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002784 (SFD)4TWyl 4 4 aall A& P.O. BOX 1504 N o . Building 51—%r, $LIMMhollaw miva 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner EdWal!d ArklemtoYt r Mailing Address CityZip Tel. � 1 Contractor Sam City lZip Tel. State Lic. City & Classif. 396799 Lic. # Arch., Engr., Designer Address I Tel CityI Zip I 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 ofnot 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. (Seca 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. 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.) ❑ 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 contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 amexempt under Sec. B. tx P.C. for this reason Date Owner ?r s w 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 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: 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 1 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 FINAL DATE INSPECTOR 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.2"'2� "�� I certify that I have read this application and state that the above information is correct. Issued by: Date hermit 1 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. _,NValidated by: +. x Signature of applicant Date - Mailing Address Validation: City, State, Zip A 7 0 0 8 12 30 i 8, 5,27 U HARD COPY _ T 002784 JILDING: TYPE CONST. OCC. GRP. P. Number 773'474'023 Description 11 Project Description Sigliale fam1Y dwUiM 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 ITt 2450 S�,� 420 Size, M= 200 No. Stories No. Dw. Units New Qi Add O Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 76E0.72.00 PERMIT - AMOUNT Plan Chk. Dep. 4411 Liu Plan Chk. Bal. bar+dti Const. E264.401 Mech. 32,00 Electrical 755.05 Plumbing 109.00 S.M.I. 5.36 Grading 20.00 Driveway Enc. 20.00 Infrastructure 1113 5.58 TOTAL 2.055.27 1,805.27 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 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS ROUGH PLUMB.''// BONDING HEATING (ROUGH) STORAGE TANK YARD SPKLR SYSTEM 2 ND FL. SQ. FT. p DUCT WORK ROCK STORAGE FOUND. REINF. MOBILEHOME SVC. BAR SINK POR. SO. FT. ® REINF. STEEL GAS (FINAL) TEMP. POLE GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS WATER HEATER SERVICE FINAL INSP.7];2 --.$-o DRAINAGE PIPING CAR P. I SQ. FT. WATER SYSTEM GRADING cu. yd. $ plus x$ _$ WALL SQ. FT. �L�NAL INSP. �( DRINKING FOUNTAIN SO. FT. ® ROOFING /Q URINAL ESTIMATED CONSTRUCTION VALUATION $ REMARKS: WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES RkFIREPLACE _ O - WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED MESH LAUNDRY TRAY AIR HANDLING UNIT CFM INSULATION/SOUND l 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 - SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE FDBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR ETBACK AZI16ROUND PLUMBIN O� UNDERGROUND A.C. UNIT COLL, AREA LAB GRADE .,�g 1 ROUGH PLUMB.''// BONDING HEATING (ROUGH) STORAGE TANK RMS ?. �is j SEWER ORS I ANK 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.7];2 --.$-o BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. �L�NAL INSP. �( �� FRAMING % /• /_/_ INAL INSP.J-� ROOFING /Q ����f ♦ `x A�� `� � C i c �7`/ I ML 19yY � ^/� REMARKS: VENTILATION FIRE ZONE ROOFING RkFIREPLACE _ O - SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND l FINISH GRADING 04FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS, GARDEN WALL FINAL :d - Tihf " P.O. BOX 1504 APPLICATION ONLY Building Address l Owner Mailing Address ",�.' City Zip Tel. - Contractor P=A• "IL r -C4 acl`v►["r' 1 '41 a lRol 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 City Zip Tel.. P,,_iom. 1L- e.f rwC oN7Z & e.. -:a,2.0--�J Q State Lic. ' J City & Classif. _X6,-7 r Lic. # Arch., Engr., Designer Ed, A e\de r� o I fi Address Tel. City P Zi State r� Lic. # 11 1 N f� ` 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. 