003437 (SFD)` Building
If Address
Owner
Mailing
Address
City
Palm
Contractor
Address
P.O. BOX 1504
78-105 CALLE ESTADO
52-565 Eiseht.=ar LA QUINTA, CALIFORNIA 92253
Coachella Valley Land Co.
247 E. Tahquitwz Way 02
Zip Tel.
pzings - 92262 • .322-.1C20
No. 003437
BUILDING: TYPE CONST.- OCC'.-GRP.--
A.P.
CC:GRP...A.P. Number- • • 773-295--017
Legal Description
yProject Description Plan A Sinals, r ST ilV Mg.
Q4UAUt;
City
Zip
Tel."
subject to the Workers' Compensation provisions of the Labor Code, you must "forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: '
Front Setback from Center Line
State Lic.
City
Side Street Setback from Center Line
& Classif. 387934
Lic. # 895
Sq. Ft. 1410
No. No. Dw.
Side Setback from Property Line
Size
Stories Units
Lender's Address
'This
FINAL DATE
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
/ p,7Permit
read application and state that the above information incorrect.
Issued. by:
Date
1 agree, to comply with all city and county ordinances and state laws relating to building
City
Zip
State
-
Lic. #
Validated by:
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
Validation:
effect. j d-) at✓' .+' :r_.i� +% C'rr
SIGNATURE.- _ - DATE
OWNEWBUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
�.-�� 441
• reason'' (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
t
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 •
-PERMIT.
AMOUNT -
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
-r
' Divisiiin 3 of the Business and Professions Code• or that. he is exempt therefrom, and the basis
for the Any Section 7031.5- 'any for
Plan Cihk. Dep.-^,�r7,(�
alleged exemption. violation or by applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk.. Bal.
- - - - -
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Zp t A
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
Professions Code: The Contractor's License Law does not apply to an owner. of property who
�� (�
builds or improves thereon andwho does such work himself or through his own employees,
Mech.'
"
provided that such improvements are not intended or offered for sale. If, however, the building.
4 - inn
or. improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
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-
Plumbing
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
S. M. 1. -
•a
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. t3. & P.C. for this reason
A on
_ _
Driveway Enc.
->A,nn
Date Owner
Infrastructure
1 _ 19
WORKERS' COMPENSATION DECLARATION
I hereby affirmthat 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., 0 Certified copy is hereby furnished. .
TOTAL
d Cl 79
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.
.REMARKS
. r,rtr: 4In't i!k `Inn: ; ,,. np.. n-:� ;7}
Date Owner
NOTICE TO APPLICANT. 9, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must "forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: '
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY.
Side Street Setback from Center Line
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.)
Side Setback from Property Line
Lender's Name
Lender's Address
'This
FINAL DATE
INSPECTOR
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 this
/ p,7Permit
read application and state that the above information incorrect.
Issued. by:
Date
1 agree, to comply with all city and county ordinances and state laws relating to building
r- -
construction, and hereby authorize representatives -of this city to enter the above-
bovementioned
mentionedproperty for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPYI -
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. @ $
UNITS
COLL. AREA
LAB GRADE %�� %� �%
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. @
POWER OUTLET
I ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT. @
GAS (FINAL)
WALL SQ. FT. @
DRINKING FOUNTAIN
SQ. FT. @
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
NAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
%
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES _[_MICRO
FEE
MECH.FEE EPL.CK.FEEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMBIN90'
-�r
1 UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE %�� %� �%
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SE ICT
6
ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. REINF. J/j/�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
Z EMP. POLEIC) _ f;)
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. 2 /
FRAMING 17
NAL INSP.
/n�
e4o ROOFING // // .
i
`C —VENTILATION
%
7
REMARKS:
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
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES �r
C�
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado NOTICE: THIS DOCUMENT CANNOT
La Quinta, CA 92253 BE DUPLICATED.
This is to cert-ify, tha & ,
developer of 2 which is
located atwithin
this District, has paid school f cility fees imposed purs ant to the
au hority generat d by Government Code Sectiol► 53080 in the am� t of
s 36
, ao ( —�-
covering a total of square feet of ( r sidential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
for D ERT SANDS UN F ED SCHOOL DISTRICT
White -Building Department • Yellow - Facilities Planning 0 Pink - Accounting • Gold - Developer
(10)-37
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO
NAME�COACHELLA VALLEY LAND CO.
ADORNS 247 E. TaHQUITZ Way, Suitt; 2
Palm Springs, CA c?2262
CITY &
6TATE L
MAIL TAX LLTATXMENTe TO
NAME SAME
Aooncee
CITY e
6TATt L
Fscrow N?,07783 — _---
Title Order No. 78587`L
- I
—J
SPACE ABOVE THIS LINE FOR RECORDER'S USE
8.25
Documentary tran.>fcr. tax 8 ...........................................
E3 Coml,uted on full value of property conveyed, or
❑ Cornputed on full talue le liens & enuumhrances
remaining thereon at time of F -ale.
