Permit P/P, CU, etc. e :
Other
G00(<C
v
��
%
Dwelling111 Site P
,��
plioant
Date
CATEGORY: �•' ��� REV CODE _
CATEGORY: REV CODE FEE
C� SUBSURFACE DISPOSAL 12 $ 57.00
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
co
❑ MULTIPLE PARCELS WITHIN SAME
, (NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION ' 7348• $ 17.00.
ZO
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)
UY
❑ Site Evaluation in Coniunction with " U
❑ HOLDING TANK 7351 $ 47.00
_,t Crttical Area 7346 $111.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
0 Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
"~
INIT7�p/�� DATE
Holding Tank Agreements Completed ❑ Yes N
Certification of Existing S.D. System Required ❑ YesNo I
WQCB Clearance required. (Attach Form Yes No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes ,
Special Feasibility Boring Report Required. ❑ Yes
Detailed Contour Plot Plans Required (1 to 5 R interval) ❑ Yes
Other ❑ Yes No I
Staff Specialist Lot Inspection Required ❑ Yes A No,
Lot Inspection Daae
Soils boring report by / Project it ' n, Date
Soils Map Page r Solt Type Approved by -` 'w -_ Date & 7"
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No. of Systems
T of Systems)
No. Dwelling Unrls( 1)
(1) Septic Tank
So;;/Wl-
r�
"
O��F ding Tank ❑ Exiating
❑ Replacertwnt
Bedrooms, Fi re Units
G IntopU
p
-
QQ1l,blp� aBQi1/
��q
_gLeechr
GalI
Gd
LU Cf)
� Line Sq. Ft
Sidewall allowance
Install Line(s) tL long it wide with
LbaetyBed sq. it
�
_ ft sq. R
min. �trpdSbelow drainlines or
of boltom�eree'��
—
.
perrunning K
-"'�.r
—
Leachlines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below
(TD) Seepage P/ Total Depth
441)
Applicable
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N/A Overburden factor
� 6 f
(B)
Max NAI gble Depth
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No. 2 SystemN/-4
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REMARK
This application i PPROVED ,ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicates
on the accompan' p t p n, using the requirements set forth in SECTION C above. A building permit • is necessary for the installation of the
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above -designed system. No construction is permitted in the required reserved 100% expansion area.
O
0 Septic tank and sewer lines must be 50' minimum from any wells (y/Q Tti2Q/J
U(2
W
Leach lines must be 100' minimum from any wells, including expansion rea
(3 Seepage pits must 150' minimum from any wells, including expansio area �Q -'XX__J
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Signature of Health'Official w Date --_7
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RECEIPT NO. / 7 r 44 .9� 0 Issued By 0 � � Date
DISTRICT: ❑ Riverside, • 60Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW • Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
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