1 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or knproves 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.) 0 1, as owner of the property, am exclusively contracting with licensed contractors to con- 8truct 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 contractors) licensed pursuant to the Contractor's License Law.) P I am exempt under Sec.' ! t B. & P.C. for this reason Dater ? J.v I.. 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 O 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 lhp 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. ,} ` /' ! J� Date _/ 7- 11^ Owner�%`� r = 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 car lly 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, Zlp BUILDING DIVISION BUILDING: TYPE CONST. /� OCC. GRP. A.P. Number -' r / 7 v Legal Description Lo� Project Description +r� ct �� N::u I11A k Rti'.'"i t`k-- r'Xe.•y'F i4-SraT= T1s/ Fc -E' .�mo G Z ---o0 4 G. Sq. Ft. 4•e W"pNo. SizeStories No. Dw. Units New,W Add ❑ Alter ❑ Repair ❑ Demolition ❑ Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR 76, 07,-7 Date Permit Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. A 6 9 4 1 Plan Chk. Bal. 6 �� Const. 3G o0 Mech. 33-m4r_> Electrical 75 .oS Plumbing o j .,p 0 S.M.I. - 3G Grading .20 .pp Driveway Enc. dAO. ©o Infrastructure C-, TOTAL 7� 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 Permit Validated by: Validation: A 6 9 4 1 12 18 275.00 R CONSTRUCTION ESTIMATE GROUND PLUMBING NO. ELECTRICAL FEES NO. PLUMBING FEES $ v �O A� UNITS BONDING HEATING (ROUGH) STORAGE TANK SO. IST FL. FT. ® SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEGUIP. YARD SPKLR SYSTEM GAS (FINAL) 2ND FL. S0. FT. GROUT WATER HEATER SERVICE // 7 ®'�o 7v MOBILEHOME SVC. WATER SYSTEM BAR SINK ' GRADING cu. yd. $ plus x$ POR. SO. FT.® GAR. 41.2-0 SO. FT. ® D S 9a� POWER OUTLET FINAL INSP. ROOF DRAINS FINAL INSP. ROOFING DRAINAGE PIPING REMARKS: CAR P. I SD. FT. VENTILATION WALL SO. FT. ® • e/ FIREPLACE DRINKING FOUNTAIN SD. FT. SPARK ARRESTOR URINAL GAR. FIREWALL ESTIMATED CONSTRUCTION VALUATION $ ow t' LATHING WATER PIPING — NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FINISH GRADING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN CERT. OCC. WASHER(AUTO)(DISH) — APPLIANCE DRYER INSPECTOR'S SIGNATURESIINITIALS, GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GARDEN WALL FINAL LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR, HP 1� — POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT `a SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER S — MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/a c 3� SEWAGE DISPOSAL 30— SO.FT.GAR ® 3/ac 36 HOUSE SEWER �O GAS PIPING— PERMIT FEE 0 — PERMIT FEE 0 — PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEECONST. FEE SMI FEE PLUMB. FEE 33-� 3��f�e2 3� o0 JELECT.FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR 4-, 4 SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEGUIP. 