07518 (SFD)4
P.O. BOX 1504 N0. 07518
Building ?� 78-105 CALLE ESTADO
Address - _ LA QUINTA, CALIFORNIA 92253
Owner S
Address PO BOX 366
City Zip Tel.
La Quanta 42253 .%4—U32
Contractor
Address
ity Izip
State Ljc.Cit
& Classif. 487584 I Licy# 626
Arch., Engr.,
Designer
Address I Tel.
City I Zip I State
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am liceJed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 3 of the Businbss And Profeftions Code, and my license is in full force and
effect. I !
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 or 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 or 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 fodsale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does notw6pply 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' COMPENSAJ.o
DECLARATION
I hereby affirm that I have a certificate se t to self-insu e; or a certificate of
Worker's Compensation Insurance, or certifiet ereof. (Sec. 3800 a nr.Godq
Policy No. Company
❑ Copy is filed with the city. ❑Certified 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 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.
Dale Owner
NOTICE TO APPLICANT., If, after making this Certificate or 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 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 c' and county ordin��.nces and state laws relating to building
construction, and hereby a thorize representati`Ss -of this city to enter the above-
mentioned property for insp do purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number L-002 / f 7 ` G 7,7 CiC� 3
Legal Description Lam- "F -_ II,Sw
Project Description Single Family DwIling
Sq. Ft. No. No. Dw.
Size 2.226 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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
419/90
Issued by: Date Permit
Validated by:
Validation:
Estimated Valuation
t
A
PERMIT
,r.
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
368904
Const.
744,50
Mech.
_ 53.50
Electrical
135.89
Plumbing
_
157.50
S.M.I.
9.10
Grading
20.00
Driveway Enc.
20.00
Infrastructure
2,716.08
TOTAL
1 34.4755.62
4.225.61
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
419/90
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SQ. FT. ® $
2ND FL SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SO. 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
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SEWER OR SEPTI
LAUNDRYTRAY
AIR HANDLING UNIT CFM
DUCTWORK
IKITCHEN 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
TEMP. POLE
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
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
SEWER OR SEPTI
A K ROUGH WIRING,
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
i-
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 xi
=$
LUMBER GR.
FINAL INSP.
FRAMINGG
FINAL INSP.
ROOFING �j
C
T
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 4W/rp� 7 Q
MESH
INSULATION/SOUN
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
Indio, CA 92201
TO: l 1_�'�M � L Date:
-7 2,-1 cTc�ltyo� �Cc'�^
This is to certify at Q M C C
developer of O /Z t-1
., which is
1 ocdted at ��n— '—�/) — - 1 Ai
with' thi school district, ,is required to y school facility fees
pursuant to the authority generated by Government Code Section 53080. The
amount of fees due for they'above referenced pr ect i,5 $ a3 j(p
covering total applicable square footage of (o square feet,
which is subject to final verification at time payment is presented.
l Lo
rC�a300�
TAX
& M WHIM
Con#,trao
P.O. Boz 366
r+La Quinta
°�°" Ca 92253
ADM02740
nwmw3797,-JC
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O va, i bo
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4.
SPACE ABOVE THIS UNE FOR RECORDER'S USE
GRANT SEED
THE UNDERSIGNED GRANTOR(S) DECLARE(S)
DOCUMENTARY TRANSFER TAX IS $ 61�r "sa
X3 computed on full value of property conveyed, or
- - _ O computed on full value less value of liens or encumbrances remaining at time of sale.
4 0 unincorporated -area -
;.- s. U7 city of La Quints - -- --
': AND,
FORA VALUABLE CONSIDERATION, receipt of. which is hereby acknQwiQdged, _
aTeo Howard, a married man as his sole and separateproperty
_
I
hereby GRANT(s) to
.. & M Construction, A California Partnership
the following described real property in the City of La Quints
County of Riverside
; State of California:
opts 33,.34. 35, 39, 42. 43,--44, 45 113 -
MUBB-TRACT UNIT •NO.5, as shown b ' 115, 131, 135, 138 of D SSRT
Of Maps, Records of Riverside County, on file - in Book 21 Pages 61 and 62
. y, California.
v
Jan. 4, 1990 - - . - - V - ---
'ST OF CALIFORNIA l Le O Howard
COUNTY OF L oS AJ 8�(` S T ss.
