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12171 (SFD)P.O. BOX 1504 Building78-105 CALLE ESTADO Addres54-040 Ramirez LA QUINTA, CALIFORNIA 92253 Owner Humbf A, Inc. Mailing Address P.O. Box 1555 City Quinta, CA ZIp92253 Tel564-1338 Contractor Htl>bi 1, Inc. Same City lZip Tela State Lic. City & Classif. B 537333 Lia # 2526 Arch., Engr., Designer Address Tel. City I I Zip State Lic. # �! _t`IICENSED CONTRACTOR'S DECLARATION I hereby of I m that I J" licensed under provisions of Chapter 9 (commencing with Section 7000) of 6 sionp3 of•the Business and -.Professions Code, and my license is in full force and 1� effect. / + IGNATIIRE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Busihess 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 or 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 ($500). O 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 orimprovement 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.) ❑ I, 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.) ❑ 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 zelcopy 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 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 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 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 authorise representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip w J., No. 12171 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 7714- 212-002 Legal Description Lot 23 Block 284 Project Description 8FA 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 DA' Issued by: Validated Validation Sq. Ft. 1419 No. No. Dw. Size Stories Units ,.j New a Add ❑ Alter ❑ Repair ❑ Demolition ❑ Permit includes rear south, and front eli garden wails. Pool permit to he i obtained separately prior to constructing 5' front walls. Estimated Valuation $90,216.00 PERMIT AMOUNT Plan Chk. Dep. 250.00 Plan Chk. Bal. 259.57 Const. 599.00 Mech. 62.00 Electrical 123.33 Plumbing 141.00 S.M.I. 9.10 i Grading 20.00 Driveway Enc. .00 Infrastructure 1,882.42 - r•.+ TOTAL 3,346.72 3,096.72 K REMARKS ' ti 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 DA' Issued by: Validated Validation CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS0 SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK FOR. SQ. FT. ® GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® TEMP. POLE. GROUT DRAINAGE PIPING CAR P. SQ. FT. ® FINAL INSP. WALL SQ. FT. WATER SYSTEM DRINKING FOUNTAIN. GRADING cu. yd. $ —Plus—X$—=$ URINAL SO. FT. ® FRAMING y. �d_y3 FINAL INSP.s c 3 0 J ESTIMATED CONSTRUCTION VALUATION $ q �/�Qrtil fKP 1 -t 6-13 0 WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES VENTILATION WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER FIREPLACE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT.. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac _, ., HOUSE SEWER , CERT. OCC. GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE' "`= •, ELECT. -FEE , SMI FEE PLUMB. FEE' STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. . SOLAR'.'`..'"' SETBACK GROUND PLUMBING6- UNDERGROUND i4.C. UNIT COLL, AREA SLAB GRADE ROUGH PLUMB. BONDING CHEATING (ROUGH) STORAGE TANK FORMS0 SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ,ROCK STORAGE FOUND. REIN GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP: REINF. STEEL GAS (FINAL) TEMP. POLE. GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM 1,90-23 <�-o WATER SYSTEM GRADING cu. yd. $ —Plus—X$—=$ LUMBER GR. FINAL INSP. /t��`O/ FRAMING y. �d_y3 FINAL INSP.s c 3 0 J s, ROOFING ��3 / �L� q �/�Qrtil fKP 1 -t 6-13 0 wca JO/��Gjr3 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL Z .G2 LATHING —Z-L/—?,g to MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION �� ���L , CERT. OCC. FENCE FINAL ' INSPECTOR'S SIGNATURES/INITIALS "' •� GARDEN WALL FINAL DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 Date 8/17/93 Type of Permit I La Quinta No. 112380 1 Permit # Owner Name Mumbil, Inc. Log No. 54-040 Street Ramirez City La Quinta Zip 92253 Study Area 110 APN # I Tract # I = Lot # 0 Square Footage 11419 Type of Development I Single Family Residence No. of units 1� Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/ carports, covered patios/ walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.65 x 1419 or $ 2,341.35 have been paid to D.S.U.S.D. for 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. Fees Paid By Mumbil, Inc. Telephone 564-1338 Name on the check By James E. Lively Assistant Superintendent, Business Services Fee collected /exempted by Tomi Doebereiner Payment Received Signature �t,� ,1�Q� Check No. 5879 Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/ Receipt Copy - Accounting 0 i� AND W14EN RECORDED MAIL TO r --1 (Jame Mumbil, Inc. Street c/o Mary C. Marshall Address 1 Vista del Golfo city & Long Beach, CA 90803 Stete L J MAIL TAX STA7EMFNTS TO r —I IJ a,n e Same as above Street Address' City & / G .' sista L CA'r. NO. NN00582 TO 1923 CA (2-831 - J r � 8 LIc � � a�a o d �'cr- p� i Q12 �o�o' fir' Q a? a b M p tS .t --SPACE ABOVE THIS LINE FOR RECORDER'S USE Individual Grant Deed TNIB roRM Funtookeo BY riCOR TITLE INSURERS The undersigned grantor(s) declare(s): Documentary transfer tax is $ 75.90 X ) computed on full value of property conveyed, or ( ) computed on full value less value of liens and encumbrances remaining at time of sale. ( ) Unincorporated area: ( X )City of La Quinta and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, H. H. BLACK and HAZEL J. BLACK, husband and wife hereby GRANT(S) to 14UMBXL, INC., a California corporation the following described real property in the City of La Quinta County of Riverside , State of California: Lots 3, 4, 21, 22, 23 and C24f BlocC284",of Santa Cannelita at Vale .fa Quinta, p Unit No. 26, as per ma recorded in Bbgk�220, page 50 of Maps, in the office of the County Recorder of Riverside County. Dated: December 12, 1998 H. H. Black STATE OF CALIFORNI COUNTY OF On ie ,�e-^ before me, the undersigned, a WN ary Publi* 1. and..for siid.State, Ha J:' B. personally appedred /� ,.;41. /moi z C-r-*rL.. XIACA-4 5K personally known toa or proved to me on the basis, of sat- isfactory evidence to be the person whose name subscribe( to the within instrument and acknowledged ==: tltatAcr—CXecutetl the same. wl"CNES 1y hand and fCicial seal.;: << .�,, , r171R Signature G2-��-��-e� rte'' -ti �� Title Order No. (This area for official. notarial seal) Escrow or Loan No. _ 88-1524 MAIL TAX STATEMENTS AS DIRECTED ABOVE Recelved Fro COACHELLA VALLEY WA TER m: ` CAS DISTRICT Address: /� H RECEIPT DETAIL Account No. G Service Address eters) — rvlce(s) House Lat petectorChraecks)' (s) Mete%SUrchar9e ,t.. It atlon CaPacit Y. Charge ' TemporaryConstr uctlon Meter omcha —. JUN �Oate: i ' LJ Cusfo mer De poslt 0.Other t Rel _ O Copy to. Cash Check. Money, ! Order •.,TOTAL Water Service Cashler