07984 (SFD)444
P.O. BOX 1504
No. 07984
Building 78-105 CALLE ESTADO
Address 54-035. Har'tf rm LA QUINTA, CALIFORNIA 92253
Owner `
Mailing
f , BUILDING: TYPE CONST. OCC. GRP.
Address 1225 Kamer Court A.P. Number 774-221.415
City Zip Tel.
Cardiff. hp theS a 92407 . Legal Description Lot a1Q & 297
Contractor
oar Project Description
Address
City Zip Tela
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition O
Address Tel.
City Zip 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 Estimated Valuation
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 Q
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT
Me 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 Plan Chk. Dep.
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 Plan- Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
Code: The Contractor's License Law does not apply to an owner or property who
builds or improves thereon and who 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
orimprovement is sold within one year or 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 IS7. So
does not apply to an owner of property who builds or improves thereon, and who contracts for S. M. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading 037
❑ I am exempt under Sec. 8. 8 P.C. for this reason 20.00
Driveway Enc. 20,00
Date owner Infrastructure
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.
TOTAL t1% _ On _ 1 t ci 11101111% 11
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`Californiar, t1l 1 X
Date, 1 t r• t Owner
NOTICE'TO APPLICANT: If, afterr riaking°this Certt1cat 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 tie 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 stale 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, Zip
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 504191)ermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
FOR. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
ROOFIN
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
VENTILATION
SO.FT.GAR ® VVic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES7-1
EE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK ?/P /1*0
GROUND PLUMBIN ,
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 8 Q
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
i
FOUND. REINF. 7 y
c
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
D
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. ¢ /
GRADING
FINAL INSP. 9 cu. yd.
/ $ plus x$
,
`O
_$
LUMBER GR.
FRAMING D /
ROOFIN
n/
Cj
I
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
Building
Address % /
Owner C\ T "f/ C 1 /
P.O. BOX 1504 APPLICATION ONLY
78-105 CALLE ESTADO
l LA QUINTA, CALIFORNIA 92253 / P 9U- 4W
—W....a
Address Wanetlq.-A- G
Ci Zip Tel.
4ddress
l /'5 Mace /a,-- C f
State Lic. / / City
i Classif. y 3 76: /3 Lic. q
krch., Engr.,
liesigner _ ` -, („ 1 l
- I Tel.
JbDO Pt Ve &% I re -7r y
a (t A+a L997-5 3 Lictit-/3(,P;L5
LIC8ISED CONTRACTOirs DECLARATION
1 edftrrtt IfM 1 am licensed under provisions of Chapter 9 (commencing with Section
1000► W Divbion 3 d and t rMessions Code, and my li se is 19 full fort and
attect r /
aAre
DECLARATION
I Aersbp ,,o,"Apt frorre the Contractors License Law for the following
sasort ISM 7 1 Rahaealont Lode: Any rly or county --hW rePfes a
enaR iso ata. arp my , - I or repair any structue, prior to Its issuance also
mpeaiae Or appaeant for as I PORIA Me a &re 0 staternerA def M a ecensed pursuant ro
'u provtalorw d lir ContacloAt License Lew, '1( rapte►r 9 (owrurw.chp with secom 7000) of
hta+on 3 of be Bualgaa and Acids i a Coft or ".he is exenpt Mersfrcm. and Ne Dosis
V dee aaepad exanpaon, Any vaotatlorr of Section 7031.5 by any applicant for a permit
uf>►ecfs 0r appiaI ID a des pain" of not mono Dean On hu cted doasrs ($500).
1 I, as owner of Be property, or my employees with wages as their sole compensation, will
o the world and the structure Is no( Intended or offered for Bele. (Sec. 7011, Bursnese and
Sofetaiana Coda: The Cantrack" Licmw Law does not appy to an ower of property who
cAk+r or PVM,.S 6ra:. araC via doe- ate: wcrh :haeff Of 5..;erp1. :. S own nrpbyew.
modem L'W and AWovaaewrwr Am not ieww/ec or atfered for sale. e, however, the building
r irprovaeern1 —sold varve ort yaw d rnrrpiseon. dr owrwbLa0er w0 neve the burden
I proalnp Mr he dd not build or reprove kr tfr purpose of sub.)