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS, GARDEN WALL FINAL 10FIEp o� � 2 -o O y BERMUDA DUNES r RANCHO MIRAGE INDIAN WELLS H of, PALM DESERT a ,PLA OUINTA �O INDIO V) Desert Sands Unified School District 82-879 HIGHWAY 111 • INDIO, CALIFORNIA 92201-5678 • (619) 347-8631 December 29, 1986 * City of La Quinta Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 Re: 51-965 Eisenhower Dr., La Quinta, CA - 1 unit Gentlemen: The developer of the above referenced project has mitigated its impacts on our overcrowded schools by payment of the amount of $628 per unit. This amount is to be applied to the cost of additional district educational facilities made necessary by,such new. development. Sincerely, John D. Broo Assistant S p rintendent Business e ices �, Richard M. Beck Facilities Planner JDB/vmm * This certification of payment of developer fees is valid for issuance of building permits only up to and including December 31, 1986. Ir - NN00057 . CA4,-83' J TICOR TITLE INSURANCE STATEMENT OF INFORMATION TO: Ticor Title Insurance Company of California Order No. DEC 19 1986 r LA! app'-.� To expedite the completion of your escrow, please fill out and return this form at your ear��h&�&t�mi� *hgiMormation is for confidential use by Ticor Title Insurance Company of California in searching the land records in connection with the order number shown above. Further explanation of the need for this information is,brinted on the reverse side of this form. Please Print all information PERSONAL IDENTIFICATION Name GEo(-cjsZ FIRST NAME FULL MIDDLE NAME—IF NONE, INDICATE LAST NAME Year of Birth 1 9 i4_5 Birthplace � a /tyf �Ie= ,Social Security No. -� � Wife n Full name of n `(G� h ZC)r'VI, FI RST NAME /% ;/L�r/�_Social NAME—IF NONE, INDICATE LAST NAME j We were married on JC, >7 1Z l9f�lo at L/Iliq T 1 04- DATE W CITY AND STATE Wife's maiden name r 0 LU n RESIDENCES DURING PASTe10 YEARS ' ��-}'o�',., X41(-I(Iyc; Ccd i 1) 75-- / 9,81 NUMBER AND STREET CITY FROM (DATE) (If more space Is needed, use reverse side of form) OCCUPATIONS DURING PAST/ WEARS Husband's Wife's 69) (DATE) TO (DA OCCUPATION FIRM NAME ST.REET AND CITY FROM (DATE) TO (DATE) (If more space Is needed, use reverse side of form) FORMER MARRfAGE(S), IF ANY If no former marriages, write "None" �� N Otherwise, please complete the following: Name of former wife Deceased ❑ Divorced ❑ Name of former husband -76-5 Deceased ❑ Divorced 0 When Where _ 716/ When .�9�� Where.;W40 (If more space is needed, use reverse side of form) Buyer intends to reside on the property in this transaction Yes ❑ No THIS PORTION IS TO BE.COMPLETED PY THE SELLER The Street Address of the property in this transaction is (LEAVE BLANK IF NONE) The land is unimproved or improved with a structure of the following type; IMPROVEMENTS: ❑ SINGLE RESIDENCE OR 1-4 FAMILY ❑ MULTIPLE RESIDENCE ❑ COMMERCIAL OCCUPIED BY: OWNER ❑ LESSEE ❑ TENANTS ANY PORTION OF NEW LOAN FUNDS TO BE USED FOR CONSTRUCTION IMPROVEMENTS, REMODELING OR REPAIRS TO THIS PROPERTY HAVE BEEN MADE WITHIN THE PASTSIX MONTHS IF YES, HAVE ALL COSTS FOR LABOR AND MATERIALS ARISING IN CONNECTION THEREWITH BEEN PAID IN FULL) ❑ YED © ❑ YES NO ❑ NO Thr undorsionod doclnrr.. widor onnalty of oeriurv, that the foregoing is true and correct. ` + (IF MARRIED, OTH HUSBAND AND WIFE SHOULD SIGN) a of Property Transferred A. ( ) Single-family residence E. ( ) Mobil ehome B: ( ) Multiple -family residence (no. of units: �) F. �4) Unimproved lot C. ( ) .Co-op G. ( )'Commercial/Industrial W D. ( ) Condominium H. ( ) Other (description: ) caaaccsaaaassaaazassaccaacansaascacrccaxcaaa:=caxxca:asxcaaassax=sasaaaaa:aaa:acaaaaasacnacaac=caasacccaaaaaaaaaaaaaa a aaa .7, 5 3. A. Cash Downpayment or, Value of Trade (excluding closing cost)...... .......................f 0 0 B. 1st Deed of Trust at % Interest for years -Amount..... *........