SFD (08618)Building
Address
Owner
t
.44
P.O. BOX 1504 N o . 08618
78-105 CALLE ESTADO
0 Navarro LA QUINTA, CALIFORNIA 92253
Mailing
Address
City """"" Mjp ITel.
Contractor
Mercies Diff"10paamt iszc.
Address
State Lia City
& Classif. Lic. #
Arch., Engr.,
Designer
Address '"' " Tel.
City P Zi ; State
?:ra�kx4x*tsr 92223 Lic. #
LICENSED CONTRACTOR'S DECLARATION
` I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of DNisiorr3 of the Business and Professions Cod>eland my license is in full force and `c
effect
. i' j
SIGNATURE •' ! r 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 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).
,C) 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.
w- • }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, asowner 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.)
0.1 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. O 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: It, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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 it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Sig;ature of applicant Date
Mailing Address
City, State, Zip
S
BUILDING: TYPE CON T. 1 OCC: GRP
A.P. Number
Legal Description
Project Description
i,1P.Do
aA
Sq. Ft.
Size 152.2
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
4,472.40
PERMIT
AMOUNT
Plan Chk. Dep.
7.50.00
Plan Chk. Bal.
245.45
Const.
Mech.
Electrical
126, A .
Plumbing
S.M.I.
0 _
Grading
20,03
Driveway Enc.
20,
Infrastructure
TOTAL
3077041
REMARKS ti`i a
1 . .itd t32�- &'JAV _.—i'to
A V tt�1prY . r t
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:
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. @
GAR. SO, FT, ®
CAR P. SO. FT.
WALL SO. FT. ®
SO 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
STORAGE TANK
FLOOR DRAIN
MECHANICAL FEES
DUCT WORK
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REINF. STEEL
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
VENTILATION
SO. Ff. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ec
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
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK /0 � / 9d 114,
pGROUND PLUMBING a ERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
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
If., -cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. /
FRAMING �, Ah
FINAL INSP.
// L
ROOFING v
/�//►� CJ /��/_[�
�I ✓ �V ///�//< O /I " `�'�
1
o
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 0110
MESH
INSULATIONISOUND `!
FINISH GRADING
FINAL INSPECTION Qf
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
y 82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 10/1/90
No. 10176
Type of Permit ILa Quinta
Permit #
Log #
Owner Name William O. Wilkinson
No. street See Below
City La Quinta zip 92253 Study Area
APN # Tract N Lot .# E= SquareFootage 12,44$
Type of Development I Single Family Residence No. of units
Comments .9;1-Rdk Ramirp7 -F;d-190R„},;r►
Llilyi l7lr_ .r r-r�.r nr. I u[rn".r :7G-n.�lr nBTI"HTi1 An❑ :] 1-A/I1 rll]RTP.7.
Each home is 1556 s!_ft_ (Areae 1 in 110, 1 in 111, 2 in 112, 4 in 112)
t.
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 of 1.58 X 112.448 1 or $ 19,667.84 have been paid to D.S.U.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. a
Fees Paid By William O. Wilkinson Telephone 545085
Name on the check
By Richard M. Beck ;' + , '•..` i !',
Director, Facilities Planning & Development
Fee collected /exempted by Shelley D. Bennett S '
Pa;� ent rFe a ved
Signature ' C1,eck No. 019694
Collector: Attach a copy of County or City plan check application form k, Dittx4ct copy.
Embossed Original- Building DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
Y
City & L
State
NAT -30 (5-87)
cc
°a
cc CN
�_.A
•�,
ati
o 3 $ .o.
_ E�as
W
4 ~ 8 V- �
gig $
SPACE ABOVE THIS LINE FOR RECORDER'S USE
Individual Grant Deed
The undersigned grantor(s) declare(s): , 90
Documentary transfer tax is $ y
aa ( X) 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: (,X ) City of 1-4 QU1.,07V , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
James W. White and Edna L. White
hereby GRANT(S) to John L. Hart, an unmarried man as to an undivided one half interest
and William 0. Wilkinson and Barbara_L. Wilkinson, husband and wife as joint tenants,
as. to an undivided one half interest, as tenants in common
the following described real property in the
County of Riverside , State of California:
Lot 20 Block 121 Santa Carmelita at Vale LaQuinta, Unit 4112, -as per map
recorded in book 18 pages 79-80 of maps, in the office of the county
recorder of said county.
