9904-255 (SFD)w ;- ;,.,� LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty'of perjurythat 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
5 7'33 A. 9 r� Ot3131 s
\ Dated' 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:
(.) 1, 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).
(v, I, as owner of the property, am exclusively contracting with licensed
Contractors to construct the project (Sec. 7044, Business & Professionals
Code). �
( ) 1 am elxemm under Section B&P.0 for`thlis•re son
Date s t iG t 1"o Signature Of Owner �� tom.:
WORKER'S COMPENSATION DECLARATION
I hereby affirm, under penalty of _ perjury one of the following declarations:
j4'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.
STA. I.7 FUND 11ons 1m
(This section need not be completed if the permit valuation is for $100.00 or less).
O 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; F shall forthwith comply wit / hose/, .14
Date: '(,/ i,: f} ApplicantT/,
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 a(,_°
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 fo r inspection purposes j
Signature (Owner/Agent) E/V Ili " Date' ? ! t
BUILDING PERMIT PERMIT #9904-255
1 S704-2 55 �
DATE VALUATION $ 4n LOT t 33 TRACT + r K 2M
JOB SITE
ADDRESS .4-445 AVENMA RAN3.1 EZ
- 6
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MfJmelf.,, TNC.
Sb1CSM}31I,, CNC.
P.O. BOX 10758
P.O. BOX 1075
PALM DESERT CA. 92255.Or/M
PALM DESEWr CA 92255_07'
(700)340-2726 CSL# 2526
USE OF PERMIT
SINGLE FAMILY NVELL NIG
SFU - P Rr"T DOES NOT l2ok.`'i UDL-' BLOCK WALL OR POOL
TW -.Cr CONSWICUCTION 1.,415.00 SF
1~Ota."ii/k':�TE:I ' 15Q.il0 SF
GARAGEUCARPORT .540.00 SF
5 FT. WOOD FENCE- 200.00 LF
ES".'gl9ttUED COST OF CONST RUCTION,
91,.fl410110
PERMIT FEE S;T MPKA.RY
CONS'1'ii.'Ut''TTION FM 101-000,41.8-000
PLjAJN E - .i ffiCK FF,'O 101.000-439-318
IVXICT1AMICA L FEE .101-Ot30-421-000
EL,1*C'lYUCAL RL 1>J1y01?0-=120-000: $129.83
PLUMF3.t'NO FP 101 _WO_4159-(10(1 $133.50
sTt*:.t3NGMOTIO.N! i,-?iCSI1.7 101 -00 -241 -:JPO $9,1fl
GRADMIG F'>':1: 101-000-4113-1100 :20.tt0
1NI7tASTRUCTURE VEl F . 225000-443-342 S 066'9'2
PRECISE PLAIN 101-01°11)-441-1145 $V5.00
17W:OF.Pf S!T 101-000-439-318 4250.00
SI M -TC: TAT.. C ONS,`"j"R'UC" T RDN ANI) Pi SAN (''1 71,1.',K
LESS PRE -PAW FEES
"' AID
-$250.00
SUN 2 1999 TOTAL Pii��2N�U FI :OS DU , NOW
$3,2A0ap0
341TY OF � QUINT,
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
P, I
INSPECTION (RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
k
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Z (' Q S
Exhaust Fans
O.K. to Wrap
Ste,
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 m AI
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
_ y—Q S
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
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)
ELECTRI AL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbctures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 92
Utility Notice (Perm)
COMMENTS:
,,. .. .. .. .. ...TK>♦'45^�-",..,Vr�C.•isf-•'�Y%i;.r�..��ji(J�Yi�y�iw�'�+,�i� yeTV�'VIIY•`y'-i'Y��i'4.,"M�`�N� w't'+I.�!R+V!"1Sy�yWV+�.�3�'�ry"v�'.f.
Building <LA -4
Atlrlracc
Q_
Mailing
Address
�,�
ul�cv
P.O. BOX 1504
78-495 CALLE TAMPIC
Q} 'L LA QUINTA, CALIFORNIA 153
Icy tai \bi\b � IZip �Z.�� IT3i0- 11?_L I
ress
Tel..
State Lic. City.
& Classif. ' �3. 1� Lic. #S
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I here y a firm that I am license under Drovisions of Chapter 9 (commencing ith Section
7000)bf Div 10 .8 of the Busines�and Professions Code, and my license is`iri, f II forc�'arla
effect. 7 'dal;
SIGNATURE 7 If ' i DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,9usiness and Professions Code: Any city or county which requires a
permit to construct,, alter, improve, demolish, or repair any structure, prior to Sts 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 700.0) 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 rive hundred dollars ($500).
1-11 1, 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. (Seca 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'I 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.)
17 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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, 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 authorize representatives -of this city to enter the above.
mentioned property for inspection purposes.
Signature of adplicant Date
Mailing Address
City, State, Zip
C?,11�
(3 c /#��:
APPLICATI� LY
BUILDING: TYPE'CONST.T��I, / /OCC. GRP.
.y
A.P. Number - 0z"14-ey,
Legal Description U-) —y IJ�oC -.G G7
Project Description 0.C3 0 .C3 A f
Sq. Ft.. c No. No. Dw.
