0009-035 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 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
53.7333. AB I31C 08/31!2(
Date I �`N Signature of Contractor
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 constru(y the project (Sec. 7044, Business & Professionals
Code).
() I am exempt under Section B'&P" or this reasbdn
Date -% y Signature of Owner — --�
WORKER'S COMPENSATION 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 the work for which this permit is issued.
)� 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 STAVE FWD Policy No. 1103201-99
(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--w-_'Ith_those provisions)
,Date: �t I L Applicant
1
Warning: Failure to secure 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.
jSignature (Owner/Agent)
BUILDING PERMIT PERMIT
#
DATE VALUATION LOT 000'9-03.-5 TRACT
RM 771110 .
JOB SITE 9p APN
ADDRESS 57,120 AVP-NMAPZ Ab F..AZ y'{ 773-227-1106
OWNER CONTRACTOR'/ DESIGNER / ENGINEER
1tQUMBIL, mc.
74-990 JONI DRM 'UNIT 2-D
PA)L•:1a9; D1?S:fr.R'T CA 92260
USE OF PERMIT
OW'C3LL F"AIAM Y Dom,•( I.,JA O
IvILlMB11.., INC.
74.990 JOI�TI DIS ' LTN%C 2-D `
PALM DFARM CA 92260
(760)340-2726 MIX 2526
SM. PERMIT DOLS NOT INCLUDE BLOCK WALLS OR POOL
TRACT CONSTRUCTION 1,450.00 SF
PORCH/PA.TIO 146.00 SF
LIAR AIDUC.ARPORT 343.00 SP
5 €rr. WOOD FENCR 300.00 LF
2913i1tiA'7fUD COW 011' CONURUC:'YTOIq
�.lgU1�<6U
)E'imtb a r ETU 9UMMARY
CONSTRUCTION FEE.
101-000-418-000
X612.50
r
PLAN CHECK FIEZ
101-000-439-318
$511.90
MEC>11:ANICALFEE
101-000.421.000
$60.00
=:
,
El, W— RICAL,FEE
101-000-420-000
$125.11
PLUMk YNG FEE
101.000.418-000
$110.75
STRONQ MOTION "M - REBID
101-000-241-000
$9.30
GRADIN10 WE
101-000.423-0013
$20.00
-
DEVELOPER IMPACT FEE
&1,907.00
•"
-'
PRECIMPI,;AAi
101-000.441-345
$100,00
FEE DEPOSIT
101-000-439-318
1250.00
V
•'t
Z %'
nM-'I<OTAL, CONS'TRU'CTION AND PLAN CIDUMC
LESS PRYI-PA)D FW -,Z
RECEIPT I DATE: i j I BY �. I DATE FINALED
INSPECTOR
$:1,456.56
-$gq2pp50.p000
ffr`�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
d
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_ Cto _
Exhaust Fans
O.K. to Wrap
7
_ _
(
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�7 7
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs (, v
• (}�-
Electric Bond
Footings
Main Drain
Bond Beam
—4po S-7
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
0. K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
• G>0
Encapsulation
Gas Piping
Gas Test
j 2v -,V0
Appliances
Final
COMMENTS:
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
s
Utility Notice (Perm)
Z •Lp ipp S
Building
Address S 2,
Mailing �J� .x 0 -7�C7
Address P. O
2L
v ry\ 611- -
Q)7S
& Classif. �3 333 h I
Lic. #
Arch., Engr.,
Designer
Address
78-495 CALLE TAMPICO APPLICA N ONLY
LA QUINTA, CALIFORNIA 92253 (: �
BUILDING: TYPE'CONST. OCC. GRP. �.
A.P. Number/ )_1 .,2,Z -00 l0 ���11
Legal Description 1✓p'C 1 � !)Lk --71 UN I'+ 1 V
Project Description
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under"orovisions of Chapter 9 (commencing yyy++vlth Section
d000)rof'D_ T4TSTo'n•3�gf the Business and Pr fessions Code, and my li �nse is�D fLll I e and
effect. �Lf
SIGNATURE r DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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 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).
f-; 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, Bulsness 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.)
II I, as owner of the properly, am exclusively contracting with licensed contractors to con-
s
trucI the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
doesnot 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 Lew.)