11, as owner of the property, am exclusively contracting with licensed contractors to con
tract the project ISec. 70". Buaamwe and Prafaeaions Code: rhe contractors License Lew
Des not appy iso an oanw of property aero bold• or Inproves swoon. and who contracts for
udn prcreeb with a earvacfarls) eeareaa I pursuant b me Corwactara License Law.)
. I am arompt under a P.C. for the reason
etc owner
WKNIKE W COMPENSATION DECLARATION
I im" affirm that 1 have a certificate of consent to self -insure. or a certificate of
Yorkers Comperration 4euranos, or a certified copy thereol. (Sec. 3800, Labor Code.)
a01kp Na Cor ON
❑ Copy is filed with the city. O Certllied copy Is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
COMPENSATION INSURANCE
This awcsan need net be conpbted 9 Or parol it ler one hundred dWers ($100) vahmthn
r I Car" that in Wa penfon.ga a of work for which this permit is Issued, I shall not
fn ay matter so t to the Workers' Compensation
AM r
to TO Jr. after d5c8ti of Exemption you should become
rl0lecf to far wa Amw of the Labor Coals. you must forMwllA
apply aur ash $ , , " r or we Oe dasrtrd revolrwd.
CONSTRUCTION LENDING AGENCY
I hereby affirm Ind there is a catatruction lending agency for the performance of the
ork for which thlb 1011111 ft IS issued ISW_ 3097. Ch* Code.)
*$civ es Nar.r
Sanders Address
This Is a building pwmit when popery filled out, signed and validated, and is subject to
O.U. If mark Usereaatdw is a mpended for t80 days.
1 car" Otat I have read this application and state that the above Information Is correct.
arnd fwilth all city and
county ordinances and state laws relating to building
Wdiorled Property Ior nVM8Wtativea of this city to enter the above
-9nature of appikyrnt Date
ailing Address
iy, state, ZIP
CrhlA1krn-
BUILDING: TYPE CONST.OCC. GRP.
A.P. Number r-7 7 T 2 1(,_5d l
Legal DescriptionL // 3( 3 /z r- k R-1 7 ao,( // # 7
Project Description 744
at u /t 4., QGN.0 fa 415 ®rte M, m
y-lf.,,_ d y 7rx-e
C,a,,Tt/ l«cmZara, o xer✓%sWc
Sq. Ft.l/
Size 1 70
No. J No. Dw. /
Stories / Units
Nevv g, Add iJ
Alter ❑ Repair ❑ Demolition =
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
2
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
I of rastructu re
R
TOTAL
REMARKS
OVOSSLF''_ i 7 05 5 -ii -9 VV 14
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 Praperty Line_,_P _^____
FINAL DATE
INSPECTOR
Issued by Date Permit
Validated by:
Validation:
oil Go mal
11i "
HUI A 0
tau aaos as eeaoe as 11717—SC
aa,aca Asova Ttsa t.rei fon aCOeat+ra uu
GRANT DEED. -1- q
N
THE UNDERSIGNED GRANTOR(S) DECLARE(S)
DOCUMENTARY TRANSFER TAX IS i 23.10
0 computed on tun value of property conveyed, or
0 computed on fun value less value of liens or encumbrances remaining at tlme of sals.
® unincorporated area
O city of , AND
Fa; A VALUABLE CONSIDERATION, ntcetpt of uatdeh Is hereby acknowledged,
MAX R. TAYLOR and ALVINA TAYLOR, husband and wife
hereby GRANT(s) to JR.
JAMES W. HINES/and LOIS HINES, husband and wife, as joint tenants
the following described real property In the
County Of Riverside State of California:
LOT 3, BLOCK 297, UNIT NO. 27 of the SANTA CARMELITA at VALE LA QUINTA,
as per map recorded in Book 19, Page 82, of !laps, in the Office of the
County Recorder of Riverside County, California
Dated March 20, 1990
STATE OF CAUFORNIA
Sa
COUNTY OF ORN=
On vis _ _2nd day, of AYJU . In e» yew 1990}—.
before me, to w denipned, a Notary PW c in sad for Bald Stats.
e . pereanay known to me
(or p vjsd to nM on dw basis of satisfactory evidence) 10 be the
eenon L wtfoee name a:r► wbserbed to the wtdtln
neblarlenl, and acknowledged to mo ins —t he .y- exeWed M.