!On this _$__ day of J R a c• s► ,ea JJ
before me, the undersigned, a Notary y P b in and for asa d State,
Personally appeared 4&9c>
me
{or Proved to me on the basis of satisfactory eev dent e)nown to beo the
Peen whose name *
instrument, and acknowledged to me that _ subscribed to the within
he _ Axecuted it.
WITNESS my hand and official seal.
,%natur 4 V? �
NOTARY PUBLIC IN AND FOR SAID STATE
11 lOCv in�.
MAIL TAX STATEMENTS AS VIRECTEO ABOVE
OFSPAT,
RH0DORA E FRANK
to NOTARY PUBLIC - CALIFOfINIA
LOS ANELES COUNTY
'°°"� My comm. expires AUG 28, 1992
fTND �a br offlcigl notarial Ntlj
M�%a
RECEIPT NO. 9W Issued By He ?? ttt�� ""y" Date -3- 30—'W
Q•
DISTRICT: ❑ Riverside, �r- n t7 ❑ Hemet q Perris ❑ Ranch -Ea If. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
COUNTY OF RIVERSIDE ENVIRONMENTALAsesee n Parcel No.
1-70 —D—l( — �Z--
HEALTH 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 1181.
A non-refundable filing fee (see below) is required when the application Is submitted. Check must be made payable to the County of
Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval.
Q
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
Z
v r
O
Agent, Contractor, Contact mon
L '
Phone
411561 q9Z
Address & Firm
Lo-Lt/.� I
Owner�O
LU
Phone
Mailing Address t
�O cit 4��N TA
City '
o /
zip
Job Property, /jid
Legal Description Prop. (PM, Tract, Lot)
T 3-1 4
Lot Size ter A e loll
Use of Permit P/P, CU, etc.
Other
04
f/1D
t L
f ('
t' '� ✓
Dwellin H Site P etc.
22—
.F Date
Signature n '
CATEGORY: REV CODE FEE
---SUBSURFACE
CATEGORY: REV CODE FEE
8 DISPOSAL 1238 t $ 57.
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00
CD
❑ MULTIPLE PARCELS WITHIN SAME ` �''
(NO PLOT PLAN)
Z
LAND DIVISION
❑ SEWER/SEPTIC VERIFICATION;: 7348 $ 17.00
O
a. 1 at 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year)
8b.
Each Parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
LU
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
C/)'
❑ 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
INITI�A/L D•�AZTE
p
Holding Tank Agreements Completed ❑ Yes NNo''� l//Lt'.rV � 3T
Certification of ExWIng S.D. System Required ❑ Yes {T%� I
WQCB Clearance required. (Attach Form ❑ Yes D No
DOH SAN 007, Santa Ana Region Only)
Soils Percolation Report Required. ❑ Yes ,l�J
Special Feasibility Boring Report Required. ❑ Yes 4/ Y
Detailed Contour Plot Plans Required (1 to 5 f1. interval) ❑ Yes Ngo
Other ❑ Yes Nol -0:a
Staff Specialist Lot Inspection Required ❑Yes �No (jf
Lot Inspection Date
Soils'boring report by ProjectDate
/Q J�
/ ?
Soils Map Page �! ! % Soll Type %Q Approved J&U1 �--�
t J
by D� s�
Z
-No. of,Sysl.me
TypA of System(.)
"ding Tank ❑ Existing
No. Dwelling Unite �/
Bedrooms'AM-,�,e•"iviilts
(1) Septi Tank
Soli Rate
,Greeee/Sand
G,ao..ni„r,�,
O
o
New ❑ Replacernord
3,00 4 4 o2,4T?1,yl .
