06617 (SFD)P.O. BOX 1504 N Q
Building 78-105 CALLE ESTADO
Address 51-560 Viiia LA,QUINTA, CALIFORNIA 92253
vwncr �
Tim Duffy I
Address P. O. PDX -904
City Zip Tel.
La Quftt8 1 92253 1 .564-4977
Contractor
Address
ty lZip I Tel:
State Lic..I City
& Classif. Lic. #
earcn., r_ngr.,
Designer
Address Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70pp) of Division 3 of the Business and Professions Code, and my license is in full force and
effect:"`
SIGNATURE 1 DATE
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 !7i e a signed statementthat 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 civilpenally of riot more than rive hundred dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or unproves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or 6nprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3900, Labor Code.)
Policy No. company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the pemrit is for one hundred dollars ($ t 00) 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. N, 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 far which this permit is issued. (Sec. 3097, CivifCode.)
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 Address
City,. State, Zip
BUILDING: TYPE CONST. -DCC: GRP.
A.P. Number 773-144--008
Legal Description
Project Description SYD
4661.7
REMARKS M
ZONE:
BY:
Minimum Setback Distances:
Front Setback frorm Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Sq. Ft.
Size 1466
No.
Stories • • •
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ -Demolition ❑
-s
Validated by:
Validation:
Estimated Valuation
$95,963
PERMIT
AMOUNT
Plan Chk. Dep.
$250.,00
Plan Chk. Bal.
$46.
Const.
556. SO
Mech.
169.8
Electrical
;
Plumbing
156.01
S.M.I.
6.,02
Grading
20.00
Driveway Enc.
20.00
Infrastructure
1,852.05
TOTAL
REMARKS M
ZONE:
BY:
Minimum Setback Distances:
Front Setback frorm 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 11/2/£9 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
B G
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. FT.
HEATING (ROUGH)
STORAGE TANK
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
I POWER OUTLET
ROOF DRAINS
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO. FT. ®
OTHER APPJEOUIP.
REINF. STEEL
WALL SO. FT. ®
DRINKING FOUNTAIN
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING 12AI- Q
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
�INSP. �/H
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® Vic
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
S
ROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
B G
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
R 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
FINAL INSP.I O 9v
GRADING
cu. yd.
-plus-x$-=$
LUMBER GR.
FRAMING 12AI- Q
FINA(�L(/
ROOFING !,GVyei
�INSP. �/H
/J///(/��►�1A�0 �//'7 �7
/'��!$
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
p
LATHINGILD W/1/ IVIIIYUlh
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
1
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
y OF
SCHOOL FACILITY FEES
7. 111 OC)C� `
10
TO: City of La Qu tr'a�i��� e �CA
DATE:
Department of Community `Dev "P ment" V�®
.78-105 Calle Estado a �. 1
,La Qui.nta, CA, 92253 +
This is to certify at
developer of which is
located at 51- within..
this District, has paid school facility fees imposed pursuant to the
authorit} gea at by Go.e nment Code S ctio '53080 in amount of P G'6�
s �oD
C
a total°of square feet of ( r ide t;al or
( ) industrial/commercial development and that builds g permits for
this footage in this development may now be issued by your jurisdiction.
for'DESERT SAN S UNIFIED SCHOOL -DISTRICT .
White = Building Department • Yellow - Facilities Planning • Pink - Accounting •- Gold - Developer
(TO) -37
Vi7i �'V
g,
IFIRIONIAMP TITLE COMIFAKV
ordeP No. 9
No.
L06ii No. - �L� �!
CD
)R RECDRIJER'S US
WHEN RECORDED iviAlL TO:
9)
T -y F. Duffy &
Barbara J. Luhni
16211 Downey Ave 08
P amoun
ar'-- t, Ca. 90123
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MAIL TAX STATEMENTS' TO:
L L
w j
SPACE
OVE TH19 LINE
PCLJMENTARY TRANSFER TAX .....................
Computed on the consideration or value of property conveyed; OR
.
...... Computed on the consideration or-VelLd less liens or oncumbrbric6s
remaining at time of safe.
Declarant or Agent datorrr inIng tax, —
6 R A N 7 D E E D
MR.A VALUABLE CONSIDERATION, recelpi of which is hereby acknowledged,
tdwy C. Potter and tnez A. Potter;'husband and wife
hereby 6FIANT(S) to
Timthy F. Duffy and BarbaLra J. Luhm, -husband, and wife as joint tenants
the real pt-60ei,ty ii -ii the City of
Coulv of State of California, described at
Riverside o1
Lqt 17 in Block ill of Santa Carmeli-Ea at Vale La Quinta Unit #12 a8.�r rec b rded
in'book 18, pages 79 to 80 of Maps, Records of Riverside County, Calif6trtia-;
t
Dat
STATE 00 6A6
cou.N,ry OF--
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cf-
—e" To
------
:)Bore n.je. th-3 LibiderSigned, allotany Public in and for said Slate,pet-
Potter
a z T
A,
Q
FAA,
Jvryonally l,r,.oWn t TiWl. (Oi ; roved io mo on [he upsis of satisfactory
lvidonc6t) tb be Die oerzofl(s) whose narne(s) is/L-6 subscribed to the
within ingirurfientand Acknowledged to me that 4ejOh!§/IheY eX§GLIted
the S.inlc—
VVIT NESS my Kand and offlci6lso!.