WITNESS my hand and of kW seal.
tARY PMC N AAD roll SAD STAT[
MAX R. TAYLOR
ALVINA TAYLOR
• N MMMNM H
l i J- ' • ; 1',( 1. 11(A el. Af 1
11M
JOYCcA TSJURUTA
.l 19
9
1My ("41111. 1:.1) Mar
Rlw u.. a aN N. Im1r en
IIEOOIIONO REGUOTIM my
ORANZ OftrTM 00.
wwe iie sya+. ra Mus claw a+ .. yew
wmtlMOVIN is
Jr.
rail`
was V. Hine* And Lois Hines
36 Linda Isle
ar
Newport Beach, Ca. 92660
Hirai
a
ifivsTo
SAns as above
ns,r
We
oil Go mal
11i "
HUI A 0
tau aaos as eeaoe as 11717—SC
aa,aca Asova Ttsa t.rei fon aCOeat+ra uu
GRANT DEED. -1- q
N
THE UNDERSIGNED GRANTOR(S) DECLARE(S)
DOCUMENTARY TRANSFER TAX IS i 23.10
0 computed on tun value of property conveyed, or
0 computed on fun value less value of liens or encumbrances remaining at tlme of sals.
® unincorporated area
O city of , AND
Fa; A VALUABLE CONSIDERATION, ntcetpt of uatdeh Is hereby acknowledged,
MAX R. TAYLOR and ALVINA TAYLOR, husband and wife
hereby GRANT(s) to JR.
JAMES W. HINES/and LOIS HINES, husband and wife, as joint tenants
the following described real property In the
County Of Riverside State of California:
LOT 3, BLOCK 297, UNIT NO. 27 of the SANTA CARMELITA at VALE LA QUINTA,
as per map recorded in Book 19, Page 82, of !laps, in the Office of the
County Recorder of Riverside County, California
Dated March 20, 1990
STATE OF CAUFORNIA
Sa
COUNTY OF ORN=
On vis _ _2nd day, of AYJU . In e» yew 1990}—.
before me, to w denipned, a Notary PW c in sad for Bald Stats.
e . pereanay known to me
(or p vjsd to nM on dw basis of satisfactory evidence) 10 be the
eenon L wtfoee name a:r► wbserbed to the wtdtln
neblarlenl, and acknowledged to mo ins —t he .y- exeWed M.
WITNESS my hand and of kW seal.
tARY PMC N AAD roll SAD STAT[
MAX R. TAYLOR
ALVINA TAYLOR
• N MMMNM H
l i J- ' • ; 1',( 1. 11(A el. Af 1
11M
JOYCcA TSJURUTA
.l 19
9
1My ("41111. 1:.1) Mar
Rlw u.. a aN N. Im1r en
COACHELLA VALLEY WATER DISTRICT N2 A 0 Sa
CASH RECEIPT DETAIL fY F +
Recelved From: v e / e S ( Date.
Address: 7 X11 V O / fi1.lUr C -) 1 L o
el
Account No. m J (0,/ —7 ti/ — 7 7 • J • J Lot(e) / Tract
Service Address J /—O3j/%)Cyt/ eZ a ,d -/ U /i7en oaw
Q.A. Code
1
Meter(s) - .3 `/ aJ J• J v t O J, O J.
~C Service(s)' do . J J / D, O J
O Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s)
O Meter Surcharge 7
"b Sanitation Capacity Charge 5O , / : , JJ
❑ W.S.B.F.C.
❑ Temporary Construction Meter
O Turn on Charge
O Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
O Plan Check Fees Water I Sewer -
Tract - _
❑ Bond Payment - A.D. - Bond
Assmt.
O Customer Deposit
❑ Other
TOTAL S ' .3 •iJS O J
Remarks:C3/!/ ' i T. /! J / [ tr / c G e
,-j 0jQ%Q16JS=T 07
0 COPY to:
Cash
;;." 't . WaterServlce
Check O
Money Cashier
Order ! ` 1 ! r.: CVVVD-138(tt189)
-.l