0107-0216 (WALL)49249 Avenida Anselmo
go
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Ct,apter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
64MI C219 TOO /3 1p
Date S.ignature•of.Contraefor --'G
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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, Business& Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSAi ION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of i'ie work for which this permit is issued.
i) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
1sE01CM 11,1311RANCH W0312311203
(This section need not be completed if the permit valuation is for $100.00 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, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
..Code, I shall forthwith comply with those p.ravls ons.
Date:`) . ^ Applicant-
-Warning: Failu re,to-sedD-(e—
pplicantWarning:Failure4o-seou-(e Workers' Compensation -coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection.purposes-
Signature (Own er/Agent)/"”' T f ^" AZ Date -2--W-1 .
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
49-.249 .tE;VY.MDA, AN sELA-70
OWNER
CONTRACTOR / DESIGNER / ENGINEER
BOB MCsN32.OE
SAGOR svABONRY
49--.1A 9 AVEW.f 3A ANS MAIO
4162.5 ECLECTIC 3TRWf, -S- I
LA, QUINTA CA 92251,
PALM DEMR CA 92260
(160)674-0666 C.BW 6214
USE OF PERMIT
GMEWALg3 iX£.i3 A3`u
250 1,103'+,.I AR.OEN WKIA.., tORCO. Tf )40Ai"D
:gs "a x' !1SIV COW (XI,'C'.S$RSTRUi'«.M."
&X50AX)
C01MYRUCTION Pa. 1,51 -000-43 B-000
r .
it» A
JUL 2 U
"T311,-'1"fY1 ,I ,. 4C1AI 1 ' t ,1 C i :C l P3 t C
$90.00
IMI 3 PIR.TEv-T,PM PERS
$0100
II I VIII I VIII IIII 34
IE
RECEIPT
DATE
BY
D TSF E INSPECTOR
iiVJ
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Footings �j� jl/
Bond Beam / �7
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS.
11111III 11111IN 35
IE AE
ASSESSOR'S PARCEL NUMBER
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY" -. -
DEPARTMENT OF ENVIRONMENTAL HEALTH
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 as indicated on the attached check list.
A non-refundable filing fee is required when the application is submitted. Check must be made payable to the County of Riverside. Approval of this applica-
tion shall remain valid for a period not to exceed one year from data of payment.
LMS #
Agent, Contractor, Contact Person
Address City State Zip
Telephone
Owner
Address City State Zip
Telephone
Q�;
Z
Job Property Address
City
Zip
WLot
Size
Water Agency/Well
Use of Permit, P/P, SUP PUP, etc.
Legal Description -
v ),
Dwelling, MH Site Prep., etc.
Signature of App)Eant ���
Date
CHECK BOX IF REQUIRED
If any box is checked, this application shall be considered rejected until
❑ Detailed Contour Plot Plans Required (1 to 5 foot interval)
the information is provided and the fee paid. Resubmittals later than 90
days after date noted below may require repayment of fees.
❑ Staff Specialist Lot Inspection Required
ca
❑ Holding Tank Agreements Completed
Thomas Bros. Page Grid
Z
O
❑ Certification of Existing S.D. System Required
❑ Date Lot Inspection Completed: Initials
U
El WQCB Clearance Required
LU
(Attach for DOH -SAN -007, Santa Ana Region Only)
Remarks:
❑ Soils Percolation Report Required
❑ Maintenance Booklet Provided
❑ Special Feasibility Boring Report Required
❑ Final Inspection by Department of Environmental Health is required.
❑ Rereview Required Initials Date
Please call 24 hours PRIOR to inspection.
C/42 / Soils Percolation Boring Report by Lic/Project # Date
Soils Map Page ��!; %� �" J Soil TypeApproved By Date
No of Systems
T pe of System(s)
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand
Holding Tank ❑ Replacement
Bedrooms, Fixture Units
Grease-latcp/Lint Trap
�1
�
ew ❑ Addition
Existing
Gal.