1-1 1 am exempt under Sec. B. 8 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
n 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 ($100) valuation
or less.)
I certify that in the performance of thg workfor which this permit is issued, 1 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
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 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 a0plican
Mailing Address_
City, Slate, Zip_
1
Sq. Ft. ,( No. No. Dw.
Stories Size Units
Newx. Add ❑ Alter ❑ Repair ❑ Demolition ❑
(Estimated Valuation ' C-10 .00D
W:11it11111111
Plan Chk. Dep
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
tj
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 p'— " Will,�
Issued by: —Date—Permit).
Validated by:
Validation:
w u
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
ww "Desert Sands',Vnified School District' .
. 47 950'°Dune3Palms Road
Q
Notice: ,•
N Latiuinta; .CA 9225.3_
Document Cannot Be Duplicated �.. 760 7.71-8515.
CERTIFICATE`OF `COMPLMNCE ,
Date 9/12/00 ;,., APN#'. 773-222-006
No. 20980 q x -.Ju isdilition
. La Quints
Owner NameMumbil, Inc. Permit # 0009=035 .
N0.52120. Street Avenida R •, Log #
City La Quints r _Zip 92253 Study Area
Tract # Lq g 1450
ot #' S �, ' 4' ua-re ]Footage
Type of Development Single Family Residence t .t� - No. of Units 1
Comments _
At the present,time,, the Desert Sands Unified School District ,floes not' collect.` fees 'on :garages/carports, covered
patios/walkways; residential additions,under, 500 squarefeet, dem cfied,agcesse y structures ot'reolaeement mol ilehomes..It
has been determined the above-namedowner'is exempt from:paymgschool,fees,af this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed, pursuant to. Government Code 53080 in tWamount.of
r s- • r.a
2.05 X 1,450 .,:' ; or 2,972:50 r t• 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 .
z M r<
Fees Paid By CC / ValleyJndependent�'Bank / Bill Howard Telephone 760'340-2726
Name on the' check
By Dr. 'Doris:Wilson
Superintendent. '
Fee collected /exempted•by Annette!Barlow, Payment Received $2;972.50
Check No. 225395
- ,tl
Signature
Rr
NOTICE: Pursuant of Assembly Bill 3081,(QMAP 549, STATS:.,1996) this will serve tb notify you the 90 -day approval period in which you may protest the fees.or other payment identified
above will'begin to run from the date on which the�building or installationpennit for this project issssued or on which:they;are,paid to the District(s)).dr to another public entity authorized to
collect them on the District('s)(ss) behalf,'whicheverisearlier. ' : «: rn �,,,•
Collector: Attach a copy of county or city plan check application form^to district copyfor all_waivers.
z:I
Embossed Original- Building DeptJ-Applicant; Copy Applicant/Receipt Copy Accounting
My
F09 i
(
x; 1i
RECORDING REQUESTED'BY:
Fidelity National Title Company
Escrow No. 41216 -CB
Title Order No.
When Recorded'Mail Document
and Tax Statement To:
Mr. Bill Howard M e5
o t `r r �� •f. - l
Zzss_
DOC ` t3 1999-541705
12%15/1999 08;00A Fee: 6:00
Page 1 of� 1. Doc T Tax Paid
Recorded in Official Records
County of Riverside
Gary L'. Orso
Assessor,.County Clerk4 Recorder
_ I IIIIII"VIII ? '
IIIIIIIIII
IIIIIIIIII
IIIIIIIII
(IIIIIIIIII
III
U II Y PAGE (. SIZE`-- DA .I PCOR I .. NOCOR I SMF I I usc.
A I R I'; -;L 11 " I I . COPY' ;j -. LONG I REFUND I NCHG I EXAM
x'1'13- - -ZGRANT DEED w SPACE.ABOVE THIS LINE,FOR RECORDER'S U�\
X11 o"z�'o I
The undersigned grantor(s) declares)
Documentar, transfer tax is, $28.60
[ X 1 computed on full *value of. property conveyed, or.
[ 1 computed on full value less value'. of liens or encumbrances remaining at time of sale,
.. [ ) Unincorporated Area City of L`a Quinta
r . .
