07335 (SFD),- P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 53-305 Villa LA QUINTA, CALIFORNIA 92253
Aiux Q. Torres
+y
Mailing.,
Addres-sox n2.
Zi
City p
Coachella. 4 236 - .Tel.32. 3-44.6
A.Q. Toms Construction
Addre!sSOXs
772
Ala � 11p92236
State Lic. I City
& Classif.' 550 498 Lic- # 1451
Arch., Engr-,
Designer
Address' Tel.
cityz Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 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 /r
III v'SIGNATURE r• DATE
I 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, after, improve, demolish, or repair any structure, prior to its issuance also
. requires the applicant for such permit to hie a signed statement Mat hes 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 or 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. ff, 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 safe.)
❑ 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. & 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. ❑ 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 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.)
Lenders Name
Lender's Address
This is a building permit when property filled out, 'signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 certity 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 Address
City;. State, Zip
No. 07335
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number 774-093-015
Legal Description Lot
Project Description 5F
Sq. Ft. 1578 No. No. DIN.
Size • Stories Units
New ❑ Add ❑ Alter C Repair ❑ Demolition ❑
Estimated Valuation $86.982
PERMIT
AMOUNT
Plan Chk. Dep.,
Plan Chk. Bal.
Const.
581,00
Mech.
53.50
Electrical
113,.29
Plumbing
1.57, 50
S.M.I.
6.W
Grading
20.1
Driveway Enc.
20.00
Infrastructure
I
TOTAL
4.36 28.96 „� ) .r A
REMARKS
l,rar ca; 17-,7
'ti;XWW :i.. .t0[t11e, �Iv fti., YG
ZONE: BY:
Minimum Setback Distances:
Front Setback. from Center. Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback f-om Property Line
FINAL DATE INSPECTOR
issued by: - • Date 3/15/9.0 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE D
2ND FL SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC. r
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
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.
SQ. FT. ® c
BATH TUB
MESH
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
CERT. OCC.
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 3 ;2G -0
7-, 941JND PLUMBING j114 A
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE D
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
444r6rYTIC TANK
ROUGH 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
FINAL INSP.
GRADING
cu. yd.
$ Plus—x$—=$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING!'9A
^
Offf u
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING f l!w 5 � 9v
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION AA
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
O FI
��®Tlcp SCHOOL 'FACILITY FEES
'gym �,�OC� _ (] �
TO: City of La 2,i�t)�$� DATE:
Department of Com u 4tr bevel Ak
RSAAJ
78-105 Calle Estado �®7
La Quinta, CA 92253
This is to certi th t ,
developer of which -is
located at .,.within
this District, has paid school facility fees imposed pursuant to the
au ority gen rat d by o ernment C e Sectiot 53080 in the m unt of t
$ ( 0 )�
covering a total of' n�_ uare feet:of ( ) residen ial or
( ) industrial/commercial developmen and that build g permits for
this footage in this development may now be issued by your jurisdiction.
105+,
for DESERT SANM UNIFIED SCHOOL DISTRICT
White Building Department • Yellow - Facilities Planning • Pink - Accounting O Gold -,Developer
(10)-37
/s
RECORDING REQUESTED B"
AND WHEN RECORDED MAIL THIS DEED ANO UNLESS OTHERWISE SHOWN BELOW
MAIL TAX STATEMENT TO:
Name Petro Land Inc.
Street 40750 Meadow Lane
Address Palm Desert, CA z+4-1--4-4-71
City
Slate
MAIL TAX STATEMENTS TO
Name
Street same as above
Address
City E
Slate
TITLE ORDER NO. 20.3520 ESCROW N04 14 0 — JC
SPACE ABOVE THIS LINE FOR RECORDER'S. USE
Cios'a GRANT DEED
THE UNDERSIGNED GRANTOR(S) DECLARE(S)
DOCUMENTARY TRANSFER TAX IS $ 69.30
)] computed on full value of property conveyed, or
O computed on full value less value of liens or encumbrances remaining at time of sale.
O unincorporated area
U city of La Quinta AND
FOR A VALUABLE CONSIDERATION, receipt of which. is hereby acknowledged,
Manuel 0. Montenegro and Alice D. Montenegro; husband" and wife as Joint
Tenants
hereby GRANT(s) to
PETRO LAND,INC-. A CALIFORNIA CORPORATION_
the following described real property in the City of La Quinta
County of Riverside.. . , State of California:
ots 1, 2, & 3, Block 213 of Unit No. 20 Santa Carmelite at Vale La
uinta, as shown by Map on file in Book•19 page 38 of Maps, records of
iverside County, California.
�'
C
.
Dated Feb: 4, 1990
M el 0. o
gr
STATE OF CALIFOl
' ' } SS.
COUNTY OF A/
II c D. Monten-egro
On this �— day of '� , in the year 19 b
before me, the undersigned, a Notary Public iig ' nd for said State,
personally app ared
~ y nown o me
(or proved to me on the basis of satisfactory evidence) to be the .
persons whose name 5 CS&& subscribed to the within
instrument, and acknowledged_ to me that -:4-be executed it..