Gal.
Sq. Ft.
Total Linear
Sidewall Allowance
Leach Bed sq. ft. of
Bottom Area
Ft.
Bottom Area
ft. rock/I_sq. ft. running ft.
Install Line(s) ft. long ft. wide with
Inlet Tested Depth ❑ NA
min. in�e�rock below drainlines or
UProposed
Bottom Tested Depth
Z
Leach lines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below Inlet (BI)
Seepage Pit
Maximum
Other:
O
\
Total Depth
Allowable
F-
Applicable
Depth
LU
N/A Over Factor
c�
❑ 5' �0 5
li
" ;� �,
TD
Well Review Approved: Date: Well Drilling Permit #
SIGNATURE
Grading Plan Approved: Date:
SIGNATURE
Sewer Verification Approved: Date:
Plan Check Only Approved: Date:
REMARKS:
This application is APPROVED/DENIED for the category checked in SECTION B
FOR OFFICE USE ONLY
above, regarding the design of a subsurface disposal system as indicated on the
acompanied plot plan, using the requirements set forth in SECTION C above. A build-
ing permit is necessary for the installation of the above -designed system. No con.
structlon Is permitted In the required reserved 100% expansion area.
Revenue code Fee $
(1) Septic Tank must be 100' minimum from any wells.
Check #
(2) Leach lines must be 100' minimum from any wells, including expansion area.
Date Initial
3 Sewer lines must be 50' minimum from any wells.
Z
-
O
(4) Seepage pits must be 150' minimum from any wells, including expansion area.
H
U
LU
rn
Signature of Health Official
Date
DEH -SAN -122 (Rev 9/98) Distribution: WHITE—Office File; YELLOW—Applicant; PINK—Bldg. Dept.; GOLDENROL—Plans/Records
36
IE
P.O. BOX 1504 APPLICATION ONLY
Building,tom n� 78-495 CALLE TAMPICO
Address 'T-1 ' 2.T 1 AVF_m ma AISSFLur% LA QUINTA, CALIFORNIA 92253
vwnci .
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c�[�p2iw
BUILDING: TYPE'C•-ONST. OCC. GRP.
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R
Mailing
-00-/,
�(
Address P 0• i D TU
A.P. Number 631 —3 qZ Q 1 (2
Legal Description GOT ISS /�. ga. 77194 -50�lf
Project .Description
l�
OP
I
City ��-,1
G4 C/V/,/vi rr
Zip
y2 ,3
Tel.
-9j�V
Contractor
t"lr�f
S./%lrrLo y /-/0
v
Address
73-213 3iL A14 R0.
City. b,
ZIp�2Z/ V
Tel. �7 J
State Lic.
8 Classif. S
I - 3 .qS
City
Lia #
No. / No. Dw. /
Sq. Ft. #0,90
Size �O Stories Units
Arch., Engr.,
New' Add ❑ Alter ❑ Repair ❑ Demolition ❑
Designer
Address
Tel.
CityZip��
/A -I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed uq�er provisions of Chapter 9 (commencing with Se tion
7000) of Division 3,6 th`e5BU6,065s.rid Professions Code, and my license 'a in f.11 for and
effect. %/ y (i� �j /, vl,
X
_
SIGNATURE �' DATE
DECLARATION
/ /OWNEpt
Estimated Valuation '
ro the
I hereby affirm that` 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
PERMIT AMOUNT
the provisions of the Contractors 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
forthe 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).
.-
Plan Chk: Bal.
I: I, as owner'of the property, or, my employees with wages as their sole compensation, will
Const.
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
Mech.
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
Electrical
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.)
Plumbing
I1I, 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
S.M.1.
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.)
Grading
17 I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
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
�j/� /'jar
F) Copy is filed with the city. 0 Certified copy is hereby furnished.
