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08865 (SFD)r Building Address 52^-450 r 4 QUM& P.O. BOX 1504 N o . 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Address 44-4489 Town Center Way #418 City Zip Tel. AIM n s*,r 97761 AAO—%20A Contractor Address ity -•zip I Tel. State Lic. - - I City & Classif. 565989 Lic. # Arch., Engr., Designer .Tjohn A tine Address Tel. P.O. Box 1675 1 5i City Zip State I La Oniof-A 9?.�53 Lic. # C-13625 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 LaWfor the following reason: (Sec. 7031.5,Business and Professions Code: Any city or countys 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 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 or completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) O 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.) I ❑ 1 am exempt under Sec. B. & P.C. for this reaso i iDate < f E Owner j T1 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.) 10,11:-739—fl^ 0 Company o+sArn» latrr*Tn rucrer,la,.wsnv 0 Copy is filed with the city. O Certified copy .s 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 s ♦ M BUILDING: TYPE -CONST. V OCC: GRP. R"3 A.P. Number 771-171-011 Legal Description + Project Description Sq. Ft. 1723 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 918944.50 PERMIT AMOUNT Plan Chk. Dep. - 250.00 Distances: Plan Chk. Bal. 267 At; Const. - 60 Sill` t Mech. S _ Electrical Side Setback from Property Line Plumbing 157 SM S.M.I. - A 117 Grading 1111 Driveway Enc. 70.00 Infrastructure 4, 2058 06 TOTALI 3.577,13 3321.13 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES» 1ST FL. SO. FT. @ $ UNITS SLAB GRADE �).3 .y AO 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM POR. SD. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO, FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. OTHER APPJEOUIP. DRINKING FOUNTAIN. SO FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WA7ER 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 ROOFING/ ✓ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED REMARKS: LAUNDRY TRAY AIR HANDLING UNIT CFM 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 SO.FT.GAR ® V4c HOUSE SEWER FENCE FINAL GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE w4 +. 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 9/ GROUND PLUMBING/ 9r&APDERGROUND A.C. UNIT COLL. AREA SLAB GRADE �).3 .y AO ROUGH PLU B. BONDING HEATING (ROUGH) STORAGE TANK FORMS �` SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. /"Al GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING FINAL INSP.�/ cu. yd. $ ---Pius-x$-=$ LUMBER GR. FRAMING ( -�9?�� FINAAL/IINSP. ROOFING/ ✓ �- 1 d 6�� /'R' `�'� J/a0.4 w Q , �' rV . � u �1 � REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND y_ay� 9r FINISH GRADING FINAL INSPECTION 10/> CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL 4 P.O. BOX 1504 APPLICATION ONLY Building ^�`.r y� A 7&105 CALLE ESTADORNIA 9 Address .�U( "�� J J �>7�j� LA QUINTA, CALIFORNIA 92253 Owner Mailing Address 44-489 TOWN CENTER WAY STE r 418 City Zip Tel. DAI AA nr!cc!n r i 077F1 R1 Q_hhn_E�Onh Contractor MIKE E. DIAL Address City IZi State Lic. City & Classif.565989 I Lic. # Desjgner JOHN R. BUND Address I Tel. City P Zi State � I A (111 T Rt rA I Qiir,� I Lic. #('_1-4F7r, 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,Buslness 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 rile 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 IS. the work, and the structure is not intended or offered for sate. (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. 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.) ❑ 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. 