OFFICIAL SEAL•
JOYCE A COOPER
WITNESS my hand and official seal.
NCtTARY PUBLIC—CALIFORNIA'
i ra• :.
PRINCIPAL OFFICE IN
\
1/
R3VEHSIOF COUNTS'
My-;orn, Exp. Sept, t,, 1992
Signature
NOTARY PUBLIC IN AND FOR SAID STATE
(This area for dlicial notarial seal)
CO -441 (REV 4/05) MAIL TAX STATEMENTS AS DIRECTED ABOVE.
z
CTY:'O
OUNF RIVERSIDE ;ENVIRONMENTAL "O'1NO'
HEALTH-SERVICES'°DIVISION _ U 3
PERMITAPPOCATION FOR A -SUBSURFACE SEWAGE DISPOSAL SYSTEM'
Applicant 'Submit this form with'four copies of a;scaled plot plan'(1'-20 scale)':drawn to County.speculatlons as indicated on the: attached check Ilan;•
Anon -refundable -fling fee (see below)'Is required when`,the application is: submitted: Check Tusf be mede.pi yable to ttie_County of '.
s: Riverside Approval'of this "application shall ►eriiain valid for a period not to'exceed one year Fom date of approval
;.
Q VERIFY:ITEMS IN:`SECTION A FROM BUILDING & SAFETY'APPLICATION BUILDING DEPARTMENT APPLfvATION LOG # F
0 f Agent, Cont or; Contact Person Phone Address & Firm V/
rte, u' 6 ES z -4210 p. 7 Aa41< tom..
W; ' ' 0i"rn� ' Phone Mailing Address
CO
city State Zip Job Property Ad c Legal Description Prop. (PM, Tract, Lot)
� ♦' t: �vK. t D Z Nl�+�i1
Lot Size; Wafer Age : all Use of Permit P/P, CU, etc. Other
5.05<- 100 D13� • Ih MH Site Prep, etc V
A
Signature of Applicant Date
CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE
_ 1 SUBSURFACE DISPOSAL 1238 $ 57.00 ❑. SITE EVALUATION UPON REQUEST 7349 $ 43.00
m,' -0MULTIPLE'-PARCELS WITHIN SAME (NO PLOT PLAN)
LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION. 7348 $ 17.00
Z "a �:1 st 4 Parcels (Each) "�:
O 1238 $ 57.00 L (Less than 1 year)
b. Each Parcel after 4 7344 $ 24.00 v ❑ PRELIMINARY ELECTIVE 7352 $ 23.00.
13, Rereview 2nd review same
( parcel) 7344 $ 24.00 1.—EVALUATION (Attach DOH SAN 53)
' U - 0. - 'She Evaluation in Conjunction with - ❑ HOLDING TANK 7351 $-47.00
Crfticel Area 7348 $111.00 V ❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00 l
❑ Site Evaluation Lot Less than SYSTEM
10,000.Sq. Ft.-. 7347 $ 87.00
TIAL DATE
Holding Tank Agreements Completed ❑ Yes g1
Certt ication.of Existing S.D. System Required ❑ Yes No
WQCB.Clearuhce-required. (Attach Form ❑ Yes ❑ o
DOH SAN 007, Santa Ana Region Only)
SolisPercolation Report Required. ❑ Yes ti
Special Feaslblilty Boring Report Required. ❑ Yes
Detailed Contour Piof Plans Required (1 to 5 ft. interval) ❑ Yes
Owl
Other ❑ Yes
Staff Specialist, Lot Inspection Required ❑ Yes, 5No
y:
Lot Inspection Date
Soils boring.report by # Date
z C�
U Soils. Map. Page
Sol Type . Approved by Date
No. of Systems T of Systeme) No. Dwelling Units /f (1) Septi: Tank Soil Rate Grease/Sand
Z Ing Tank ❑ Existing Bedrooms j�xh r+►a FLtta 'Greasetop
O ❑ Replacemord
- / Gal
w
-4?J LeachLine Sq. Ft Sidewall allowance Install une(s) fL long ft wide with Leach Bed sq. tL
r; trench area ft rock/ sq ftn r,ftft
i`
min.
per running n below drelnlines a of area
} - -
r -
Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit T Depth Other
.Applicable Inlet (BI) (TD)
r•" Overburden factor Max.A1/Iowea)e Depth
No.2.System�YM
REMARKS
This application iStA PROVEDim- NIt�9 for the category checked, in SECTION B above, regarding the design of a subsurface disposal system as indicated
on ,the accompen d�pp p`lausing the ?requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Z above -designed system. No construction is permitted in the required reserved 100% expansion area.
tj Septic lank and sewer lines must be 50' minimum from any wells,,�
Leach lines must be 100' minimum from any wells, including expansion
ge pits must be 1 V minimum from any wells, including expan�saon�arr �Q/
Official �:�G/F7r�fe G 3
6�� Issued By/ Date —'tom
rside, Oe'"Indio ❑ Hemet q Perris r ❑ Rancho Calif. ❑ Blythe
DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
13