03914 (SFD)P.O. BOX 1504
Building r 1 78-105 CALLE ESTADO
Address 51—2 5 - � Ma rrora LA QUINTA, CALIFORNIA 92253
Bruce & Sue Pe icitl:er
Mailing
Address % 9 r-5a 2 -1 1;auzel.;.'•aCk Drive
City Zip Tel.
i i*;x,i�1 Dun �€� 922GI �� �
Contractor
Oumtiix/Rut . der
Address
City !Zip ITel.
State Lic. J City
& Classif. I Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provlsior,, of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Proles :font: Code, and my license is in full force and
effect.
SIGMA-TUR' _ DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the lellowing
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 rho applicant for such permit to file a signed statement that he is licensed pursuant to
the pioW Dons 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 (S500).
❑ 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 )
❑ 1, 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 contractors) 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 (S100) valuation
or less.)
I certify that In the performance of thg work for which this permit is issued, I shall not
employ any pperson in any manner so as to become subject to the Workers' Compensation
Laws of Cal i}ornla_
Date Owner
NOTICE TO APPLICANT: ff. after making this Cerlilkale or Eremplforr you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permil shatl be doomed tovoked.
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 appllcatlon 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 inspecflon purposes.
Signature of applicant Date -
Mailing Address
City, Slate, Zip
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
I Description
Project Description
Sq. Ft.
Size 1600
No. No. Dw.
Stories Unils
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
'D0ol not
incl Tdzid
Estimated Valuation
015419-14
PERMIT
AMOUNT
Plan Chk. Dep.
` 2 .0
Plan Chk. Bal.
r =• + c
Const.
. -}•
Mech.
Electrical
Plumbing
S.M.I.
ci
Grading
Driveway Enc.
Infrastructure
755 . r) 4
TOTAL
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:
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO
ELECTRICAL FEESMBAR
UMBING FEES
1ST FL SO Fl (g
2ND FL SO FT a
POR SO FT er
GAR SO- FT (r
CAR P SO FT 6
WALL 50 FT. aDRINKING
SO FT. 0
ESTIMATED CONSTRUCTION VALUATION
S
UNITS
STEM
IMOBILEHOME SVC
POWER OUTLET
DRAINAGE PIPING
FOUNTAIN
URINAL
$
WATER PIPING
NOTE- Not to be used as property lax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
-GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B T.0
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
SO. FT. RESID g 1 In c
SEWAGE DISPOSAL
SO.FT.GAR rg c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH,FEE
k.CK.FEE
CONST FEE
ELECT. FEE
SMI FEE
PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND SOLAR
SETBACK
;QjROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE
PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
�ROUGH
!/CSEWER rl OR SEPTICk
`t vv r
ROUGH WIRING
UUGT WORK
ROCKSTORAGE
FOUND. REINF
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP
REINF STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP
BOND BEAM
WATER SYSTEM
$
GRADING
cu- yd.
plus x5
=5
LUMBER GR.
FINAL INSP
P
. / FRAMING&) -
FINAL INSP.
ROOFING
1 G — 6 —��
'�, �✓ � /'� � /L� 'off- �'
c r U ^I='
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
� LATHING
MESH
' INSULATIONISOUND/(}
FINISH GRADING
FINAL INSPECTION
CERT. OCC
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
gbNNOT
NOTICE: THIS FACILITY FEES Ei lel
BE DUPLICA E . Q R -G
TO: City of La Quinta DATE: (J 416
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to certify that
developer of which is
located at within
this District, has paid school faci ity fees imposed pursuan to the
aut orit ,,g�en rate by Go rnment Code S ction 80 'n t e -a-mount of
S U, ( ) /8
co ening a total of square feet of residen or
( ) industrial/commercial development and that building permits for
this footage in this development may n be issued by your jurisdiction.
or SERT SANDS•UNI IED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting 49 Gold - Developer
(10)-37
s RECORDING REQUESTED BY
RECORDING REQUESTED BY
FIRST AMERICAN TITLE INSURANCE COMPANI
AND WHEN RECORDED MAIL TO
I
NAM[ ROBERT J. PELLETIER
ADDR[[[ c/o Classic Realty
73080 E1 Paseo
CITDesert, CA 92260 _j
r MAIL TAX [TAT[M[NT[ TO
_same as above.