11/ (J
TOTAL
_ CERTIFICATE OF EXEMPTION FROM --
WORKERS' COMPENSATION INSURANCE
REMARKS
(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 thF 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: If, after making this Certificate of Exemption you should become
ZONE: BY:
subject to rhe Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: f
Front Setback from Center Line
Rear Setbdck from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of the
Side Street Setback from Center
work for which this permit is issued. (Sec. 3097, Civil Code.)
oft
Side Setback from PropervA, ^
Lender's Name-
9"
FINAL DATE INSPE5VC !-R 11 ` 100
�JL`
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.
Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
r�. Y": 1 �►
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Validated by: _ A
Signature of aOplicant Date
Mailing Address
Validation:
City, State, Zip
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
VANE H. SIMOf+'IAi1, Trustee ana ANI K. S1MONIAN, Trustee, or their successors in trust,
under the V and A Simonian Family Trust, and any amendments thereto, dated.4/10/92
hereby GRANT(S) to G3! 3,ya— 0l0
ROBERT C. MONROE, Trustee and MARY ALICE MONROE, Trustee of The Monroe Family Trust Dated
2/14/95
the real property in the City of LA QUINTA, County of RIVERSIDE, State of California,
described as:
LOT 128 LA QUINTA GOLF ESTATES NO. 1 AS PER MAP RECORDED IN BOOK 37, PAGES 96
THRU 98 INCLUSIVE OF MAPS, Rc,:;uR;DS OF R.IVi_,RS1DE COUNTY, CALIFORNIA
Dated November 12, 1997
State of California
County of
On dG24 1.1 1; 1i a? N f- / Y?
before me, v/G.c/ OGA.vi S y A A-1,
47 i G personally appeared
/'/IHF H. 5-11Va 111 V 19N/9.
.9 Al IC fiH D,Al i/�,t/
n i l y kn^; ^ * (or proved to me on
the, basis of satisfactory evidence) to be
the person (s) whose .arae (s ) *-� are J Jam•- 1�'c
to the within instrument and acknowledged to
me that-ha,4-► /they executed the same in
/their authorized capacity(ies), and
that by i-is-,Lh.er/their signature (s) on the
instrument the perso.^.(s), or the antity upon
behalf of which the person(s) acted, executed
the instrument.
WITNESS my hand and official seal.
Signature �G /� � /%I a Ag 1 e ci ti
MAIL TAX STATEMENTS TO:
P
CNS
�'A.SE SINiOivli-u'v, 'lr tee
ANI K. SIMONIAN, Trustee
7L-
x
Cla OGANEVAN
•: ;a 1075250
1rt1�S510�1 ROC — Cdlf-10
Angeles CountY
es Dc 19.1999
m. F�tr
(This area for official notarial seal)
458439
®ts-' REPUBLIC T 1TLF c0.
IN s� COR FI ED
.
--
RECORDING REQUESTED BY:
RECEIVED FOR RECOFD
AT 2:00
OLD REPUBLIC TITLE
O'CLOCK t
COMPANY
97.6983DT . 103847-13
DEC 15 1997
WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
P A I D
MAIL TAX STATEMENTS TO:
Doc. Trar;glar Tax
R�otded ofd Ramts
d R%smw Oafx 0dawia
ROBERT C. MONROE
Record
and MARY ALICE MONROE
Riv. Co. Recot�Br
Fees $
P. 0. BOX 1040
LA CALIFORNIA 92253
QUINTA,
SPACE ABOVE THIS
LINE FOR RECORDER'S USE
-7Ie14 6ZO 00 -2-
APN:
631-342-010
GRANT DEED
-4q -249
AY:ai-PA A05LL- o
The undersigned grantor(s) dec ):
Documentary transfer tax is 5.25
(XXX) Computed on full value of perty conveyed, or
( ) Computed on full value less
liens and encu^Z;rarces remaining
at time of sale.
