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11805 (SFD)r Idjng Irasc 51-200 Diaz °� �Qui"rw P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Owner A & M' Construction Mailing Address P.O. Box 366 City Zip Tel. La Quinta, CA 92253 564 -4832 - Contractor Same Address -- City ' r . lZip I Tel State Lic. & ClassifJ87584 B --I Arch., Engr., Designer Address Lic. # Tel. 626 City, Zip . State / - I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby at rm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divi ionn,,3 of the Business and Professions Code, and my license is in full force and effect. 1 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). ❑ 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 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.) 0 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. 8 P.C. for this reason Date Owner s WORKERS' COMENSATION DECLARATION 1 hereby affirm that I have a certift f to of consent to se s e ora certificate of Worker's Compensation Insurance, or a c . ' ed c thereS p.280 , abor Code.) Policy No. Company /6 Copy—is-filed with the city. 0 Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (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 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. 11805 BUILDING: TYPE CONST. OCC. GRP. A.P. Number 773-044-� 01-882 Legal Description Lo Cs 24 & 25 Black 48 Project Description BI' D Sq. Ft. 2712 No. 3 No. Dw. Size Stories Units Newer Add ❑ Alter ❑ Repair ❑ Demolition ❑ Permit dncludes block wall - pool permit to be obtained separately. Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. 250.08 Z_,>u - ? Plan Chk. Bal. Const. , Mech. Electrical Plumbing 1 �{ S.M.I. 16.58 T j Grading Driveway Enc. ,infrastructure • x ♦ _ 9 • �/ i ur 4Y Ax3 TOTAL REMARKS _ LC''tRAU rIE.'.0 1.ecU lrjr- murger incentive. 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. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS OUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) _9 METER LOOP 00 GAR. SQ. FT. ® POWER OUTLET IROOF DRAINS GAS (FINAL) TEMP. POLEA 349 ( DRAINAGE PIPING CAR P. I SQ. FT. GROUT WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN SQ. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ _$ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING 79 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 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1 % c SEWAGE DISPOSAL INSULATION/SOUND jj SQ.FT.GAR ® 3/ac HOUSE SEWER FINISH GRADING 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 OUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) _9 METER LOOP 00 HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLEA 349 ( GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP4/0— jt—'(j3 4P FRAMING 79 FINAL INSP.�I�.Q l ROOFING 318'19541 ! q J P'r� �� M �� �( S�•/�j l� 13 ( [ 7 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND jj FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 2/8/93 1 Type of Permit I La Quinta No. 112005 Permit # Log Owner Name A & M Construction No. 51200 Street Avenida Diaz City La Quinta Zip 92253 Study Area 114 APN # 773-044001-00 Tract # I Lot # 24-25 Square Footage 12712 Type of Development Single Family Residence No. of units 1� Comments 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 of 1.58 x 2 712 or $ 4,284.96 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 A & M Construction Telephone Name on the check By James E. Lively Assistant Superintendent, Business Services Fee collected /exempted by Vickie J. Durrett Payment Received Signature . Check No. 9276 Collector. Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting COMMONWEALTH LAND RECORDING.REQUESTED BY MAIL TAX STATEMENT TO 0. ADDRESS AS SHOWN BELOW WHEN RECORDED MAIL TO Name Street A & M CONSTRUCTION Address P.O. Box 366 city aI La Quenta, Ca 92253 L_ state ORDER NO. 4101101307-42 ESCROW No. 2695 - 917582 ZES 7 Oo N 01 C7 N The undersigned grantor(s) declargg Documentary transfer tax is $ V. 50 h t NO COR MLED cc cc a _ of �$ 0 J s c3 -1 oc W N 1s SPACE ABOVE RECORDER'S USE ONLY GRANT DEED (INDIVIDUAL ( X)D Computed on full value of property conveyed, or ( ) Computed on full value less value of liens and encumbrances remaining at time of sale. ( X)o Unincorporated area ( ) City of Tax Parcel No. FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, ELIZABETH STEPHENSON, AN UNMARRIED WOMAN hereby GRANT(S) to A & M CONS'RUCTION, A GENERAL PARTNERSHIP (� the following described I, al property in the Q County of Riverside , State of California: Q1` Lots 24 and 25, Block 48, Santa Carmelita At Vale La Quenta, Unit'No. 4, "I, in the County of Riverside, State of California, as per map recorded in Book 18, Page 62 of Maps, in -the Office of the County Recorder of said County.T7 3 - 04q - rot. - 0o -z -• 2 2 EL'IZAB H STEPHENSON Dated JUNE 24,. 