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 ($100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and countyaordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant \\ Date Mailing Address City, State, Zip BUILDING DIVISION JILDING: TYPE CONST. V OCC. GRP. R-3 P. Number 773-271-011 Description �+ } :t Description Sq. Ft. No. No. Dw.1 Size 1723 Storie� Units New"X❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ itimated Valuation s O PERMIT AMOUNT Plan Chk. Dep. s Plan Chk. Bal. .8 Const. Mech. 5$• O Electrical 32.3 S Plumbing I5"7, fio S.M.I. 6.37 Grading W— Driveway Enc. — 11rastructure o58, p6 . � 332/ • 3 d� TOTAL REMARKS v ZONE: BY: Minimum Setback Distances: Front Setback from Ce der LLine _ Rear Sema 1c rorra� elar'2 ropy{ 1 �e —Y Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE GROUND PLUMBING NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ e� UNITS BONDING HEATING (ROUGH) STORAGE TANK 2ND FL. SQ. FT. SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK YARD SPKLR SYSTEM t POR. SQ. FT. ® O MOBILEHOME SVC. OTHER APPJEQUIP. BAR SINK GAS (FINAL) GAR. SQ. FT. @ POWER OUTLET GROUT ROOF DRAINS SERVICE CARP. SQ. FT. BOND BEAM WATER SYSTEM DRAINAGE PIPING GRADING cu. yd. $ plus x$ WALL SQ. FT. 51-2 LUMBER GR. FINAL INSP. DRINKING FOUNTAIN FINAL INSP. SQ. FT. ® ROOFING URINAL REMARKS: ESTIMATED CONSTRUCTION VALUATION $ VENTILATION WATER PIPING NOTE: Not to be used as property tax valuation FIREPLACE FLOOR DRAIN MECHANICAL FEES WATER SOFTENER GAR: FIREWALL VENT SYSTEM AN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) MESH APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINISH GRADING LAUNDRYTRAY AIR HANDLING UNIT CFM CERT. OCC. IKITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC INSPECTOR'S SIGNATURESIINITIALS WATER CLOSET COMPRESSOR HP tb POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER—f �J BOILER B.T.U. SQ. FT. ® c -7-U — BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® IVa C 0 / SEWAGE DISPOSAL SO.FT.GAR ® 3/ic 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 So 6 o3.so 132.3 6.37 7-s0 8zSTRUCTURE PLUMBING EL HEATING & AIR COND. SOLAR 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 ROCKSTORAGE 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 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 :d DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 12/10/90 No. 10318 Owner Name Type of Permit Innovative Designs No. 52450 street Eisenhower city La Quinta .zip 92253 La Quinta Permit # Log # Study Area 112 APN # 773-271-011 Tract # Lot # Square Footage 1723 Type of Development No. of units 0 Single Family Residence Comments At the present time, the Desert Sands Unified School District does not collect fees on 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount ofFl-.5-8--1 X 11.723 1 or $ 2,722.34 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. Fees Paid By Innovative Designs/Bank Check Telephone 44-5204 Name on the check By Richard M. Beck _ Q l Director, Facilities Planning & Development =4ti� `"'' wjs c," �I Fee collected /exempted by Shelley D. Bennett ' ;,, Paymient Reg@i it Signature '+ Chock- No. Collector: Attach a copy of County or City plan check application form to Distribileb'p`y: Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting MAIL TAX STATEMENTS TO %Name ABUVB ADDRESS Street Address City a J State L 3 CAT. NO. NNO0582 TO 1923 CA (2-83) SPACE ABOVE THIS LINE FOR RECORDER'S USE Individual Grant Deed THIS FORM FURNISHED BY TICOR TITLE INSURERS The undersigned grantor(s) declare(s): Documentary transfer tax is $ 23.10 (XX computed on full value of property conveyed, or ( ) computed on full value less value of liens and encumbrances remaining at time of sale. ( ) Unincorporated, area: ( XX) City of La Quinta , and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, RICHARD L. BLAIR AND MARILYN J. BLAIR, husband and wife hereby —GRANT(S)—to ROBERT A.-COLONNA, an unmarried man the following described real property in the City of La Quinta County of Riverside , State of California: Lot 12, Block 99 in Santa Carmelita Vale La Quinta Unit #11., as per map recorded in Book 18, Page 75 of Maps, in the office of the county recorder of said county. Llatcd: A,,g,,gi- q -r 1 Caq� STATE OF CALIFORNIA COUNTY OF Los Angeles }SS. Ony'; /./. /qv O before me, the undersigned, a Notary Public in and for said State, personally appeared Richard L. Blair. and Marilvn J. Blair personally known to me or proved to me on the basis of sat- isfactory evidence to be the person s whose name s are subscribed to the within instrument and acknowledged that thQyecuted the same. WITNESS my hand and official seal. Sight 'title Order No /112 RICHARD L. BLAIR I MARILYN J. AIR,/ 6`''I OFFICIAL SEAL t Lloyd A. ArnnJann. J. p4,:!