*.S d ( ) Fixed Rate ( ) Variable Rate ( ) New Loan ( ) Assumed Existing Loan Balance ( ) FHA ( ) Finance Company t. ) Cal -Vet ( ) Savings d Loan ( ) VA ( ) Loan Carried by Seller ( ) Bank ( ) All Incl us i ve Balloon Payment ( ) YES ( ) NO ........ S C. 2nd Deed of Trust at % interest for years. Amount .....................:....s ( ) Fixed Rate (. ) Variable Rate ( ) New Loan t ) Assumed Existing Loan Balance ( ) Loan Carried by Seller Balloon Payment ( ) YES ( ) NO ....... .E D. Was other type of financing Involved not covered in (b) or (c) above? a.( ) YES b*(?<I NO Type at Interest for years. Amount,,,,,',,,,' ..........*......*..aE ( ) Fixed Rate (, ) Variable Rate ( ) New Loan ( ) Assumed Existing Loan Balance ( ) Loan Carried by Seller Balloon Payment ( ) YES ( ) NO......a.E' E. Improvement Bond: Outstanding Balance: Amount . .......... :.......a..aa....a.a.a.*....5 F. TOTAL Purchase Price or'Acquisition Price, if Exchanged:...:...................::.......E �' cassacacccaaaacsaaccacaxaaccxaascccxacaaccaaacccaaaacaacsasaccaaaaassaaaacaaaccaaaccaaaacccasacaaanaaaaacaaaaaaaaaaaac 4. Was any personal property Included In. the purchase other than"•a• mpbil ehome subject to local property tax? a.( ) YES bX ) NO If yes, enter amount and attach Itemized i.Ist of personal property: c. Amount S 5* Transfer is by: A. ( Deed; B. ( ) Contract of Sale; Co ( ) Foreclosure; D. ( ) Other - Explain: 6. "Was only a partial Interest in the property transferred? aa.( ) YES b.(%pO NO If "YES" indicate the percentage transferred..................:loo a.:..a....a..............c. *7. A. ( ) Date of Transfer / 19 or B. ( ) If.an I r t n e, Date of Death / 19 Month Day �� /e�ie�/��Month Day 8. Is, or will, the property (be) producing income? a.( ) YES bo OV) NO 9. If answer to Question 8 is yes, is A ncome pursuant to: A. ( ) Lease; B. ( ) Contract;. Mineral rights; D. ( ) Other - Explain: 10. Did .the transfer of"this property involve the trade or exchange of other real property? a.(. ) YES b.(—) NO *11. Is this property intended as your principal place of residence: a.( ) YE5 bo 014 NO If yes, enter date of occupancy . / , 19 or Intended occupancy ____/_ 19 Month Day Month Day *If this date will be the same as the recording date, enter "See Recording Date% =cascacccaccccaacccccccca:c=acc==caccccccaacsacacccaacaaacc=scccccxccsaccsaaa:acacccsccaaca=accts :a aacccaaassaaxacaaaasaa I certify that the the for go ng.I true, corr t and late to the best of my knowledge and belle Signed, ,; Date: Z, (New Owner/Corporate Officer) Please Prinnt Name of New Owne /Cor orate_p f icer 0aW/Q/e� Address Phone No. where you are avail abl a from 8:00 a.m. - 5:00 p.m. ( (NOTE: The Assessor may contact you.for further information) =acacaa----=ccaccaccc=_"----------------•'_---_---_--- -------_-____--_""--_-"-----^-----acsaacc--a=• If a document evidencing a change of ownership Is presented to the recorder for recordation without a concurrent filing of a preliminary change of ownership. report, the recorder may charge an additional recording fee of twenty dollars ($20). The additional fee shall not be charged If the document Is accompanied by an affidavit that the transferee is not a resident of California. ' _____________ c_____aace ea:ac_a_______aaa-a----=msaxa:amaasasaacessaaaaa----_sac-s----acacas------cca--c----eaaaasmaaa=e AFFIDAVIT OF N01 -RESIDENT 