Dated: January 17. 1989
%4 A5" J N 6. `[ ON
STATE OF G4bW-0R+4A_
COUNTY OF K tiJ Ci JSS.
�
On � �D . 1 g�`� before
me, the. undersigned,la Notary Public in and fob said State,
personally appeared )rAnwS kl
EkhG L.. vJN,4-e
personally known to me or proved to me on the basis of sat-
isfactory evidence to be the person g_whose names
subscribed to the within instrument and acknowledged
that executed the same.
WITNESS kny hand yid qfficjal seal.
Signature
Edna L'. White
t
.. -/d
(This area for official notarial seal)
Title Order No. Escrow or Loan No. I
MAIL TAX STATEMENTS AS DIRECTED ABOVE
RECORDING REQUESTED BY
UNION LAND. TITLE COMPANY
AND WHEN RECORDED MAIL TO
Name
MR & MRS WILLIAM 0. WILKINSON
38344 Poppett Canyon
Address
Palm Desert, Calif. 9'2260
City &
State L
J
MAIL TAX STATEMENTS TO
F_
same as above
Name
Street
Address
City & L
State
NAT -30 (5-87)
cc
°a
cc CN
�_.A
•�,
ati
o 3 $ .o.
_ E�as
W
4 ~ 8 V- �
gig $
SPACE ABOVE THIS LINE FOR RECORDER'S USE
Individual Grant Deed
The undersigned grantor(s) declare(s): , 90
Documentary transfer tax is $ y
aa ( X) 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: (,X ) City of 1-4 QU1.,07V , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
James W. White and Edna L. White
hereby GRANT(S) to John L. Hart, an unmarried man as to an undivided one half interest
and William 0. Wilkinson and Barbara_L. Wilkinson, husband and wife as joint tenants,
as. to an undivided one half interest, as tenants in common
the following described real property in the
County of Riverside , State of California:
Lot 20 Block 121 Santa Carmelita at Vale LaQuinta, Unit 4112, -as per map
recorded in book 18 pages 79-80 of maps, in the office of the county
recorder of said county.
Dated: January 17. 1989
%4 A5" J N 6. `[ ON
STATE OF G4bW-0R+4A_
COUNTY OF K tiJ Ci JSS.
�
On � �D . 1 g�`� before
me, the. undersigned,la Notary Public in and fob said State,
personally appeared )rAnwS kl
EkhG L.. vJN,4-e
personally known to me or proved to me on the basis of sat-
isfactory evidence to be the person g_whose names
subscribed to the within instrument and acknowledged
that executed the same.
WITNESS kny hand yid qfficjal seal.
Signature
Edna L'. White
t
.. -/d
(This area for official notarial seal)
Title Order No. Escrow or Loan No. I
MAIL TAX STATEMENTS AS DIRECTED ABOVE
1
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH An«"7
Pafow 11110.ENVIRONMENTAL
SERVICES -DIVISION
IA-:RMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM V
,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 non-retundable filing fee'.
ee (see below) is required when the application is submitted. Check must be made payable to the County of
Riverside. Approval of this.applicati6n shall remain valid for a period not to exceed one;year from date of approval.
VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # d_1 1A
Agent, Contractor, Contact Person
T-ncr
Phone Address & Firm
'
Owner
Ph6m905 Mailing Address
a soon
ltY
I.State
Zip
J p.,ropeRy Address
Legal Description Prop. . �MR�Tract. Lot) r
gL
f
�iL/(�.A• •G� •NAVA
DO, Rvlk
Size�/
ter n'gency etl
Use of Pennit P/P, CU, etc a �( fit,,
Other` lc ��G ^� �
1L�ot
✓ 0f X O i�rAM
R.�'Q OCQ
Signature of Applicant `
Date
CATEGORY: K' REV CODE FE ,y
y CATEGORY: ` REV CODE FEE
:O SUBSURFACE DISPOSAL . / 1238 g
Q` SITE EVALUATION UPON REQUEST 7349 $ 43.001
0 MULTIPLE PARCELS WITHIN SAME
;^'''(NO PLOT PLAN)
LAND DIVISION ""
❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00
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
❑ Rereview (2nd review same parcel) 7344 $ 24.00'—,
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $.47.00
Critical -Area ,,� 7346 $111.00
❑ ALTERNATIVEIEXPERIMENTAL 7345 $222.00
SYSTEM
❑ye Evaluation Lot Less than r
j,i0;000 Sq?Ftr^ - ' ; : ••^K , �t.7347'" i $ 87.00
-Y NIT �' DATE
Holding Tank Agreements Completed ❑ Yes
Certification of Existing S.D. System Required -• ❑Yes I.A' N;
WQCB Clearance required. (Attach Form ❑ Yes l�No #
DOH SAN 007, Santa Ana Region Only)
Solis Percolation Report Required. ❑ Yes R 7
Special Feasibfitty Boring Report Required. ❑ Yes k
Detailed Contour Plot Plans Required (1 to 5 fL interval) ❑ Yes
Otter ❑ Yes
Staff Specialist Lot Inspection Required ❑ Yes No
Lot Inspection Date
Soils boring report by . Project, Date
Soils Map Page Sca Type -� ApproJed by Delta_
No. of Systeme
of System(e)
Homing Tank ❑ Existing
Unita f)
(1) Septic Tank
Soil Rate❑
Be ❑ ReplaoerrwntJ
ftNo.elling
.
i Leach Line Sq. Ft
french area
Sidewall allowance
ft rock/ sq. It
I I Line(s) ft long fl wide with
'
LeachBed sq. ft
•-+•"'"�
per running fl
min. � rode below dralnlines or
�. r
,.
a
+
Leachlines/bed speorel design for slope: pe:
(3) PA Diameter
No. Bits
Pit Below
Seepage Pit To�al Depth
Applicebl
+ ;'
IAt@I (BI)
(TD)d
NOverburden factor
/A
j
Max. A.Ilowabrle Depth
�0
No..: 2 System � A
n- 1,
REMARKS: ���� •r �� Qin
O
7
- I /
This application i APPR�DlEB.for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompanieng the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
above -designed system. No construction is permitted in the required reserved 100% expansion area.
`/ ,.
1) Septic tank and sewer lines must be 50' minimum from any wells �/ (q ' �� QQG 7` 44,Zr (�iti,�
(2 Leach lines must be 100' minimum from any wells, including expansion ea
Seepage pits must be 150' minimum from any wells, including expansion area ,//
9
Signature of Health Official (Ns pate
RECEIPT NO. i6e-79 Issued By r`"' -� Date
DISTRICT: ❑ Riverside, 111001n P ❑ Hemet O Perris q Rancho Calif. ❑ Blythe K
E
DOH -SAN -122 (Rev. 3/90) DISTRIBUTION:
WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records
J..
r
► OFFICE OF E
u
AGRICULTURAL COMMISSIONER "
.� •�,.. • AND
WEIGI-ITS & MEASURES CALVIN C. KAMINSKAS . n
JAMES O. WALLACE
LEMON SIREEI. ROOM 19
n++{+}ontcommh+}anm
Aak,AMol co{,�naa{�+ RIVERSIUE..CALIFORNIA 92501 CLEMENT OENVENISIE
I Cdgolm d Wdph11 A Mea►ue► -
(714) 787.2561.
49613 ilighway 86, . Suite B12 ,t
Coachella, Ca. 92236
( 619) 342-8291 .'
4 DATE /0///
�� CASE No.
DEVELOPER'S NIMI N'1 �vC_; e �v.�- b ,•��
{
(1
ADDRESS
-7 7� O C.
.,
LUNE � 3 4 ,
i 7ELEE'I (�-�1�11 ' "_ (cI
1 Dear Developer! 1.
After reviewing your landscaping plans, all pliant material listed is not in ?
violation of quarantine laws .governing the Coachella Valley. if substitutions +;I,• !.
�1 do occur and they differ from plant material listed, ti>lis office iinJst be notified
imllediately.
1• .
" I1rlank you for protecting and preserving" the Coachella Valley's pest -free .environment.
(! Actura! Can ss one. "s OF1 cue
i col indiq slid Riverside Office