10556 (PLBG)dinraseg 52-040 Villa
Jon .Srov n
Mailing
Address Box 4329
City Zip
Palm Desert
Contractor .
Tity/ 4UWA ,
`
qq
P.O. BOX 1504 fj �Q. iO���
78-105 CALLE ESTADO f � ,
LA QUINTA, CALIFORNIA 92253
BUILDING: -TYPE CONST. OCC: GRP. -
45 --6836
-1 Y 170 San Nicholas
City Zip Tel.:
Palm Desert 92260 34.0--3724
State Lic. City
& Classif. C36 577430 Lic. # 2014
Arch., Engr.,
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.
SiSiNATI1RE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Buslness and Professions Code: Any city or county which requires e
permit to construct, after, Improve, demoksh, 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 7009) 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).
CH, 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
Professlons 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 far 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.)
❑ 1 am exempt under Sec.----L-B..& P.C.-for this reason
Date Owner Z1 -+ ^ ' � �� �'•�
3
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 flied 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 th¢ work for which this permit Is Issued, I shall not
employ anyPFarson In any manner so as to become subject to the Workers' Compensation
Laws of Cellfornla.
Date Owner
NOTICE TO APPLICANT., It, 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
Ihereby 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 It 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 sof this city to enter the above-.
mentioned property for Inspection purposes.
Signature of applicant Date
Malling Address
City, State, Zlp
.P. Number
Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add O Alter O Repair O Demolition 0
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const:
Mech.
Electrical
Plumbing 30.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS r r . a: 7 4 ^ -T-,r F.f A ,ftp 7 a _.431) 4 -rt
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 ESTIMATENO.
ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ 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)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
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 ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Ac
HOUSE SEWER
REMARKS:
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
EWER,0111 &EPTIC I ANK
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER L60P
HEATING (FINAL)
OTHER APPJEQUIP.
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
W-
Received From:
Address:% L727ek,_
ACcumillio..
Service Address
• Meter(s)
• Service(s)
• -Backflow(s)
0 House Laterals)
COACHELLA VALLEY WATER DISTRICT'
CASH RECEIPT DETAIL
• Detector Check(s)
• Meter Surcharge
ASanitation Capacity Charge
0 W.S.B.F.C.
0 Temporary Construction Meter
0 Turn on Charge
0 Uncollected Account -Name
0 Inspection Fee-Tract-
Fee
ee-Tract-Fee -
0 Plan Check Fees Water I Sewer -
Tract -
• Bond Payment - A.D. --Bond
Assmt.__
• Customer Deposit
• 'Other
TOTAL $ e;r
Remarks:
0 COPY to:
Cash
Water Service
..T
Money ,P t.,
Check
Cashier
Order —7CVWD-4
fZ
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 1.11
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 7/12/91 1 Type.'of Permit La 'nta
No. 10730 Permit, #
Log #
Owner Name Don Brown -
No. 52-040 Street Villa
city La Quinta zip 92253 Study Area 115
APN # 773-234-002 Tract # I Lot # ° Square Footage 11779
Type of Development. IrSingle Family Residence No. of units
Comments
At the present time, the Desert Sands Unified School District does not collect fees on y
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:
I x.
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 5.3080
in the amount of 1.58 X 1779 or $ 2,810.82 have been paid to D.S.0 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.
r
Fees Paid By Don's *.Desert. Designs Telephone 341-8310
Name on the check r
gy James E. Lively ,k 7 41
Assistant Superintendent, Business Services _J
Fee collected /exempted by Shelley D. Bennett + "
` Payment ReLeived} h=l
Signature { ''0�. Check No �1 G19
Collector. Attach a copy of county or city plan check application form to district copy +'o 'rul waivers.
Embossed Original-Building Dept./Applicant Copy - Applicant/Receipt Copy -Accounting e
JUL 10 '91 12,0&
s
Order No.
Escrow No.
LoanNo. v
WHEN RECORDED MAIL TO:
Don Arnold Brown
Sally Francis Winn
P. 0. Box 4329
Palm Desert, Ca. 92261
JUL 2 0.
.COPY of Document Recorded
cin as No.
has not been compared with
criglnal.
