08090 (SFD)•44 4)
P.O. BOX 1504 N o . 08090
Building 78-105 CALLE ESTADO
Address 51-501 villa LA QUINTA, CALIFORNIA 92253 C -N
Owner
Flamm
Mailing '
BUILDING: TYPE CONST. OCC. GRP.
Address A.P. Number 773-143-013
City ITel.
Cont
Address
City -
Zip
Tela
State Lic.
No.
Stories
City
& Classif.
New ❑ Add ❑
Lic. #
Arch., Engr.,
Demolition ❑
Designer
Address
Tel.
City
Zip
State
Lic: #
LICENSED CONTRACTOR'S DECLARATION
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.
SIGNATURE 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, 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, Bulsness 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.)
O 1, asowner 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 ` ` 1 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.)
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
Legal Description Let 1
Project Description Sin4le Family Dwllinq
ZONE:
1
Sq. Ft.
Size 1498
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑
Demolition ❑
Estimated Valuation
7
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical '
Plumbing
157-50
S.M.I.
Grading
Driveway Enc.
Infrastructure
1831.64
e
TOTAL
a K
REMARKS
T ..r.s
r r t x.7 F iy f 4
fw5s f 3—
_3035A3—
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 $41191OPermit
a
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SD FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) AP AlMETER
/
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
IP
SQ.FT.GAR ® 3/ic
HOUSE SEWER
REMARKS:
GAS PIPING
I
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE LPL.CK.FEE JONST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK jllel%,41 //'Zf
GROU L MBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE �8 /0
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH) AP AlMETER
/
LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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. /% sip
�t
FRAMING 7�
FINAL INSP. 7 40
/ /
ROOFING
IP
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING AI �Q O
MESH
INSULATIONISOUND 7ZtVA
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERT.IFIC+AtION OF PAYMENT
OF
SCHOOL FACILITY FEES
ID
9..cs
TO: of
DATE: LQ n f
This is to certify that Lili U C—U ,
developer of - whch is
located at - 6A— within
this District, has paid school facility fees imposed pursuant to the
authori gee rat d b G v rnment Code a £iof� 5 080 i th ount of
s 3� c o CL I
covering a total of square feet of Cy) residential or8�
( ) industrial/commercial development and that buildIng permits for �(J�
this footage in this development may now be issued by your jurisdiction.
N #a 11�4j& 19 - /�
for DESERT SA S UNIFIED SCEOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • 3old - Developer
(10)-37
RECORDING REQUESTED BY
';AT!
r
0NAL TITLE INS. CO.
MAILTAX S'rNri�11LN-F W 10
V�
0.
C; V
GO X; Ce
LLJ CD
0 0 C)
WHEN RECORDED MAIL T) C) C>
2
b I
Vo
Fkl.Nw— ELEAZAR D. LOPEZ ANTI iV t,a
oK
.U,.
IKA GUADALUPE C. LOPEZ :W 7
40*
AddrS, ,Ujl -,
9A.?! I , _<
85235 Medina Avenue
cil.
California 92236
Zip Coachella,
RECORDERS USE ONLY
§W5
ORATION
okm-RNO. 100566 NT DE
GRA
CORP
1-11, JoW.1 No. .1-867-SB
ORK
-7
Si
The undersigned grantor(s) declare(s): .4
V.-
ikv., -C' - 10 V,4"
Documentary transfer tax is 23.
or
property
conveyed, 1. r
X Computed on full.value of ps .1
tirni, of ale P_
at s valueofilidns-and !'encufiibmnces remairung,
Computed on full value le
Unincorporated area City of rd
773-143-013-3:'.-'.; _,t
Tax Parcel No.
FOR A VALUABLE CONSIDERATION,. ni6eipt of which is hereby ;ickn6vledged,,,
unmarried,man AND UNLIMITED HOLDINGS, INC
a Nevada Corporation
DAVE SASS, an
a corporation organized under the laws L.of the State of Nevada
hereby GRANT(S) to
UPE C. LOPEZ, Husband and Wifd, as Joint Tenants
ELEAZAR D. LOPEZ AND MA GUADAL
•
9
the Followin 'described ieal,proper.y in the State of California:
County of Riverside
Lot One (1) Block One Hundred Twelve (112) of Unit 12 Santa Carmelita at
Vq "I. e La Quinta—as per-map...recorded,.-in,Boo.k-18-Pages--79-and,80,of-Maps,
rder of Riverside County.
if the office of the County Reco
ELEAZAR D. LOPEZ AND MA GUADALUPE C. LOPEZ, Husband and Wife, as Joint Tenants
the following described real property in the , State of California:
County of Riverside
Lot One (1) Block One Hundred Twelve (112) of Unit 12' Santa Carmelita at
Vale La Quinta, as per --map recorded- in Book_18_Page .s__79--.and-80-o1•-Maps,
if the Office of the County Recorder of Riverside County. -
Dated March 7, 1990
(Corporation Acknowledgment)
STATE OF ?KA11DMUff&X . NEVADA
County of Clark
DAVE.,SASS
4
UNLI E OLDI Ke"INC., a Nevada
Corporation
By" • A TADMOR President
By Secretary
da of March 19 90 , before me, the undersigned,
On'this 9th y RHONDA TADMOR
a Notary Public in and for said County and State, personally appeared
and `�
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) who executed
the within instrument as the
X President -and as the. Secretary
on behalf of the corporation therein named, and acknowledged to me that such corporation executed the
within instrument pursuant to its by-laws or a resolution of its board of directors.
