0010-213 (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
� A 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 exclus%ely 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 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.
• « .(,-) 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.
STATE M D 11A3381 -(!J
(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
5"I"ject �Ih workers' compensation provisions of Section.3700 of the Labor
Code,tl(Iloart�with comply witkt•ihos'e'provisions.
Date: {{ Applicant—
Warning:
pplicant 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
Kee—
above-mentioned property_for,.inspection purposes.
a✓
Signature (Owner/Agent)'"" Date 4 �
BUILDING PERMIT PERMIT Jt
DATE VALUATION LOT;. TRACT
JOB SITE
APN
ADDRESS
52 1410 .a3VT?'.NWA IZ 1;'R_1rZ
773_222-007
OWNER
CONTRACTOR /?DESIGNER / ENGINEER
Fryry rpyyY�
MIJviam, NC.
.NfUM . 11, !NC,'.
74-990 xt?M:1:S1a.TV'.,, UHi1 2-D
714...9.9U JONI DIM, UNIT 2-D
PALM DF.SERT CA 92260
PA'LFv2 .®Ii M. ' C.A. 92260
Q60)340-2726... C'BVI 2526
USE OF PERMIT
SY D • PERMIT i7.O.MS NOT INCLU09 0I.,S3C r'a`IfAIJ.6PO'C3.LAPA O
faPP)IOAC H i.?ItiIVEWAY
�i
TRACT C ONSMUCTION 1,00.00 6V
PUL P.CHIPATIO M0.6810
QARA(JFJC.•,A.U.0RT NF) 10,642.80
5 rf. WOOD FENCE ifto0 LF
E'YMMA' OM COOT OF Cp.-,TS pS.nw
PkThlr!"fM 9UMMARY
COMOTRUC:TION ISLE 101.000.418.000 1
PLAN CH= IMF, 101-000— i9-1318
FEE DE11 )S'1T 101-000-439-316 .3215.0106
If XCD'1.RaRf ICAL FEE 101-000-421.000 $Et�:Ot1
ElM"TRICAL FEE 101.000m420-000 5110111
PI,:IIIt!'ISINO M 101-000.419-000 :110.76
iSTROM 1640TION FEE - F( SID . 101-+DO0-241.000 89.E
ORADING MI 1, -000- 423-000 .t}0
DEVELOPERIMPACT FEE
PRZCI.9E PLAN
SU3-'r0TA.L COMMUDOMON AND Rl'...W C'I•31f CK
53,432.59
.ESS PRE -PAID IrMp .9
4250.00
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
,z -(Ya 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
p(
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 3 do
BLOCKWALL AP ROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
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
j,
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
ot
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 O
Utility Notice (Perm) g - (Fa -- O(
COMMENTS:
71
r M It
2
%
q-
-.0. Box
-`""APPLICATION
48465
C TAM666i 504 "
Building
Address LA QUINTA, CALIFORNIA 92253
Owner
J vY\
IBUILDING: TYPE'CONST. OCC. GRP.'
Address
Contractor
Address
IZi Tel 4r
J
..d Izip '. , , , . . 1 let.
State Lic.t!#
& Classif. ic
Arch., Engr.,
Designer
Address Tel.
City Zip
State
Lic. If
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
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.Susiness and Professions Code: Any city or county which requires a.'
permit to construct. after, Improve, demolish, or repair any structure, prior toffs 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 penndt.
subjects the applicant to a civil penalty of not more than five hundred dollars (411500): '
1-1 1, as owner of the property, or my employees with . wages as their solb 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 8A01Y 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 safe. If, however, the building
orImprovement is sold within one year of conplation, the owner-bulkle * r will have the burden
of proving that he did not build orknprove for the purpose of safe.)
Il 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 contractor(s) licensed pursuant to the Contractor's License Law.)
Cl I 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
I-) Copy is filed with the city. 0 Certified copy Is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit Is for one hundred dollars ($100) valuation
or less.)