...........................................................................................
5:cn ture of de,larant or spent determinlnp tax firm name
l
La 'rllnr•orl,oratea area cit, of ..... Quint
............ .a .........
Grant Deed
THIS FORM FURNISHED BY STEWART TITLE COMPANY OF RIVERSIDE COUNTY
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
CLINTON DOUGHERTY, a married man as his sole and separate.,property as to an
undivided interest; and JAKE L. GREENWALL, a single man as to an undivided
z interest; as tenants in common
hereby GRANT(S) to
COACHELLA VALLEY LAND COMPANY, A CALIFORNIA LIMITED PARTNERSHIP
the following described real property in the
county of RIVERSIDE state of California:
LOT 3, BLOCK 150, UNIT #16, SANTA CARMELITA AT VALE LA QUINTA, AS SHOWN BY MAP
ON FILE IN BOOK 18 PAGE 99, OF MAPS, RECORDS OF' RIVERSIDE COUNTY.
Dated_ SEPTEMBER 23, 1 98.7 __ _
(lndhidual)
STATE- OF CALIFORNIA
SS
RIVERSIDE
COUNTY Of _—
CLINTON-D U ERT.
JAK1�L—GREENWALL
\
23rd of September, 1987
On b fore me, th understgnea, a Notary rablic in and for said State, personally appeared
in on oug�r� an�cl -Tke :.1^ GGreenwal`1
(known to me) or (proved to me on the basis of satisfactory evidence) to be the
person S whose name a a re— subscribed to the within instrument and acknowledged that they
executed the. same.
N•ITNf;SS my hand and official seal
Signawre
Dorothy Tates
FORM 72.13
Name 0 ypcd or Printed I
FOR NOTARY SEAL OR STAMP
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yh1. ,:. \. SIU. ' 9E-- Y'e ti`
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W. b
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iA; t:wnrtt EXp. 11ft 11, ISM
MAIL TAX STATEMENTS AS DIRECTED ABOVE
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f
COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISIONo��r..
PERMIT APPLICATION FOR. SUBSURFACE SEWAGE DISPOSAL SYSTEM �� 7
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.
Building Department Application Log #
Name (Owner, Agent, Contractor, Etc.)
Mailing Address
% %'
?�
City
6A <MZ1J4<
State °�
Zip Code
od�e
/
'Telephone
on
''Job Property Address'
eommunityA
Legal Description of Property. (Lot, PM, TR)
'Assessor's Parcel No. (,�.`,.Watet
A e�ncy -Well
A'9 �J / `
Use of Permit !+(�r�/• [ih� ,2'%Plarfning Case N
Lot Size
77,:?-) 2 G,
��
KFS ��� '
SFD, MH Site Preparation Etc.
nature of Applicant Date
'The above information must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
Initial Date
Existing S.D. System El Yes 2`
Certification of required. Nom!
WOCB Clearance required. ❑ Yes 2 No
Soils feasibility report required. ❑Yes E] No-
oDetailed
Detailedboring report required. ❑ Yes
Detailed contour plot plans required. ❑Yes [] Nom
Staff Specialist approval required. ❑ Yes .0 o Lot Inspection Date
Soils/boring report by� Project # �� Date
t!'
Soils Map Page 1/ > Cf Soil Type � C Approved by lr�C�2-- �'� Date_2(0 - � ' .
Type of System: v
No. of Bedrooms
(1) SepticT,arnk?.
j� Soil Rate Required
Existing New Additional Replacement
❑�` ❑ ❑
Gals.
(2) Leach line sq. ft.
h
Sidewall allowance
ft. Sq. Ft.
Instalh.Line(s) Ft. Long,
Ft. inches
[
L, each bed Sq.
Ft.
(Bottom"tre area)
`�•"w
rock/
wldb-wit min.
orbottQ
per running ft. ZLN/A'�
rock below drain lines.
area
Leach lines/bed-special design for slope:
Applicable
(3) Pit Diameter j
No. Pits
Pit BI1
Seepage Pit total depth
103,55! 6'
t
Max. allowable depth
N/A Overburden factor
Al
/r
' r
This application/.,isaapproveotdenied for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements
set forth in Section B a'aCove A building permit is necessary for the installation of the above -designed system.
(1) Septic tank arid sewer lines must UAA
e' , 0' from any wells�r(D� t^u�-. �^ t' '" a- '"�% "✓
2 Leach lines must be 100' min. from an wells including ex anslonn� area
() Y 9 p.
(3 Seepage pits must be 150' min. from any wells including expansiioon area/ itj
i'1 `Q.[.. rt.0
.t� ! Gr .LtT'l.�+r � -�. ,L p � f, !1•
l �
,�
Signature ofHeallh Official r/
r
RECEIPT NO. ��� Issued by 57h_ 4 Date 161'
District: ❑ Riverside E Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe tt
Distribution: WHITE—Office file YELLOW -Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH -SAN -122 (Rev. 6/86)