ADORE[[
CITY a
STAT[
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X U (L 00
OJ O U
c W gO
m ci T-7
U Yj Q
at
SPACE ABOVE THIS LINE FOR RECORDER'S USE
IDocumentary transfer tax .5.x.3 6.,` ................................
__._._..____.XK].Computed on full value of property conveyed, or
❑ Computed on full valueless liens & encumbrances
remaining thereon at time of sale.
........................................F.Q�Z1.S.z.�'N...NS.C.RO.W..... IN.C.......
Signature of derlarant or agent determining tax • firm nume
❑ Unincorporated area City of..... ,La ... Quianta......
I ' Grant Deed L
This form furnished by Orange Coast Title Company
PARCEL NO -77"l- Z4,T " /_3'J
7L/-2,45-0/4-(
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, FERDINAND ERNEST PERRY,
A Married Man as His Separate Property
hereby GRANT(S) to ROBERT J. PELLETIER and G. ELLEN PELLETIER,
Husband and Wife as Joint Tenants
the following described real property in the city of La Quinta
county of Riverside , state of California:
Lots—�an�i-2�n�B3'ock'290; Salrta Carinel�'ta; .Unit-li26; as per map recorded `in stook
20, Page 50 of maps in the office of the County Recorder of said county.
October 19, 1987
Dated
rdin d `Erne Pry
STATE OF CALIFORNIA SS.
On _..0 C:T— —91r7 before me, the under
signed, a Notary Public in and for said County and State, personally
appeared
Al A -A1 f —&-A) >T F it i�q
—------- known to me
to he the person —.whnse name / subscribed to the within
instrument and ackn wledge thatexecuted the same.
o �7/�7
Signature 01 Notary
N , - -Fim ay)
Name (Typed or Printed) of Notary
Title Order No.
Escrow NO._
FOR NOTARY SEAL OR STAMP
OFFICIAL SEAL
DIEP N. FINTLAND
• NOTARY PUBLIC - CALIFORNIA
• LOS ANGELES COUNTY
My Comm. Expires May 19, 19119
MAIL TAX STATEMENTS AS DIRECTED ABOVE
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COUNTY OF RIVERSIDE, ENVIRONMENTAL 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 specifications required on the attached check list.
A non-refundable filing fee of $40 is required when the application is submitted. Check must be made payable to the County of Riverside.
—T4 �, �-I �"' Building Department Application Log #
1grf/�•1~. f
Name (Owner. At. Contractor. Etc)
-
Mailing Address
State
Zip Code
Telephone
;'
'Job Properly Add,e55 r!.{
"Legal Descriplicip of Properly (Lot. PM. TR) ,d4,,Vj C c -L
'Assessor's Parcel No
ater Agency-*~
i� �/1A + ,r7./� Q,,, r
Use of Per t !�((2(�.V ty /�N^' �6 "rrA ng Case #
Lot Size
`� b
— —
VJ Cj
(/6 797 �G1' 4
Etc.
SFD. MH Site Preparation/
9
Signature of Applicant Date
'The above information must be verified from Building Application
STAFF USE — DO NOT WRITE BELOW THIS LINE
i� Ilni�tial Date r
Certification of Existing S.D. System required. El Yes Np� / -C/ �1- •� �O
y
WOCB Clearance required. ❑ Yes
t=.1
Soils feasibility report required. ❑ Yes / --
Special feasibility boring report required ❑ Yes{
Detailed contour plot plans required. E)Yes LrJ/f�o's`�'•
Staff Specialist approval required. ElYes 0 No Lot Inspection Date
Soils/boring report by Project # Date (�
Soils Map Page Soil Type �— Approved by -r'-1//"/ - — Dater "l1 <
Type of System: ,_
No.. /of Bedrooms
(1) Septic Tank
Soil Rate Required
��*-'2�ea
❑ Existing L�'"New C3Additional EJReplacement
Gals.
(2) Leach,line sq. ft.
Sidewall allowance
Ft.
Install Lines) Ft. Long,
Ft. h,mio..—inches
r f
Leach bed Sq.
Ft.
(Sotto nch area)
ft. rock/ Sq.
wide wt
( bottom
per running ft. [9 -N/A
rock below drain lines
area .
Leach lines/bed-special design for slope:
(3) Pit Diameter-
No. Pits
Pit BI
/
Seepage Pit total depth
Applicable
factor
x5r.