x
(This area for btficlai
J;f. j
notarial se51)
V
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II X 'ATrf&h
MATA NITS
AS 0 f 1 F T f V r
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COUNTY OF RIVERSIDE ENVIRONMENTAL
HEALTH 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 list
A non-retundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of
Rivefside. 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 Penson
Yr L ui t
Phone
SZ. y_S/ 77
Address & Firm
e Zavel ✓no
Owner�-Phone
A9 1JuCx
Mailing Address
City
State
Zip
Job Property Add
Legal Description Prop. (PM, Tract Lot)
t/
&
G!at •
2.S
5 -(14 vt//
r. 7- AL 4- 1 /
Lot Sizege,Wr-W
II'
Use of Permit P/R CU, etc.
Other / �o,a
� p !
!G-0
a X �Q
V r D
a
Dwelling H Site Prep, etc.
Signature of Applicant
Date
,,.� CATEGORY: REV CODE
CATEGORY: REV CODE FEE
(1100SUBSURFACE DISPOSAL' - 1238 . $E57.P0�
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION 7348• $ 17.00
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
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $,47.00
Critical Area 7346 $111.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
❑ Site Evaluation Lot Less than
SYSTEM
10;000 Sq. Ft. 7347 $ 87.00
IINITI / DATE
Q —C2 V 9
Holding Tank Agreements Completed ❑ Yes l I t
Certification of Existing S.D. System Required ❑ Yes ;�N,
WQCB Clearance required. (Attach Form ❑ Yes No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes c
Special Feasibility Boring Report Required. ❑Yes J:,@
-Detailed Contour.Plot-PlansC]:Required (1 to 5 it interval) Yes
Other ❑ Yes l
Staff Specialist Lot inspection Required ❑ Yes fNo
Lot I Cate
Soils boring report by PrgjQd* Date
/�/J
Soils Map Page _ Soil Type J • r d Approved by AIZ Ile Date -
No. of Systems
of Systems)
Tank ❑ Exisling
No. Dwelling Unita !
(1) Septic Tank
Soil Rate
®Greaee/Sand
�QI=
��
Bedrooms filxture of
Irkcp
❑ Replaoert>dnt
:?J OAA' ✓f/bi+ �
Gel
,S
Line Sq. Ft
Sidewall allowance
1nsW Line(s) K ft vide with
Leach Bed sq. R
trench eras
R rock/ sq. R
per running It
min. inched roek+Welow._ drahrl'mes or
fbottorrr.aree
Leachlines/bed special design for slope:
aRe
Applicbl
(3) Pit Diameter
No. Pits
Pit*bw
l(Bt)
Seepage Pit Taal Depth
(TD) �i%J
49095, 60 6 (
Max. Allowable Depth
N/A ¢� 0_—Wrden factor
---...iii------
No. 2 System*4
REMARKS:
This applicat OVED _ Ei l - -for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
,on,Lthe accomp)a p15T°`'p`I5n, using the requirements set forth in SECTION C above. A building permit is necessary for the •installation of thea,;
above designed system. No construction is permitted in the required reserved 100% expansion area.
(1 Septic tank and sewer lines must be 50' minimum from any wells a /kk e'er
�.(2. Leach lines must be 100' minimum from any wells, including expansion Area
(3) Seepage must be ' minimum from
.pits any wells, including expansion area Q Y
Signature HeaitFi Official �" �G�,/U4
of _ / r Date
RECEIPT NO. .'' Issued By S Date
DISTRICT:. ❑ Riverside, nlr3�l" bol ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
i
roti
OFFICE OF
AGRICULTURAL COMMISSIONER
AND
VVEIGWTS &MEASURES
CALVIN C. KAMINSKAS
JAMES O. WALLACE 4080 LEMON STREET, ROOM `19 Assistant Commissioner
Agrfcu�turoi CommissionerRIVERSIDE• CALIFORNIA 92501 CLEMENT BENVENISTE
Director of Weights & Measures (714)'787 2561 Sealer
49613 Highway 86, Suite B12
Coachella, Ca. 92236 nn
DATE n �0 1�� � (619) 342-8291
DATE L�� - — x
DEVELOPER'S NAME: .. ,J U/`C4, ,(') ccs�Q
ADDRESS: Q 6',., -
TELEPHONE:
TELEPHONE: ( .0 l4q 4
Dear Developer:
After reviewing your landscaping.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 mu-st be notified
-immediately.
Thank you for protecting and preserving the Coachella Valley's.pes.t-,free environment.
Agric ural Commissioner's Office
cc.: Indio and Riverside Office