1RANSFEREE +J The Transferee (buyer) name.1 above is a resident of and not a resident of the State of California. i State Signed Date SBE -ASD AH 502-A BACK (3-6-85) The land is unimproved or improved with a structure of the following type; IMPROVEMENTS: ❑ SINGLE RESIDENCE OR 1-4 FAMILY ❑ MULTIPLE RESIDENCE ❑ COMMERCIAL OCCUPIED BY: ❑ OWNER ❑ LESSEE ❑ TENANTS ANY PORTION OF NEW LOAN FUNDS TO BE USED FOR CONSTRUCTION' IMPROVEMENTS, REMODELING OR REPAIRS TO THIS PROPERTY HAVE BEEN MADE WITHIN THE PAST SIX MONTHS Q ❑ IF YES, YES NO HAVE ALL COSTS FOR LABOR AND MATERIALS ARISING IN CONNECTION THEREWITH BEEN PAID IN FULL? ❑ YES ❑ NO The undersigned declare, under penalty of perjury, that the foregoing is true and /jcorrect. DATE HOME BUSINESS PHONE ��- PHONE (IF MARRIED• OTH HUSBAND AND WIFE SHOULD SIGN) FOR RECORDER'S USE ONLY Recorded: Date: Document No. FOR OFFICIAL USE ONLY S.P. E. PRELIMINARY CHANGE OF OWNERSHIP REPORT ..4. . z. To be completed by transferee (buyer.) prior to transfer of subject property in accordance with Section 480.3 of the Revenue and Taxation Code. SELLER: McDaniel Ernest ,& Ann, McDaniel, Stephen & Wadie BUYER: Anderholt A- PI&C L Zgm- 1 ASSESSOR'S PARCEL NUMBER(s): LEGAL DESCRIPTION: Lot 11 ADDRESS (If Improved): MAIL TAX INFORMATION TO: Address Block 116, Unit 12 :/ e5&L!,./yT50'0 �3saaca--- ac=ccccccccccmccccacxcaaccaaccaccc=ccacacaacaaaccaaacaaaaaaaaa=aaacaacc^cc�rcaacacasacsm�aaaaaccaaaacaaac The property which you acquired may be su U ect to a supplemental assessment In an amount to be determined by the Riverside County Assessor. For further information on your supplemental assessment roll obligation, please call the Riverside County Assessor,at (714) 787-1661. =ccaccaaccc=caacaaascccccaasaaccaaccaccac=caccacaaacccccccaa=ccxccaacaaccaccc=cccaccaccccaaaca xcccccccaacocacaaoc 1. Transfer Information: a:. _= A. Was this transfer.solely between husband and wife, addition of a spouse, death of a spouse, divorce settlement, etc? a.( ) YES b. 04 NO B. Was this transaction only a correction of the name(s) of the persons) holding title to the property? a.( ) YES b. NyA NO C. Was this document,recorded to create, terminate, or reconvey a lender's interest in the property? a.( ) YES b. -M) NO D. Was this transaction recorded only to create, terminate, or reconvey a securlty Interest (e.g., co-signer)? a.( ) YES b.(e) NO E. Was this document recorded to substitute a trustee under a'deed of trust, mortgage, or other similar document? a.( ) YES b. (W) NO F. Did this transfer result In the creation of a joint tenancy in which the seller (transferor) remains as one of the joint tenants? a.( ) YES b.04) NO G. Does this transfer return property to the person who created the joint tenancy (original transferor)? a.( ) YES b.(V) NO H. Is this transfer of property: 1) to a trust for the benefit of the grantor? a.( ) YES b.()() NO 2) to a revocable trust? a.( ) YES b.(9) NO 3) to a trust from which the property reverts to the grantor within 12 years.? a.( ) YES b.()e) NO I. If this property is subject to a lease, is the remaining lease term 35 years.or more including.written options? a.( ) YES b.