M
7SF
FOR A VALUABLE CONSIDERATION, receipt of whichiis hereby acknowledged, George Davis Kilmer and Bonnie
Norquist Kilmer, Husband and Wife ,as Joint- Tenants;,'.'
hereby GRANT(S) to Mumbil, Inc.,. a California Corporation
the following described real property in .the City of La Quinta
County of RI. ide; State of California:
15 t�� 17; Block 77 of Santa.Car..melta at Vale La Quinta, Unit #10, as per map recorded in Book 18, Page 70
of Maps, in Office of the County`;Recorder.of said. County..
DATED: December 6, 1999
STATE OF CALIFORNIA
COUNTY OF LOS ANGELES
ON .DECEMBER 7, 1999 _ "`before"me,
A. GHORBANI personally- appeared
personally known to me (or pro<v,ed to me on the basis
of satisfactory evidence) to be the:'p'erso..n S : `whose
name(s) is/are subscribed to:th6e within instrument: and
acknowledged to me ,that- he/she/they -.executed 'the'
same in his/her/their authoeized capacity„(ies),�°and that
by • his/her./their signature(s) on the,' instrument the .
person(s), or the entity upon behalf,.Of which thi'
person(s) acted, executed the instrument.
Witness my haad and official seal.
( a r”, VY
Signature
U
Q
George Davis Kilmer
Bonnie. Norquist"�'Kii ` er
AE ANI
< ? 1192601 zz � CaliforniaCounty Aug 8, 2002
MAIL TAX STATEMENTS ASDIRECTED ABOVE
FD=213 (Rev 7/96) GRANT DEED
a a. _ w;r F�nr•.dlmW 5 wa74°, 6h n v ...r, . F7�a m rem.%'' x F px} "ta r :nom/
r
4 •
RCjDI'STRICT_-PLANNING REVIEW FORM.
This form is to be used by CDDJstaff for re'view.of sing'l'e family dwellings. in the RC (Cove Residential)
District, in order to, deterrnine the applicability of compatibility issues or need to require the filing of Master
Design 'Gu delines by the applrcafl..It shall�be`transmittedto`tlie Building and Safety -Department as your
i
correction list. Please attach additional explanations oas necessary.
APPLICANT .MUM -BIL INC:
SITE ADDRESS 52-120. Avenida.. Rami=rez
APN 773_ 222 . - -006 :F; BIN NO.: 2. C- CASE.NO.. 9 0 (j 0_ 12
LEGAL: LOT 17 BLOCK. 77 F UNIT 1'o S.C.@V.L.Q.
CHECKED BY: Gr-eg..`Trousd'ell ' ., . DATE:
Inform the- assigned Building plan checker upon ,your assignment to this case. T ecutive
Secretary maintains.a log book to` track applicationstand assign case numbers.
REQUIRED ITEM Y N COMMENT/CON.
4 .
Compatibility.Review:00000W
Case logged and number assigned
ryi _
.• k VV
Verify legal and A'PN information
.^ _.'j' tip• ' Ae �r {
Consistent with MDG`on file (asapplicable, t `n�t�9 ����"� 0� '+ V
MDG filing required (5 filings since 9/,3%98).
Consistency with street/surrounding area
Colors,
Materials.,
� ag
' Architecture
Other' Requirements: '
Zs -e
• ... .. .ems - 1.. n .. r... �.sr f, r .. - _..+. C i ..
Certificate of Occupancy
City of LaQuiffta'-
:. ;tet .. ..-.,,,. ..•..�-
But -.in g and Safet De artrnent
Y .:p
This Certificate issued pursuant..to the requirements..of Section: 109 of .the. Uniform Bui/ding;, Code; .
certifying that, at the time of issuance; this',
tructtre :was n.cornp/lance. with the v4 --bus ordinances
of the:,Cify regulating bt ilding construction. -or use. For the .fol%:wing:
BUILDING ADDRESS; 52=_120` AVENIDA RAMIR'EZ
.Use Classification: SFD ' Bldg. Permit- No.: 0009-035'
Occupancy Group: R 3 Type.of, Construction: VN Land Use Zone: RC:, '
Owner of Building: MUMBIL, INC Address: 74-990 JONI' DRIVE,. UNIT 2-D=
City: PALM DESERT; CA. 92260
By: STEVE TRAXEL
drb„l Date: 01-17-01
Building .Official
POST IN A CONSPICUOUS PLACE