-----------------.
WITNEmy hand and official seal. 1 NotaryPublic-sta:eOf Nevada I
COUNTY OF CLARK
SA1,vD9A BIAHO
/' My Commission Expires
1.-' �G �J �✓ I .. ° Nov. 8. 1993
Notary Public in and for said County and Sia e.. L.— ----_J
(Notary Seal)
MAIL TAX STATEMENT AS DIRECTED ABOVE
FD -13A
b
M.
Ypft
SECURITY . UNI®IV
� �?r STATE'OF)MYW Nevada Title Insurance Company
3titr,CL
COUNTY'OF Clark r �" �. S S �. • r
LL
'On this the `9th- '
c day of"*'_' -";March.
!)Pfore me, the undersigned; a Nota P {" '
ry ubllc In and fortsaid do R
ti c and State, personally appeared k ' r
RHONDA TADMOR
EF
R NOTARY SEAL OR STAMP
personally. .
`, knowm to me or proved to me on the basis of satisfactory` evidence to be,`
+fir the person(s) whose name is/are subscribed to the within instrument y y
as the Attorney(: es) in fact of •' --- - otary Public -State Of Nevada '
a DAVE SASS couNTY of cls ard and acknowledged to me that she , SANDIRA BIANCO )
z subscribed the name •My Commission ESc 1 of DAVE SASS Aires
' a rinci al HER thereto asNov. t3,1993 )p P and ownname as Attorney infact.-----!
Signature
`- —�
r������' � - ` _ • Y .' * s .; _ � _ fid' a .. '.
f
•^,^�+f`r1r*i.ski?+E-i"`,..Yd4,�,xw:,,.:y,�,: �.:..EL��:� 'cY-•.•.a5-.i•�,�;..•�-.�... „iter t ,wc+fal-- ... . _ �� °-••'r..Y �.r� .
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COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH A""'0f Pioi1No'
ENVIRONMENTAL 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
TYE
A non-refundable filing fee (see below) is required when the application Is submitted. Check must be made payable to the County of
this application shall remain valid for a period not to eiceed one year from data of approval.
��.�4
VERIFY ITEMS0IrfECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT L4AA[tt�
APPLICATION LOG #
��
A�9e'r�J't+'Contractor, Conteai�e n Phone f/t
rr�ibb/ (P Address & Firm
%a.E:•�L /cis "��'6 'C7�s .
v
Owner
W
Phone Mailing Address
City ��tt
I � t"/�{? L' /l` •
Stta+te/)
C /'t"'
Zip
/ � ? J
Job Job Property AddressC4-6 --04?
.J�U • ��/ � ���..
Legal Description Prop. (PM`, Tract, Lot)
o �' e i��OC�C r< �.. rilVl'.I 1 Z..
Lot Size
_ter Age y� Iw^
Use of Permit P/P, CU, etc .c 70 ,.. >ltY.
Other
�j
�/
lot)°
V (� r ��
Dwel�1. MM Iti i5rrep-, etc•
f �✓
signature 'Applicant
Date
�' CATEGORY: REV CODE _007--. FEE
h CATEGORY: REV CODE FEE
[fi, SUBSURFACE DISPOSAL 1238 $ 57.00
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
CD
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
Z
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
UJ
❑ Rerevlew (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
CD
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $ 47.00
Critical Area 7348 -.; $111.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $222.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
INITIAL DATE
Holding Tank-NAgreements Completed ❑ Yes
Certification of Existing S.D. System Required ❑ Yes 0 N'
WOCB Clearance required. Attach Form ❑Yes
DOH SAN 007, Santa Ana Region Only)
Solis Percolation Report Required. ❑ Yes u?, I
,F'`
Special Feasibility Boring Report Required. ❑ Yes ❑��0Z
Detailed Contour Piot Plans Required (1 to 5 ft interval), ❑ Yes
4�
Otter • ❑ Yes No'
Staff Specialist Lot Inspection Required ` . ❑ Yes ITNo
Lot Inspection Das
Solis boring report by. P"ectS Data
t
Solis Map Paget W1 Sol Type Approved by fes__ Data
U
!
Z
No. of Systema
T, of Systems)
of I06Tank ExistingBedrooma,
No. Dwelling Untie 6 r
FlxWr8-,tk is
(1) Septic Tank
Son Rate
Grease/Sand
G Imp
O
0 O Replacemont
CO'(
Leech Line Sq. Ft
Sidewail allowance
ball fl long tr wxm with
Leach Bed eq fL
trench area
ft rodd sq. R
per running ft
�.run�e(s)
min. iriclrea' below dralnlinea or
of bottom
Leachlines/bed speciial`, ign for slope:
Applicable '
(3) Pit Diameter
/�►,
No. Pits `
•Pit 13670P
ItttWO)B
(TD) Seepa Pit Tota Depth
OUYeR
�-s�'
Ooerburden tactor
N/AYO
Max. AJ"le Depth
No. 2 System
'
REMARKSAWA
This applicati0r -APPROVED lED`for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
0
above -designed system. No construction is permitted in the required reserved 100% expansio area.
—B
1) Septic tank and sewer lines must be 50' minimum from any wells Qs yP
?�Q,
W
�? Leach lines must be .100' minimum .from any wells, including expansion a ea �, ,�,
(3) Seepage pits must' be 150' minimum from 'any wells, including exparisioli area ! J ,iC�Qi,fi%: 41
Si nature of Healih'Officral- � � f� 4�`�" I l . Date` � €�
A
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