( M NO J. If this transfer Is excluded from a change in ownership as deflned ih Sec'lon 62, of the Revenueend Taxatloo. Code for any reason other than those listed above, set forth the specific f•xclusion claimed: At IF YOU HAVE ANSWERED -NO- TO QUESTIONS A THROUGH I, INCLUSIVE, AND HAVE NOT CLAIM►:U ANY OTHER EXCLUSION UNDF-t QUESTION J PLEASE COMPLETE BALANCE OF FORM, OTHERWISE SIGN AND DATE. =caaasccccccccacaa==aca=cacc=c=caaacaaccac=accaacacaa=a=cacccaaaaaaccaaaaaacaaacar=aaaacccc•.:=aaccac=acccacc=ccaca:aa (OVER ) SBE -ASD AH 502-A FRONT (3-6-85)' IMPROVEMENTS: ❑ SINGLE RESIDENCE OR 1-4 FAMILY ❑ MULTIPLE RESIDENCE ❑ COMMERCIAL OCCUPIED BY: ❑ OWNER ❑ LESSEE ❑ TENANTS ANY PORTION OF NEW LOAN FUNDS TO BE USED FOR CONSTRUCTION ❑ IMPROVEMENTS, REMODELING OR REPAIRS TO THIS PROPERTY WAVE BEEN MADE WITHIN THE PAST SIX MONTHS IF VES, YES • NO HAVE ALL COSTS FOR LABOR AND MATERIALS ARISING IN CONNECTION THEREWITH BEEN PAID IN FULL? ❑ YES ❑ NO The undersigned declare, under penalty of perjury, that the foregoing is true and correct. DATE Fi6 HOME �� �%/ {' BUSINESS PHONE /%PHONE (IF MARRIEDJBOTH HUSBAND AND WIFE SHOE 04 z O U W (n Do z O F_ U W U) U) Y Cr Q W tr U Z O 1= U W (n COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION _)73 _ 1-7 02 3 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 specifications required on the attached check list. A non-refundable filing fee of $37 is required when the application is submitted. Check must be made payable to the County of Riverside. CA 4j G'J Ain �PrY `o (�z Building Department Application Log # Name (Owner, Agent, Contractor, Etc.) Mailing Address Job Property Add ! zi519 'City or Community ,, / Legal Des ription of Property. (Lot, PM, TR) ,_(, (� Wor' 4-4' UfMQ j !�W 1/ z_ 'Assessor's Parcel No. Water Agency or Well Use of Permit Planning Case N Lot Size 17q— o� � � � � SFD, MH Site Preparation Etc. ��O � cg�, ��r % —( 7 S Signa ure of Applicant Date 1 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial Date Certification of Existing S.D. System required. ❑ Yes 19 No WQCB Clearance required. ❑ Yes I] No Soils feasibility report required. XYes ❑ No CtAtAlc_ 1-2 l Detailed boring report required. R Yes ❑ No Detailed contour plot plans required. ❑ Yes ® No Staff Specialist approval required. ❑ Yes ® No Lot Inspection Date Soils/boring report by Project # Date Soils Map Page Soil Type Approved by Date Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing ❑ New ❑ Additional ❑ Replacement Gals. (2) Leach line sq. ft. Sidewall allowance Install Lines) Ft. Long, Leach bed Sq. (Bottom trench area) ft. rock/ Sq. Ft. Ft. wide with min. inches Ft. of bottom per running ft. ❑ N/A rock below drain lines area Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth Applicable N/A Overburden factor ❑ 5' ❑ 6' Max. allowable depth OtMl. 'Q)A So -S I- K.cot Q10'NA This application is approved/denied for the design of a subsurface disposal system as indicated on the accompanied 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 be 50' from any wells (2) Leach lines must be 100' min. from any wells including expansion area (3) Seepage pits must be 150' min. from any wells including expansion area Signature of Health Official Date RECEIPT NO. 15 District: ❑ Riverside ..-.\Indio Distribution: WHITE—Office file DOH -SAN -122 (Rev. 6/86) Issued by VA y q Date 1 t'1 ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File SPI z O F- U W U) 07 z O H U W U) U) Y Q LU tr N z O U W COUNTY IVISION RMIT AOPPLICATION FOR A SF RIVERSIDE, OUBSURFACE SEWAGE DISPOSAL NMENTAL HEALTH SERVICES S 7 3- / 7y- 1) STEM Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County specifications required on the attached check list. A non-refundable filing fee of.s required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name ner, Agent, Contractor, Etc.) Mailing Address � phi /� G . _ City L� - State �� Zip Code tet, s ✓ Telephone - - Job Property Andress Cit anky Legal Description of Property. (Lot, PM, TRgAo/;'A C�} ►"� t �r �F IAGu•.