I certify trial in the performance of thp work for which this permit Is Issued, I shall not
employ any in any manner so as to become subject to the Workers' Compensation
Cal 0 a.
DateOwner
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 sof this city to enter the above.,
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State. Zip
A.P. Number�
Legal Description-
Prqject Description :t,
Sq. Ft. No.
Size Stories,
New 0 Add 0 Alter 0
NO. 6W.
Units
Repair 0 Demolition 0
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILD ION
Hr__-,).wA--e�
7Z
Estimated Valuation
PERMIT
AM
Plan Chk. Dep.
Plan Chk. Bat.
_Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Eric.
Infrastructure
TOTAL
is r7 >
REMARKS
;4-4
ri
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line i'', y icr
Side Street Setback from Center
P-
Side Setback from Property Line
-FINAL DATE
—INSPECTOR
ti
Issued.by: Date—
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILD ION
• , Desert Sands t iie&SclroolyDistrict '
47 950Dune'Palms Road y =x
r t
Notice:La Qumtay'CA492253 �: , _ ` r•
Document Cannot Be�Duphcated-, 760-771-8515,-'
f"'I.a i �
ICER_ TIFICA'TE OF COMPLIANCE ;
Date 1_/5/O1 V. ; APN #,; 7°73-222=007
No. 21448 �' � ` --Jurisdiction -1 'Quinta
Owner NameMumb4'Inc A Permit #0010-213
No. 5214'0 t Street'Avenida Ramirez R�1R•. �' Log #
City LayQuinta l; t 'a'"' zip 922'53 ' };Study Area'
Tract:# .Lot'# 16 Square Footage 1450
Type of Development Stngle: Family Residence No. of Units 1
t Comments
AV
At the present. time, ;the Desert;�Sands� Unified aSchool District does not collect; fees on garages/carports, covered
fi�yahf'•.G;i'. j lS?+a+F z ay p�r.aty,... -.2• ry..:• •i1.Y
patios/walkways; residenti;allaaddition under 50.0 quare�feet, detached accessory structures or replacement'mobilehomes. It .
;has been,determined the°'abovetnnariied owner; s exempt,from paying school fees.at,this time due -to the'following reason:
Er MPTION 4NOT APPLICABLE
This certifies that• schooLfacilitGo
y4fe s imposed pursuant to i vernment Code 53080 ` in the amount of
M
2.05 X;,. 1,450 i or $:;2;9=72 50 the':proper Aisted above"and that,building
permits and/or Certificates of Occupancy for this square footage i`Ais proposed project may now'beissued
a
{ CC / Valle. Inde endent Bank Bill Howar'dr ,
Fees Paid By T¢leyphone ,760-340-2726
Y P � t,• ,- .
;{ )
•`Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /e'xeted by Annette3Barl6w: Payri ent.Rec6red. $2,972..50
-•A
Check No. 236116
Signature s
NOTICE: Pursuant of Assembly Bill 3081 (CHAP349 STATS: 1996) this'will serve.to notify you thatthe'90day approval penod'in which you mayprotest the fees or other payment identified
above will begin to run from the'date on which tFre,building i installation pertriitifor this'project is'sssued or,on which they ire paib to the:District(s) oeto another public entity authorized to
collect them on the District('s)(s');behatf, whicheveris earlier.-,? •"` r
Embossed` Original- Building Dept./Applicant':;' Copy = `Applicant/Receipt Copy . Accounting
RECORDING REQUESTED BY:
.Fidelity National Title Company �V,
Escrow No. 41216 -CB
Title Order No. 4
When Recorded Mail Document
and Tax Statement To:
Mr. Bill Howard/ �
APN: 773-2.11-UUb-1 ��3_ 2•ZZ �>o-?_Z
��,((
DOC >zt'. 19,99. 541705
k) 12/15/1999 '08:00A.Fee:6.00
R;
Page: 1 of^�1.Doc T Tax Paid
�It Recorded In Official Records
�.��•.` County of Riverside
'/ Gary L,. Orso
Assessor, County,, Clerk 8 .Recorder
,I, I I I III V I I I III I I I .I I II`I V I I I `I III I,I V I I I/•III V I I I III I
IIII
M
sU..