�,1�!LLIAM E. CONERLY
County Recorder
PIVERSIDE COUNTY, CALIFORNIA
PAGE . 002
FOR RECORDER'S USE
MAIL TAX STATEMENTS T0: _0_
Don Arnold,Brown
DOCUMOffARY TRANSM . TAX
Sall Franc -s 144 -in ... Compute.d on the. consWerstion or velue of propriety eonv�yed: OR .- __...._
y : coinpui.e ai t1>♦ oaaide.r>etlon w Moe. ie.rt lie.ns o► fncumbraneei
P. 0. Box 4329 re.rna)nin9 at tlme.'of stye... .
Palin Desert, Ca. 92261
319118t re of D coram or Agent:de.aarminine ax — Fhn► Name
GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
,SALLY FRANCIS WINN, AN UNMARRIED WOMAN
hereby GRANT(S) to
DON ARNOLD BROWN, AN UNMARRIED'MAN AND SALLY'FRANCIS-WINN, AN UNMARRIED_
WOMAN, AS JOINT TENANTS
the real property in the, City of . LA QUINTA
County of RIVERSIDE : - ..State of California, described as
LOT 21'' -IN BL•O'CK 93 OF SANTA CARMELITA AT VALE LA QUINTA''UNIT NO-. '11; AS --PER .MAP - .
_2cEt;Q]{liED IN -BOOK„18: PAGE 75 OF MAP.S�.,_.i ECQ _OF.,�RZVERSI�,F,. 9 -0 -MUX
f
1
)
JUNE 28, 1991
Dated_ __ , � . _ .. ...._ .._ ..........
' C ” - WINN.-
STATE OF CALIFORNIA RIVERSIDE
COUNTY OF l
On JUNE.2&, 1991
Wore me, the undersigned, a Notary Publk: in and for said State, PW_
aonalryappeared SALLY FRANCIS. WINN
ELENA N. OOM
pemnatly known to me (or proved to me on Ilia Mata of satisfactory
.A VOTARY MMIC—
eyictence) to be the peiEcxi(s) whose name(a) Ware subscribed tia the
WOEAM Cao" \'{
. .
wrtnin instrument and, acknowledged.to me that helshe/they executed 1 M, CannNssdn Eu+*" Dec. 28. 7993 l
9 same: - I..-Mr--���N�rr.Mr�i��M��A/
'ESS my hand and offid8i seal.
(This arcs .for' official notarial seal)
MAIL TAX.STATEMENTS AS DIRECTED ABOVE
F
WOODSTOCK WEST Inc.
P.O. Box 604
Thousand Palms,CA 922.76
(619) 343-.2113
CONTRACT
Contractor � L____ ______ _ Date _�_✓_'2�t' �_ '_
Address' ------------- ---------------- Phone
Delivery Address_____— -------
��'-�
-------NO-15--c-
-------
Legal Description Gc�1------- -- -----------------------------
---------------------------------------
DESCRIPTION OF PRODUCT ORDEREDtODST CK WEST shall Fr�vid e the
fol l wing described rod ct:__2
-- --- �,- `---��° --7- s ----- -^---- ----------------=-------
-----------------------
--------------------------- ---------
-----------------------=---,-------------------------------------------
�0 +
�lo
CONTRACT PRICES $-----------=-=-`-------------=--
PAYMENT TERMSi Deposit With Order: Balance:Baiance Due Date:
t321,a �w
OWNER: LOAN:
J�
Name ------=-------
- ��-� � ��� ------ Name --------------
Address --------------- -- Address -------------------- ----
----------
City ----------------------------- -City ----------------= -
-----------
Phone _ Phone-----------------------------
Loan
------------Loan Officer______________________
TYpe of Loan ---------------------
Voucher/Draw-----------------------
------
WOO STOCK W ST CONTRA R'
If accepted. by = �� ______ these prices will
remain in'effect for a eriod of _____ ____-_____ days.
. s
' Buena Engineers, Inc.-
79-811
nc.79-811 B Country Club Drive -
Bermuda Dunes, CA 92201 • (619) 345-1588 '
Client Name,
Client Address 4
Client Phone
DATE
JOB NO.
3/''g •
/'-7 3yo-
,PROJECT '
FIELD TESTING
V-'LC0
LOCATION
DRY
DENSC Y
IbsJCL ft.
MAXIMUM
DRY
DENSITY
%
MAXIMUM
DRY
DENSITY
lbs./cu. ft.
CONTRACTOR
OWNER
WEATHER
TEMP.,/
o at AM
C L �� ��/4r+
9 `�
0 at PM
PRESENT AT SITE
13P6
C,
TEST
NUMBER
"
` 4TEST LOCATION
' _..i
LOT
NO.
ELEVATION
FIELD TESTING
-REFERENCE CURVE
MOISTURE
• CONTENT
%
DRY
DENSC Y
IbsJCL ft.
MAXIMUM
DRY
DENSITY
%
MAXIMUM
DRY
DENSITY
lbs./cu. ft.
OPTIMUM
MOISTURE
CONTENT
%
13P6
C,
vtac,o.,_T
X,
'
r Ku L) �. L_
REMARKS: kc •� �� T E` ITS i %4./�
CLIENT REPRESENTATIVE SIGNATURE
FIELD REPORT
t
TECHNIDIANS SIGNATURE i 7 j'
4. t