•r,� .C� i f�Al 'Assessors Parcel No. Water AgencyvJWl Use of PerAtt '% Planning Case • �� Lot Siz SFD. MH Site Preparation Etc. ` Signature of Applicant Date 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial Date { Certification of Existing S.D. System required. ❑ Yes C o WQCB Clearance required. ❑ Yes o Soils feasibility report required. ❑ Yes dNo Detailed boring report required. ❑ Yes ❑'No Detailed contour plot plans required. ❑ Yes No Staff Specialist approval required. ❑ Yes [2" No Lot Inspection Date— Soils/boring report by Project # Date C:' +� Soils Map Page/C �� Soil Type by �L. _Approved _ �Date Type of System: No. of Bedrooms (1) Sepl�cTank Iy"-Gals. Soil Rate Required ❑ Existing New E) Additional 1:1Replacement'p`°x /e.- (2) L line s ffi� Sidewall e wance Install Line(s) Ft. Long, ��F3 Leach bed Sq. (Bottom re h9 ar.�a) _ft. rock% -- Sq. Ft. ❑ with min. --inches rlott, per running ft. N/A rock below drain lines area\ Leach lines/be -special design for slope: (3) Pit Diameter No. Pits Pitim Seepage Pit total depth #0 Applicable Overburden 1 ®• (�i1 Max. allowable depth_ N/A__ factor - J V This application is -6-0 proved for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B move. A building permit is necessary for the installation, of the./ above-designed system. .5 - ! /�'G- J' , �/_ Septic tank and sewer lines must be, 50' from any wells 1b �Leach lines must be 100' min. from any wells including expansi I�areal must be 150' min. from an wells includin ex ansion area ld iSeepage,pitsY 9 P i� � -• f � of Signature Health Official Date RECEIPT NO. G 3�- Issued by- Date 7 District: ❑ Riverside [P I (9io ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File DOH SAN 122 (Rev 2/86) L7 y TITLE 4 EBBE (EiN' L_ CtJL_T a 114 A RE.4 1 5 JOHN. H. HACKER, CIVIL ENGINEER, PALM SPRINGS... LATITUDE 33.8 WINTER TEMP. 31 DEG. SUMMER TEMP. 110 DEG OWNER------- �� �t�itiV - 41 'R S_I-TE__LO-CAT I.ON_ _ - _ _ G_' ____ _ _ ��1 /N?moi • "�, - ---- -- ------ -- ------------------------------------- REF.CAL.ENERGY CONSERVATION DESIGN MANUAL, FORM 2, HEATING LOSSES MANUAL J FOR COOLING LOSSES AREA BLDG 1450 SO. FT. PERIMETER 160 SO. FT.. __-I_NSULA_T_I-ON-R_ VALUES—.. -.-SLAB- -0 ....._.. CE.I.L.I NG. -3.8_ AREA NORTH WINDOWS 40 SQ.FT. PERCENT OF AREA 2.75862 --.AREA-.EAST-._WI-ND.OWS....-4O---SQ-...F—T-.._.PER.CENT.-QF-AREA_2._..7.5.862 __.__.-- ----�--.------._-- AREA SOUTH WINDOWS,42- SO. FT. PERCENT OF AREA r-rsv 4. 'M °U-^ AREA WEST WINDOWS 60 SQ.FT. PERCENT OF AREA 4.13793 ---AR€A--SkCYL-IGHTS.. 0 SQ. -FT. . PERCENT, ..OF. AREA._0..__._._......_..._. TOTAL WINDOW AREA 151 SQ.FT. PERCENT.OF•AREA 10.4138 --TH€-U.-VAL-UE—OF=TH€--W-INDC)WS-1-S-.65----(_.-E,S=_-DUAL PANE, 1 1= GI F -PANE) THIS BLDG USES DRAPES & FLAT SHADING DEVICES* ON WINDOWS(S.C.=.41) (*.mini -blinds, rollar shades, venetian blinds or vertical blinds) —T-HE--T-OT-A' SOUTH OVERHANG LENGTH 2 .ATTIC AREA = 700 SO FT INFILTRATION (STD 0.018, MED 0.014; TIGHT 0.012) - .014 HEATING LOSSES FOOTING LOSSES... 6988.8 BTU --��T L-� NG-=L��SSFS��-.--•1-431-r65-BTU - - _ . . WINDOW .LOSSES... 387.85 BTU WALL LOSSES.... 2147.85 BTU —I WE 111 RAT I ONI nSSES-.-_-.--'6333-r6-E_T_U-..---- ----- - _ ------.._-- TOTAL HEAT LOSSES BTU/HR... 20729.8 GAS FURNANCE SIZE 35231.1 BTU OR 45,000 BTU COOLING LOSSES FOOTING LOSSES... 7168 BTU _ CF r 1 I Nor Lj0_9 9ES r--.--1-468-.-35-- BTJ —_ WINDOW LOSSES... 6296.24 BTU WALL LOSSES .... 