1 r/ l/f/ Gel
F q�
r••
'% (
UJ
(2)l Llne-Sq. Ft
om trench area
Sidewall allowance
n rock/ sq. R
V
a) ft long fr wide wMh
`7
Leach Bed eq. it
Per running ft
NA
min.11w_
n�i �e�s below draMlines ar
ofom e►ee
-
Leachlines/bed special design for slope:
(3) PM Diameter
No. Pits
PM BelowSeepage
Pit Total Depth
(TD)
4�
Applicable /
N/A ! Overburden factor
//
eafts 6/ 6
IeM.-(Bn
�
Mex. le Depth
f
,k>
No. 2 System /f///Oi
REMARKS:C��r m' -/V
� /i'G� �Jv'O 4 !/ i�•a.+ � /.�%�!' Lir- eY !'7•t�-s.
y� /� ,�
Dww%/
This appy tion i "/ °PPROVE NI_ p for the categ ry checked in SECTION 8 above, regarding the design of a subsurface disposal
{ ega 9 indicated
--
9 po system as
on the accompanied plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
Z
o designed system. No construction is permitted in the required reserved 100% expansion, area.
O
�j
CISeptic tank and sewer lines must be 50' minimum from any wells AP
lines must be 100' from
Z
122) Bch minimum any wells, including expansion rea s
ir
m
page pits must be 150' mminim�um/from any wells, iinnc�luding ex/p(annsio area
Signature of Health Official `�t� r���. Lf -c n (! Date
RECEIPT NO. 9W Issued By He ?? ttt�� ""y" Date -3- 30—'W
Q•
DISTRICT: ❑ Riverside, �r- n t7 ❑ Hemet q Perris ❑ Ranch -Ea If. ❑ Blythe
DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
e AGRICULTURAL 4 °r�'►,0� OFFICE OF
_ AL COMMISSIONER
AND
.
WEIGHTS & MEASURES CALVIN C. KAMINSKAS
JAMES O. WALLACE 4080 LEMON SIITEET. ROOM 19 Asslslonl Commisslonm
AgrlCvlhrrol Commlesloner RIVERSIDE..CALIFORNIA 92501 CLEMENT BENVENISIE
tbectos of welghls & Measures (714) 781.2561 sealer
49613 Highway 86, Suite B12
Coachella, Ca. 92236
1 Q (619) 342-8291 [� / tL Q/l
DATE ,r� \ l 1 CASE W. 1" C L G `G 63 `y
DEVELAPER' S NAME: P, w• UCS C �-�
ADDRESS: P �� 'Y_
TELEPIIONEI d,1 1
6-6 _Rao CSI s ,(f"O' L(;-:
Dear Developer:
After reviewing your landscaping plans, all plant naterial listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ fran plant naterial listed, this office irnast be notified
Immediately.
Thank you for protecting and preserving the Coachella.Valley's pest -free environment.
Agr c tural Caunissioner s Office
cc: Indio and Riverside Office
Desert Sands Unified School District
• CERTIFICATION OFrPAYMENT
FACILITY FEES
. ��,� ������ V
Tp�yci f L,aQin t a DATE
Departmen ,of Community Development
78-105 Calle Estado
La Qjuinntta, CA 92253
This is to c rtify t w
developer f_
located at
this%Distr;ict-has-pa id`sc ool
aut or.t generatp4 by Governme
$ 3 cLUM 1-41
covering a total of
( ) industrial/commercial devel
this footage in this development
M
5�'9p
1 OT-
_wh-i chi s
. , _ .,,. s , ,_ --� �,i"f'hin
t
facility fees imposed pursuant -the f`
��� 0
a
White - Bu
O—W o94
pment and that building permits for
may now be issued by your jurisdiction.
2��x
� f) - eftmj�
for DESERT SAt46S UNIFIED SCHOOL DISTRICT
X702-�
,Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
0 )-37