_!:�,• a NOTAIi'i I'U2LIC'(:hLlf0Rl;lA CFFiCC- I:I ORr'!ic COU;dTY My Commission Expires July 5, 1991 (This area for official notarial seal) Escrow or Loan No. MAIL TAX STATEMENTS AS DIRECTED ABOVE I RECORDING REQUESTED BY . �• tx � R�Vd1td1!'f� Y3URANCH w O Cn AND WHEN RECORDED MAIL TO J cc W Z cc O N i` ' C 1.1� I%= r+ Name MR. .ROBERT A. COLONNA O �? tT7 M ad -W W Address 3 citya I State J _ F MAIL TAX STATEMENTS TO %Name ABUVB ADDRESS Street Address City a J State L 3 CAT. NO. NNO0582 TO 1923 CA (2-83) SPACE ABOVE THIS LINE FOR RECORDER'S USE Individual Grant Deed THIS FORM FURNISHED BY TICOR TITLE INSURERS The undersigned grantor(s) declare(s): Documentary transfer tax is $ 23.10 (XX computed on full value of property conveyed, or ( ) computed on full value less value of liens and encumbrances remaining at time of sale. ( ) Unincorporated, area: ( XX) City of La Quinta , and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, RICHARD L. BLAIR AND MARILYN J. BLAIR, husband and wife hereby —GRANT(S)—to ROBERT A.-COLONNA, an unmarried man the following described real property in the City of La Quinta County of Riverside , State of California: Lot 12, Block 99 in Santa Carmelita Vale La Quinta Unit #11., as per map recorded in Book 18, Page 75 of Maps, in the office of the county recorder of said county. Llatcd: A,,g,,gi- q -r 1 Caq� STATE OF CALIFORNIA COUNTY OF Los Angeles }SS. Ony'; /./. /qv O before me, the undersigned, a Notary Public in and for said State, personally appeared Richard L. Blair. and Marilvn J. Blair personally known to me or proved to me on the basis of sat- isfactory evidence to be the person s whose name s are subscribed to the within instrument and acknowledged that thQyecuted the same. WITNESS my hand and official seal. Sight 'title Order No /112 RICHARD L. BLAIR I MARILYN J. AIR,/ 6`''I OFFICIAL SEAL t Lloyd A. ArnnJann. J. p4,:!_!:�,• a NOTAIi'i I'U2LIC'(:hLlf0Rl;lA CFFiCC- I:I ORr'!ic COU;dTY My Commission Expires July 5, 1991 (This area for official notarial seal) Escrow or Loan No. MAIL TAX STATEMENTS AS DIRECTED ABOVE I M .- ._�....� � ,-_-..-r.R, .—'"�, u:yti,�,.��.i^.,�,:.�._��.. _,r„-„�..--^ b-.R.`-*���y,f�i,.�-•,�'^a�.GT"•4.l Qy�'s`;;SKYT-`✓'M�v?"�I-.-"�'.�t'h....�'f1-�i� cM� ice. 1: COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH- A89888 Issued r- -4 ❑ Hemet ❑ Perris Dade ❑ Rancho Calif.. ❑^ Blythe 1 WHITE - Office file. YELLOW - Applicant PINK Bldg. Dept GOLDENROD - Plans/Records RA 0f P"°i1 NO' 1773-.271 - 0// 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 �A nonce{refundabte filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riverside.proval of this application shall remain valid for a period not to exceed one year from date of approval. .� Q VERIFY ITEMSAWSECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # O t Agee Contractor, tact Person Phone Address & Firm M -E 44o--culolA-44-480 6 N GEN LU INMoVA ,-/c Phor+e, t ` Mailing Address t 1 Zn 1,Owner CA t Stat � Zip Job Prope P Ry Add. � IJY21lLE Legal Descriptan Prop. (PM, T� Lot). /07 / Lot Sizeer Agency I Use of Permit P/P, CU, etc. cKA Other LQC,C' 5vxl vq Ar 4Ge� /_4 Dwell' Site Prep etc. o ty .... { NIT --4F / Signature of Applicant Date CATEGORY: REV CODE CATEGORY: REV CODE FEE ❑ SUBSURFACE DISPOSAL 1238 f4rD SITE EVALUATION UPON REQUEST' 7349 $ 43.00 m ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DMSION ❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00 Z 0 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 Wb ❑ Rereview (2nd review same parcel) 7344 $ 24.00 EVALUATION (Attach DOH SAN 53) fn ❑ 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 + AE D i G Tank Agreements Completed ❑ Yes Holding ?No Certification of Existing S.D. System Required ❑ Yes WQCB Clearance required. (Attach Form ❑ Yes DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yes Special Feasibility Boring Report Required. ❑ Yes Detailed Contour Plot Plans Required (1 to 5 It interval) ❑ Yes N/ toStaff Other ❑ Yes V,No Speciallst L.ot Inspection Required ❑ Yes Lot Inspection Date Soils boring report by Project #+ Date Cdcl 4'��-- Soils Map Page SOA Type Approved by Dame U Z_ No. of Systems / Type S s) ❑ ilarT T�e'nk ❑ Fxisfing No. Dwelling Unita % t3edrooms FTtQ�i�n Tlnfls (1) Septic Tank Soil Rate rease/Sand `� � 00 Y :l New=,. <-•._..