1991. u STATE OF CALIFORNIA s.s. County of On this day of said County and State, personally appeared SEE NOTARY ATTACHED 19 , before me, the undersigned, a Notary Public in and personally known to me (or proved to me on the basis of satisfactory evidence) to be the person subscribed to the within instrument and acknowledged that WITNESS my hand and official seal. Notary Public in and for said County and State whose name _ executed the same. (Notary Seal) FD -13B (Rev. 9/88) MAIL TAX STATEMENT AS DIRECTED ABOVE - �� — ..........:-.. ewem�el►.'.�oN7M.''etLF__ .. ,.. %;...i& .� r. .. .. .b _ �. .w a Of R,- CALVIN C. KAMINSKAS DAN RILEY Assistant Commissioner �>` ' Sealer, Weights & Measures (714) 275-3000 ; (714) 275 3030 OFFICE OF AGRICULTURAL COMMISSIONER JAMES O. WALLACE, Commissioner 83-612 Avenue 45 Suite 7 Indio, CA 92201 (619) 342-8291 DATE - . l Jr3 CASENO. NO. Pc L V (a l DEVELOPER'S NAME ----Am ADDRESS: FO Co L-� Q✓� NTS TELEPHONE: aocs Dear Developer: After reviewing your landsgaping 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. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agric tural Commissioner's Office cc: Indio and Riverside 4080 LEMON STREET, ROOM 19, RIVERSIDE, CALIFORNIA 92501 — FAX (714) 275-3012 C� COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY Assessors Parcel No. DEPARTMENT OF ENVIRONMENTAL HEALTH 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 list. A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riverside. Ap r vel of this application shall remain valid for a period not to exceed one year from date of approval. _U z10OG 0 v'li VERIFY ITEMS IN SECTION A FROM A NON-FEE BUILDING & SAFETY (goldenrod) APPLICATION Agent, Contract fJpntact Person �, Phone bIQ�oNy83a- Address �✓ City S�t�Zip (- el _ t f3/1 i' 14 U 6 to& 22s Owner krn� Phone 56 ff-m i. Address City State Zip 5 'mc PK -10- Job Property Address Er/ld4t pity State Zio Legal Description Prop. (PM, Tract, Lot) Lot Size Wate enc rN1el Use of Permit PIP, CU, etc. Other SAv-r4 Ao" '?1A i7ic [ y` A Qui�✓rR �i(/%; (L / w DwQ ling H ite Prep, etc. T (N Z-7-f3 i nature of Applicant Date CATEGORY REV CODE FEE CATEGORY REV CODE FEE j�/SUBSURFACE DISPOSAL (per system) 1238$153.00 ❑ SITE EVALUATION UPON REQUEST 7349 $120.00 (NO PLOT PLAN) ❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $ 58.00 a. 1st 4 Parcels (Each) 1238 $153.00 ❑ PRELIMINARY ELECTIVE EVALUATION b. Each Parcel after 4 7344 $ 55.00 (Attach DOH-SAN-53) 7352 $ 69.00 ❑ REREVIEW (2nd review same parcel) 7344 $ 55.00 ❑ 'HOLDING TANK 7351 $119.00 ❑ SITE EVALUATION in Conjuction with Critical Area 7346 $197.00 ❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00 ❑ GRADING PLAN REVIEW DETAILED 1238 $104.00 ❑ SITE EVALUATION Lot Less than 10,000 Sq. Ft. 7347 $172.00 ❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00 ❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00 ❑ COPIES (LAND USE) 7786-81 $ .50 INITIAL DATE 0 Holding Tank Agreements Completed ❑ YesNo Certification of Existing S.D. System Required ❑ Yes No :;No WOCB Clearance Required ❑ Yes (Attach Form DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required ❑ Yes // 7" o Special Feasibility Boring Report Required ❑ Yes ;;No, ;;N Detailed Contour Piot Plans Required (1 to 5 ft. interval) ❑ Yes , Grading Handout Provided ❑Yes kT Nyy Staff Specialist Lot Inspection Required ❑ Yes%r o X? Maintenance Booklet Provided ❑ Yes No Lot Inspection Date Initials C/42 / Soils Percolation Boring Report by Lic/Project # Date 11?Soil d� Soils Map Page Type Approved By Date No. of Systems Type of System(s) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Sand grease ❑ yolding Tank ❑ Replacement Bedrooms, Fixture Units / Ir �0/y /�,� I`untrrep gir ew ❑ AdditionB/)/1 y a 1-;,4,)4AcArA, f �Q al. ate,; Ate+ Gal. ❑ Existing 4 t . bag* . Ft. Total Linear Sidewall Allowance Leach Bed sq. ft. B om Area —ft. rock/ -- sq. ft. per running ft. Install-n!! ,r Line(s) ft. long e. wide with o Bottom Area - Inlet Tested Depth NA min. inc k below drainlines or .._ Proposed Bottom Tested Depth Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit Total Depth iv / '`Othe Applicable �' � � Inlet (BI) (TD) Depth Max. All�� N/A � Overburden Factor / f �o O � Well Review Approved: Signature Date Well Drilling Permit # Grading Plan Approved: Signature Date �.w.P> REMARKS:Ar M 4'CCYL(S.f�/ s' This application /0 P OVED/ b1 f r t e category c ecke in ION B abs oe9�fding the esign of a subsu ace ispo syste as indicated ants on the accompanie pot plan, using a required set forth in SECTION C above. A building permit is necessary for the installation of the above-designed systeKI (1) ' Septic tank must be 100' minimum from any wells =:f / 0 ��P_!�a i�,N" Arco ( Leach lines must be 100' minimum from any wells, inclgpension area lludin�expansion ,/ U3' Seepage pits must be 150' minimum from any wells, in area-/ / _.14.,j� c/G `7-_ �"/� " Signature Health Official �/• ��GG� �1 ':'7 of Date tf" ❑ CASH C CHECK NO. 9-27-1— RECEIPT .2%-1— RECEIPT NO. 2K 9, Issued By /�K_ Date cl? - d'- U DISTRICT ❑ Riverside E7 Incl+e- ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe DOH-SAN-122(Revt/92) DISTRIBUTION: WHITE—Ofticefile YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Plans/Records is