2202.93 BTU - INET N -LOSSES, .-_6 +,96 BTU ---- ---- - NO. OF PEOPLE... 5 COOLING LOSSES... 2000 KITCHEN... 1500 BTU -I?- LOSSES-4hI UD€ -Ii I-N--T0TAL ------ _ -__- TOTAL COOLING LOSSES 27131.5 BTU GROUND, SULA-T LON —4.POINTS INSULATION, 0 PAINTS 2 POINTS INDOWS GLAZING rST 0 POINTS NDOWS GLAZING 0 POINTS %NDOWS---NDOWS GLAZING -2 POINTS T GLAZING 0 POINTS EAST SHADING COEFFICIENT -1 POINTS SOUTH SHADING COEFFICIENT ¢.2 P> —/*. POINTS WE--T-.-SHAD hNG--COEFF I C -I -ENT- NORTH SHADING COEFFICIENT 0 POINTS SKYLIGHT SHADING COEFFICIENT QM POINTS. INFILTRATION -t POINTS. .6-POINTS-,.-- SOUTH 6-POINTS--._.SOUTH OVERHANG 0 POINTS GAS NANO€ -7-1 --- S€--AND-REAR-I-GE-RAT-I-(:'!q-CCJOL-I-NG—----------- THE EER OF THE COOLING SYSTEM IS 8.7 THE ALLOWABLE POINTS PER AB 163 IS -4 FOR THIS AREA 15 -T-HE—TC-POIN -S--ARE-- THE FOLLOWING MANDITORY FEATURES/DEVICES-ARE REQUIRED PERCAC TITLE 24 4t4SUL-AT-I-ON--AS-SPEC-I-F-I D.;....P€R--MANUFACTURES ..L- ABLE ---------- -- ---.-..--- -- - INFILTRATION CONTROL. DOORS, WINDOWS FULLY WEATHERSTRIPPED ,OPENINGS CAULKED AND SEALED AROUND JOINTS IN WINDOW AND WALL SOLE PLATES AND €L€-GT-R4-E-C1UTLE-T-..GASKETS--ON-AL-L-EX-TERIOR WALLS MANUFACTURED DOORS SHALL MEET APPLICABLE STANDARDS BACK DRAFT DAMPERS ON EXHAUST FAN -F-I-REPLA-CE-S.-MUST-HAVE- T-I-GHT -FI-TTI-NG,-� CL�OSEAELE �DcIORS ..COVERING FIREBOX . PROVIDE COMBUSTION AIR INTAKE DUCTS (6 SQ. IN.) WITH TIGHT FITTING DAMPER_ DUCTS; BUILT PER CHAPTER 10 U.M.C. C3AG-FkJ#IAIAN+,GEE--_-l-ZED TO -11-33 DF=.9!GN--L-OC*.S--+--10--BTUH-,IER--Sc3=-.FT.--OR. -45., 000...BT-U---- SETBACK THERMOSTATS SHALL HAVE AUTOMATIC SETBACK CAPABILITY /2 PERIODS PER 24 HR WATER HEATER TO HAVE R-12 INSULATION WRAPPING, AND R-3 ON FIRST 5, OF PIPE -NAS.---5AS-STOVES-..SHALLL--NO-T--HAVE---CONT: RURN.ING .PIL-OTS.. _ .... _.._ LIGHT IN KITCHEN AND B TO BE FLOURECENT, EXCEPT BATH MIRROR KIT SINK, TABLE CERTIFIED I --------- ..--....... O F RI SA cu h , J cr O�'iy o OFFICE OF AGRICULTURAL COMMISSIONER 1 J 4080 LEMON STREET, ROOM 19 RIVERSIDE. CALIFORNIA 92501 ' (714) 787.2561 µsr .yj,4Y+9,c.1 g93 46-209 Oasis Street, Room 14 Indio, CA 92201 (619) 342-8291 Y Dear Developer/Landscaper: E. LEON SPAUGY C0M.+US5tONER JAMES O. WALLACE ASSISTANT C0MSII5SI0tiER Thank you for inquiring with the Agricultural Commissioner's Office regarding local quarantine laws. Any diseases or insects associated with the plants/landscaping material presented on your landscaping plans do not pose a threat to the Coachella Valley Citrus, Date, Grape, Vegetable, or Field Crop industry, We therefore approve your landscaping plans. If however, any substitutions of plants/landscaping materials within your plans occurs between now and the actual planting date, you must contact this office ;.,ithin 48 hours before delivery into the Coachella Valley. Also, the substituted plants/landscaping material must be held for inspection upon arrival. Any sub- stituted landscaping material found infected/infested with: quarantine pests will be immediately treated or shipped out of the Coachella Valley at the discretion of the Agricultural Commissioner's Office. Under penalty of perjury, I the undersigned will comply with the above. Authorized Agent: Kame 6 • Ed w aed .� N 4e r � cn / -� Date Signature Permit Numbers) J 47e� f''i S] Er Developer Address % ev AGRICULTURAL COi•LMISSIONER' S APPROVAL 17 Date Authority cited: Agricultural Code; Sections 6301, 6461, 1, 6521- 6524 cc: 2 Plan Check, Indio Office, Riverside Office APPROVED . BY: W� � DATE: 'pi .41 Form A - 10/,0,4 ORAL C00