❑Replacement QpM.. [ Gal T Gal LUV"'I CAI Line Sq. Ft Sidewall allowance Instal Lnela) ft long fl wide with Bed eq. R hof arae ft/ fl per running It. min. inches drainlines or bo d bpn Leschlines/bed special design for slope: (3) Pit Diameter / No. Pita Pit Below (TD) Seepaa �k l Depth Applicable 1 Inlet (BI N/AOverburden factor 15W51 cis /(� (T Max. Albwa�le depth (J No. 2 System REMARKS: This application is A"PPROVED • ENt for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompan using 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% expans' area. % .,L (1) Septic tank and sewer lines must be 50' minimum from any wellsal0 I / Y l•,--ct.r-.� Leach lines must be 100' minimum from any wells, including expansion res l n �� Seepage must be 150' minimum from any wells, 'ncluding (3 Pits xparis n ea V Issued r- -4 ❑ Hemet ❑ Perris Dade ❑ Rancho Calif.. ❑^ Blythe 1 WHITE - Office file. YELLOW - Applicant PINK Bldg. Dept GOLDENROD - Plans/Records RA G ``•,. OFFICE OF to ' AGRICULTURAL COMMISSIONER 11, 4 AND +`;� ;;:� WEIGHTS & MEASURES CALVIN C. KAMINSKAS JAMES O. WALLACE 4080 LEMON STREET. ROOM 19 Assistant Commissioner Agricultural Commissioner RIVERSIDE. CALIFORNIA 92501 CLEMENT BENVENISTE Director of Weights & Measures (714) 787-2561 seater 49613 Highway 86, Suite B12 Coachella, Ca. 92236 DATE ( G 190 I I ( (619) 342-8291 CASE NO. (PC - C(_A / tCK Q DEVELOPER'S NAM: ADDRESS: "Q.,Qj� �'oW N Ga�x6\�- PAL4tvN.�L� , TELEPHONE: ��- 77,7-a7'1/-onil 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 must be notified immediately. r Thank you for protecting and preserving,,- the Coachella Valley's pest -free environment. Agricult Commissioner's Office cc: Indio and Riverside Office ••ROwN PPINT,NO, ND10 2900 71" 292822-U T4'yl " 4-60 P.O. BOX 1504 APPLICATION ONLY Buildingf 7&105 CALLE ESTADO Address `' %1 ��LA QUINTA, CALIFORNIA 92253 Owner BUILDING: TYPE CONST. _V_OCC. GRP. R — 3 Mailing r 44-489 TOWN CENTER WAY STE 418 Address A.P. Number 773-771-011 City I Zip Tel. Contractor Address ZiD I Tel. State Lic. I City & Classif. 565989 Lic. # Arch., Engr., Designer JOHN R. BUND Address Tel. ■■IIAf/���1�1:�I�)L! Nl�i�1t1L">">� ■ABRf'i�� • � L7L�i�e<1'1 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, after, improve, demolish, or repair any structure, prior to Its issuance also requires the applicant for such perk to lila 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 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 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 conlractor(s) licensed pursuant to the Contractor's License Law.) O 1 am exempt under Sec. B. 8 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 perp 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: ff, 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 perk shall be deemed revoked. CONSTRUCTION LENDING AGENCY I.hereby affirm that there is a construction lending agency for the performance of the work hir 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 expiation It work therqunder is suspended for 180 days. I ceriiy that 1 have read this application and state that the above information is correct. I agree to came ly 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 Legal Description r Project Description C3 r Sq. Ft. Size 1723 No.No. Dw. 1 StorieJ Units NewXD Add 0 Alter ❑ Repair ❑ Demolition O Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. _ Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. I rastructure TOTAL I o 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: