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003433 (SFD)C Building Address5. Owner r 845 Villa.:` Mailing Address 247 E. City Paln - Springt3 Contractor CV P.O. BOX 1504 N o . 003433 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 R- xes e.1f irilFdE3 +L°t3.• -BUILDING:, TYPE CONST. OCC: GRP. • . Ta$tq> itz Way 03 + A.P. Number773-333- 019 Zip Tel. - 92262 322.71020 Legal Description City' Zip - Tel. Project Description. �� "'• �' �� 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 the work for which this permit is issued, I shall not employ any person in any manner so as to become subject4o 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 hereby affirm thattheie is a construction fending 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 HARD COPY 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' Issued by: Date b/R1AZPermit Validated by: Validation: State Lic. City & Classif. .' - 387934 Lic. # 395' S ft. 141... No. No. Dw. size ...... ...Stories ' Units Arch.,'Engr.; . _ . .. . . Designer New ❑ Add ❑ Alter -:1 Repair ❑ Demolition ❑ Address Tel. - City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION., n 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.. p - �1..rr .. SIGNATURE' - q,- - DATE _ .. .. . .. ... ' OWNER -BUILDER DECLARATION .. Estimated Valuation .. I.hereby affirm that I am exempt from the Contractor's License Law for the following ' Any ,, A- � AA1 .reason: (Sec. 703 1..5, Business and Professions Code: city or county. which requires.a permit to construct, atter, improve, demolish, or repair any.struclure, prior to its issuance also - requires the applicant for such permit to file a signed statement .that he -is licensed pursuant to. PERMIT'' ' 1 ._ . AMOUNT - the provisions of the Contractor's License Law, Chapter 9 (commencing with .Section 7000) oft, 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. subjects the applicant to a civil penalty of not more than five hundred dollars. (5500). = • . - ^ Plan.Chk..Bal. - S 'A4 1 A. O 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 ' - i ✓�. 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,;Mech.- provided that' such improvements are not intended or offered for sale. If, however, the building, ..Const. - in - 2 Pift or improvement is sold within one year of completion, the owner -builder' will have the, burden Electrical' v - of proving that he did not build or improve for the purpose of sale.) .: - 1'7 ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- . Plumbing _ 1 R 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. - + such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading -00. • • O 1 am exempt under Sec. 8. & P.C. for this reason Driveway Enc. 20.00 Date owner Infrastructure 1,121.12 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. . ❑ Certified copy is hereby furnished. ' TOTAL 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 the work for which this permit is issued, I shall not employ any person in any manner so as to become subject4o 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 hereby affirm thattheie is a construction fending 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 HARD COPY 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' Issued by: Date b/R1AZPermit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. p $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. WALL SO. FT. ® SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM 7 BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GA ROUGH) LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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 BOND BEAM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/. c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® 3/ac HOUSE SEWER FRAMING /197 FINAL INSP. 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 OUND PLUM BIN36� UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS R P ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GA ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING /197 FINAL INSP. ROOFING j 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 , RFCORDING,REOUESTED-BY - " AND WHEN RECORDED MAIL TO FCOACHELLA VALLEY LAND CO. NAME 247 E: Tahquitz Way, Suite.2 ADDREss, CITY _& Palma Springs, CA -92262 = STATE ' J ' - MAIL TAX STATSMENTS TO - NAM[ - ADDREBB CITY 6 = STATE - Escrow No. 207863 i SPACE ABOVE THIS LINE '.FOR RECORDER'S USE Documentary transfer tax$..9.•.3.5 ......................:....:... ® Computed on I full Value of ' p'-operty conveyed, of ❑ Computed on full Value less 1 --ens 8' encumbrances remaining thereon at, time of -ale., ...... .................................................. _.................................. Signature of declarant or as ent detern ininF tax •Firm name L ED Unincorporated area City oi.........a ...Q.....uant .... a.......:.. Title' Order No: 78893A . Grant. Deed .THIS FORM FURNISHED BY STEWART TITLE COMPANY OF RIVERSIDE COLN TY FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, BERNARD F. SKERBA and MARJORIE E-4 SKERBA hereby GRANT(S) to COACHELLA VALLEY LAND CO.,. A CALIFORNIA LIMITED.PARTNERSHIP the following described real property in the the. City of La' Quinta .county of Riverside ; state of California: LOT 6, BLOCK 147 OF SANTA.CARMELITA AT VALE LA QUINTA, UNIT 15, BOOK 18, PAGE .92 OF MAPS, RECORDS OF-RIVERSI6E COUNTY, -CALIFORNIA.'.'. - Dated September 16, 1987 1�n BERNARD F. SKER A- - s (Individual) STATE OF CALIFORNIA Ss. C_ " COUNTY Or Orange MARJURIE E. SKERB I on September 21 , 19 87 th ride otary rubhc in and for said State, personauy appeared $eriag� . s-i�r-a ate--iga 2� a � `: 'K'��b` ? (known, to ire) or (proved tome on the basis of satisfactory etRa e) to be the person 'S whose name a eln subscribed to the with in- instrument and acknowledged that e executed the same. FOR NOTARY SEAL OR STAMP, WITNESS my hand and official seal ♦�N r.ro " t o. OFFICIAL SEAL' BARBARA A..NAHRA Signature . J �� �` I � Notary Public -California Barbara A'. Nahra Principal Office In Orargge County Name (Typed or Printed) My Comm. Exp. Jan. 4, 1991 . FORM 72.13 MAIL TAX' STATEMENTS AS DIRECTED ABOVE 2 07 z O Pz U LU U) Go O U Lu rn 6 Y Q W Ir X z O_ U W U) COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE, DISPOSAL SYSTEMS — 33.E — 0/q Applicant: Submit this form with four copies of a scaled plot plan (1-20. scale) drawn to County specifica-ions required on the attached check list. A non-refundable;filing fee of,$AiS required when the when s submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name (Owner, Agent, Contractor, Etc.) i' t&GCS - .d0 C . Mailing Address :2117 40. r <� City Slate Zip Code Telephone 3.7 2 - /v a v Job Property Address �}��Nr City o Communityz is Legal Descriptioa of Property. (Lot, PM, TR) �aYr• GssPj� {'g/3` lli LL,u t 1417- 'Assessor's Parcel No. Y fwWaker=Age ,c`�1/�o,, ell- �q n /� j,�.,[ Q .+` - Use of Permit �/ / b�lr r+�1�+�4 ' Plannmg Case # Lot Sze 7 /3 _� � / r®/di>7�/rl,�i b MH Site Preparation Etc.S rQ. 0 jSFD, Signature of Applicant Date The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW .THIS LINE Initial Dae'Ek If Certification of Existing S.D. System ❑ Yes required. .O" No WOCB Clearance required. ❑ Yes No / , Soils feasibility .report required. El Yes D N / Detailed boring report required. ❑YesN ©�o Detailed contour plot plans required. ElYes I Ncr` Staff Specialist approval required. ❑ Yes • ❑ No Lot Inspection Date Soils/boring report*by ,�� .+ Project I# Date Soils Map Page f ' e ,Approved by /0,4///. Date ��" 16 1 Soil Typ— if f Type of System: y No. of Bedrooms . (1) Septic Tar -.k Soil Rate Required f t 1:1 Existing D New El Additional' ❑Replacement G7�. Gals. (2).Leach linesq. ft. (Botta trench area) Sidewall _allawance ft: Sq. Ft. Install Lines) Ft. Long, G i Leach bedlSq.' rock/ running ft. Ft. wide_ ith min, inches' below drain Ft. ofb�otto per ,9,'N/A rock lines area Leach lines/bed-special design for slope: Applicable-4.r'� (3) Pit Diameter No. Pits Pit BI SeE'page Pit total depth _ N/A Overburden factor , .g.❑.S19 6 Mas. allowable depth V a rit./«!/t .<G,�_>!�.4:..-C •r�. �>•��. r,�=�"lll ��C? .f'sl�''�"�'GL.'?+,.- f, This application is,apiro e-'/de,ied-for the design of a subsurface disposal system as -indicated on the acconpanied plot plan using the requirements set forth in Section B above. A building permit is necessary for the installation of the_above-designed system. (1) Septic tank and sewer lines must b6,50' from any wellsa ld g '%� Q. � ►� "�-Gc � .- > / (2) Leach lines must be 100' min. from any wells including expansion area(f%lG (3) See age pits must be 150' min. from any wells including expansion areay/, /D x71-17 �f/ G � ..� �� A92,4'1 Signature of Health Official / 11.00- , Dte / ,tir•lfi stGa RECEIPT NO. >/ Issued by Date District: r ❑ Riverside El dio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: :' SWHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File 0OH,s,AN-122 (Rev. 6/86) 'v.,iJ