PAGE,
SIZE
DA .I
'P.COR
NOCOf
SMFSMI, AuSCAuSC.
L
COPY
IO VG���Fllll....c
EXAM
GRANT DEED
SPACE ABOVE THIS• LINE FOR RECORDER'S USE
i TL pZc:O 17 �� (�
The undersigned grantor(s) declares)
Documentary transfer tax is $28;60;
( X 1 computed on full value of property conveyed, or
[ ) computed on full value less. value of liens or encumbrances remaining, at time of sale,
( ) Unincorporated Area City of La Cluinta
FOR A VALUABLE CONSIDERATION, receipt of which is --he' reby'acknowled'ged; 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 Riverside, State of California:" -
0 A„�d17, Block 7'7 f Santa Car,melita at Vale La Quinta,..Unit-#l10, as'per.map recorded in Book 18, Page 70
of Maps, in the 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
GEORGE DAVIS KILMER AICD.
BONNIE NOROUIST KILMER
personally known to me- (or proved to m,o,n the basis
of satisfactory evidence) to be the person(s) whose
name(s) is/are subscribed to the Within instrument and
acknowledged to me that ,he/she/they' executed:-- the
same. in his/her/their authorized capacity( i.es)," and that
by his/her/their signature(s) on the _instrument the
person(s), or the entity upon , behalf of which the
person(s) acted, executed the instrument.
Witness my ha and Official sea
� l.
J .�_
Signature
MAIL TAX STATEMENTS AS DIR.ECTE_D ABOVE
L
George Davis Kilmer
Bonnie Norquist Kil er .
A.;GFiORBANI
�. Commission S (1.92601 Z
i Nolory Public ollfomia
Los Angeles County,
MY Comm. Exo�res Aug 8,"2002
— C�_..
Y :
FO -2-13 (Rev 7/96) GRANT DEED '
RC DISTRICT PLANNING REVIEW FORM
This form is to be used by CDD staff for teview of single; family dwellings in the, RC .(Cove Residential).
District, in order to determine the.applicabilrty of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant: _ It.shall be•`transmrtted to the=Building and Safety Department -as your
correction list. Please attach additional explanations as necessary:
APPLICANT MU•MBIL- INC.
SITE ADDRESS 52-140, -Avenid'a.>Ramirez
APN 773 - 222 `00j, "BIN'NO.:, CASENO.: 20:00-328
LEGAL: LOT' 16 .BLOCK 77 UNIT 10 S.C.@V.L.Q.
Fred Baker
CHECKED BY: DATE:.
Inform, the assigned Building .plan tcheckeri upon -your assignment 16 this case. The CDD Executive
Secretary maintains a log book to -track applications and assigri.case"numbers.
REQUIRED ITEM Y ,N' COMMENT/CORRECTION
Compatibility Review
b.
Case logged and number assigned.
Verify legal and APN information
Consistent with MDG on file'(as:.applicable
;.
MDG filing required (5 filings since.9/3/98)
DATE
Consistency with street/surrounding'ar'ea:, L . XH16 T .` ..
.Colors v
Materials
Architecture.
Other Requirements:
Certificate of Occupancy
City of La Quinta.
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifyingthat, at the dMe'of issuance, this structure was in compliance with the various ordinances
of the City regulatjng'buflding construction or use. For the following:
BUILDING ADDRESS- 52-140 AVENIDA, RAMIREZ
Use Classification: SM. Bldg. Permit No.: 0010-213
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner "of Building:, MUMBI.L, INC Address: 74-990 JONI DRIVE, #2-D.
City: PALM DESERT, CA 92260
By: . STEVE TRAXEL
Date: 05-31-01
Building Official
POST IN A CONSPICUOUS PLACE