J.
Max. allowable depth
N/A Overbu en
,F.li�..i-wt.ua�i � �/J/1[�r�/�j '"'Tu
r%a� // � h� i-L!i[.C� r✓�� _.ter-,,..
//%>fn�.Y /rr y.+f-l�f�i.�/v�
//s/'.+� i.a-/_a% M.i/'sa�' /7C./iYl�!—rviL'-�� �1�f% d_E��Y �� �r �/ C!� /.C.�io•/' f..�7�C�if!. L••d
r �, '-'�C.•l"e--Gf� l%t�t..�+t ) e+ �C .r—s-r�,rx'���.•,�.�r/
This application i {a ro d i®d-for the design of a subsurface disposal system as indicated on the accompanieU prt plan using the requirements
set forth in Section B above. A building permit isAr ecessary for the installation of the above -designed system' _
(j Septic tank and sewer lines must be 50�m froany wells'lf /d y '1 c,LG� c\>/(�(i1C�-ra�4lrct.-w f' _
2) Leach lines must be 100' min. from any wells including exp nsion,area C
(3) Seepage pits must be 15/0' m` from any wells including expansion area
Signature of Health Official t , Bate
RECEIPT NO. Issued by Date
C'
District: ❑ Riverside Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe
Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File
DOH SAN 122 (Rev 8I87)
M
i
y
r
9
First Intentatq Bank
PALM DESERT ESTATES OFFICE
77-916 Ave. Of 5t6tes
Palm De3ert, Calif, 92g@g.
** USE BANK LETTERHEAD **
DATE:
;Planning& Development Department
City of La Quinta
78-105 Calle Estado
P.O. Box 1504
La Quinta, CA 92253 L
SuspA),
SUBJECT: SAVINGS PASSBOOK FOR: (NAME)
ACCOUNT NUMBER: ni a %3
BUILDING PERMIT NO.:,
�tAr�✓P�) dollars has been deposited
with this bank in the form of a savirfgs pass ok account in the name
of The City of La Quinta on behalf e ) t -N �e.11� p -
It is agreed and un erst.�ood,that this bank will not release any money
to Si 5Ak] (NAMEAJekl2Cnnev until written authorization has been
received from the Planning Director of the City of La Quinta.
This money has been deposited to guarantee the following improvements
at 54,355City of La
Quinta, Riverside
County California:
1. 2_fNb5cf)PE 0-0XI\ Ie C -
2.
3.
BANK OFFICE -
(signature)
TITLE:VV
l �,
MR/FORMJH.001
IMPROVEMENT AGREEMENT
This agreement, made and entered into this ��� ay of
�c�cP M1p�( 19 g , by and between uS n- lU I P r) ,
hereinafter referred to as "Applicant", and the CITY OF LA QUINTA, a
municipal corporation of the State of California, hereinafter
referred to as "CITY".
WITNESSETH:
1i WHEREAS, the .Applicant had a home constructed at
S-IocS.S in the City of La Quinta, County
of Riverside, and under Building Permit No. ;
WHEREAS, as a condition to release electrical services to
said home by the City, certain improvements must be installed;
NOW, THEREFORE, IT IS HEREBY AGREED by the Applicant, in
consideration of releasing electrical services to said home by the
City of La Quinta and the subsequent issuances of a Certificate of
Occupancy, that the Applicant will install the following improvements
at
1. LeNOSCIAP CoMp)C�C_
2:
3.
4.
5.
in accordance with specifications required by Chapter 9.42 of the La
Quinta Municipal Code on/or before 2 It being
understood and agreed that e \ _q dollars has
been placed in a savings passbook account at iL ,
and any interest accrued shall be paid to the Applicant. Upon
authorization of the City, the money will be released to the
Applicant upon satisfaction of this Agreement. Upon failure to
fulfill this Agreement, the money will be released to the City for
the completion of said improvements.
IN WITNESS WHEREOF, the Applicant has executed this document on the
day and date first above -written.
lJU\G M 'U(
Subscribed and sworn to before me this 15thday of December , 1988 •
&U.-& (Notary Seal) . W"o,
. , y OFFICIAL SEAL
a PATRICIA A WEBB
m •g NOTARY PUBLIC - CALIFORNIA
RIVERSIDE COUNTY
P My comm. expires OCT 2, 1990
MR/FORMJH.001