( ) Unincorporated area: ( )
City of
, and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
VANE H. SIMOf+'IAi1, Trustee ana ANI K. S1MONIAN, Trustee, or their successors in trust,
under the V and A Simonian Family Trust, and any amendments thereto, dated.4/10/92
hereby GRANT(S) to G3! 3,ya— 0l0
ROBERT C. MONROE, Trustee and MARY ALICE MONROE, Trustee of The Monroe Family Trust Dated
2/14/95
the real property in the City of LA QUINTA, County of RIVERSIDE, State of California,
described as:
LOT 128 LA QUINTA GOLF ESTATES NO. 1 AS PER MAP RECORDED IN BOOK 37, PAGES 96
THRU 98 INCLUSIVE OF MAPS, Rc,:;uR;DS OF R.IVi_,RS1DE COUNTY, CALIFORNIA
Dated November 12, 1997
State of California
County of
On dG24 1.1 1; 1i a? N f- / Y?
before me, v/G.c/ OGA.vi S y A A-1,
47 i G personally appeared
/'/IHF H. 5-11Va 111 V 19N/9.
.9 Al IC fiH D,Al i/�,t/
n i l y kn^; ^ * (or proved to me on
the, basis of satisfactory evidence) to be
the person (s) whose .arae (s ) *-� are J Jam•- 1�'c
to the within instrument and acknowledged to
me that-ha,4-► /they executed the same in
/their authorized capacity(ies), and
that by i-is-,Lh.er/their signature (s) on the
instrument the perso.^.(s), or the antity upon
behalf of which the person(s) acted, executed
the instrument.
WITNESS my hand and official seal.
Signature �G /� � /%I a Ag 1 e ci ti
MAIL TAX STATEMENTS TO:
P
CNS
�'A.SE SINiOivli-u'v, 'lr tee
ANI K. SIMONIAN, Trustee
7L-
x
Cla OGANEVAN
•: ;a 1075250
1rt1�S510�1 ROC — Cdlf-10
Angeles CountY
es Dc 19.1999
m. F�tr
(This area for official notarial seal)
i
1
YOUNG ENGINEERING SERVICES
• Engineering • Architecture -Surveying- Building & Safety Services
Letter of Transmittal
To: City of La Quinta Date: 8/18/00
Project: Monroe Residence
49-249 Avenida Anselmo
Attn: Greg Butler W.O.:
Tel No.: Tract No.:
We are forwarding: By Messenger By Mail Your Pickup
No. of Copies Description:
2 Plan/Struct.Calcs./Title 24 calcs./Truss calcs.
Comments:
This Material Sent for:
Your Files Per Your Request
Your Review Approval
X Checking At the request of -
Other
By: Marcell McElroy
Phone # 342-9214
47-159 Youngs Lane • Indio, CA 92201 • (760) 342-9214
*Bron Young o
PLAN CORRECTION
t.
STRUCTURAL
Monroe Residence
49-249 Avenida Anselmo
La Quinta, CA
Engineer: Dennis Wish
Plan check No.:
Status: I" check
Plan Checker Marcell McElroy
Phone # (760) 342-9214
1. Resubmit redlined plans for next review. Failure to resubmit these plans may cause
delays, a new review, and/or additional plan review fees.
2. Respond to each of the below items with a written commentary as to where and how
the requirement was met. Respond to redlined items on the redlined set.
3. Note on plan and in details that all anchor bolts -to be 5/8"x 7" minimum.
4. Provide foundation connection details at locations indicated by FD on the foundation
plan.
5. Specify pad reinforcement for all steel columns. Refer to foundation plan for location.
6. Specify hanger for all beam -to -beam connection or provide detail.
7. Provide shear transfer details along line of lateral resistance at every condition where
framing changes. Refer to comment 17 above. -
8. Show size and reinforcement of all pad footings. Refer to foundation plan for
-location.
9. Provide footing details,at marked locations. Refer to foundation plan.
10. Additional comments may be required upon subsequent reviews.