Size 17 Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk: Bal.,
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
K cj
1990
Infrastructure
,--
<FTV.�
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 YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot. Be Duplicated
Date 6/17/99
No. 18900
Desert Sands Unifiedi School: District
47-950, Dii ne Pal ns Road
La Quinta,- CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN #
Jurisdiction La Quinta
Owner NameMumbil Inc.
No. 54-4.45 Street Avenida Ramirez
City La Quirita zip 92253
Tract # Lot # Square Footage
Type of Development Single Family Residence.
Comments
Permit #
Log #
Study Area.
1,415
No. of Units 1
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 ekempt-., 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 53080in the amount of
1.93 X 1,415 or $ 2,730.95. the property listed above and that building
permits and/or Certificates of Occupancy for this square.fooiage in this proposed project may now be. issued
Fees Paid By ccNalley'.Independent Bank/M.,umbil, Inc.Telephone. 340-2726
Name -on the check
By Dr. Doris Wilson =-
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2;7:,30,95
Check No. 198037
Signature U
[NOTICE: Pursuant o4Assembly 3081 (CHAP 549, STATS. ;1996)lhiswillserve to notify' you that.lhe 90 day approval period in which you may protest the fees or other payment idented
bove will begin to runfrom the date onwhich the building or installation perrr'iiffor this project issssued or onwhich they are paid to the District(s) or to another public entity authorized to
ollect them on the District('s)(s') behalf, whichever 'is earlier.
Collector: Attach a copy of county or city plan check application foram to district copy; for all waivers.
Embossed Original- Building Dept./Applicant--Copy - Applicant/Receipt Copy - Accounting
7603400394 STEWART TITLE PD 842 P01 APR 30 '99 12:53
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RC }District - Planning �RevieW, Form ..
.,
This form"is to tie, used by�CDD staff for review of jsingle family dwellings in the RC (Cove
.5 o- s . w '-' 0
Residential) District, in o�d'er' to 'determine =the applicability of',compatibility' issues or need
._S 4s• b.Y ?.
to require the filing of Master' Design Guidelines by the. applicant. It shall; be transmitted to
Building & Safety as your correction usf,�Plea'se'attach .additional.explanations as necessary.
MUMBIL,' 'IN.C.• x
APPLICANT;
PROJECT 54-4`45 Averiida`'Ramire142 .
ADDRESS:. _
LEGALLOT 11 ,;BLOCK 28,8. _,UNIT <: 2`6 ' .,,S.C. F@ V.L.Q.
CK'D BY: Stan 'Sawa }
BIN NO:. CASE N.O. 99_66 CHfCK•DATE:
Inform the assigne*d Building plan cheeker�upon�'your assignment to this case..The CDD
Executive Secretary maintains 616gbook to.,.ti,6 1,applications :and .assign case numbers.
Y
a
' • �l;'� V�.�`: U,7* , w!�V•,v, t,Q�/ .�(/y��(ti, w � v � -�.-�
The zoning code, architectural End laridscap.ing manuals, and/or assigned insp ctor should
be consulted where uncertainties arise. Thee completed checklist shall be maintained in the
Building .& Safet'y,addressFfile.
°Y
�'COMMENT%CORRECTIOIN
tiREQUIRED ITEM; �� �` ':`.4
N_
_,� •
\.\., >,.}y \{\+.M1 i+
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G`1`3iA1FP3?i`��I��f�T� Ill..::>.>..}}..}:
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Case logged 'and number' assigned .
'eand APN+information
e
i
if
Consistent withYMDG''on,file'(as'applicable) r,
MDG: filing requi[ed15+ filings since 9%3/98)'
l.
Consistency. with'streef/surrounding area., b,..
ColbrS
Materials
:..
Architecture r>=
4 i r
OTHER,REQUIREMENTS:
'ahi5<
� .!
. t. s � aye
�
. . • ��
, _
' • �l;'� V�.�`: U,7* , w!�V•,v, t,Q�/ .�(/y��(ti, w � v � -�.-�
The zoning code, architectural End laridscap.ing manuals, and/or assigned insp ctor should
be consulted where uncertainties arise. Thee completed checklist shall be maintained in the
Building .& Safet'y,addressFfile.
ificate of Occupancy
Cit of YLa mta _
Ai rCD
Bu�ldng and Safety Department{ �M Ftr
t
ThisCertificate ;issued .pursuant to the regoirements of ``Section 109 of the Uniform qui/ding Code,
certifying ttiat, at thea'tnxie ,of issuance, � this.sini0tor6 was in compliance° with` the various ordinances`
oflife City _regu/ati g bui/ding construction or use. For t/ e` fo/%wing:
BUILDING -'ADDRESS: 54-445. AVENI'DA' RAMERIZ
Use Classification: SFD. Bldg. Permit',No:: 99.04-255_
Occupancy Grou,p:. R'.3 Type of Construction: VN" .,. Land Use Zone::. RC
Owner of Building: MUMBIL; INC. Address: P.O. BOX 10758
City: PALM DESERT, CA 92255
By: STEVE TRAXEL
Date: 10-27-99
Building Official
POST IN A CONSPICUOUS PLACE
BOB HOFFMAN , Structural Engineer
8 June 1999
Re: Residence at 54-445 Ramirez
Please be advised that the design of prefabricated roof trusses are in accordance with the
intent for the completed structure.
Six Alfaro Drive, Rancho Mirage, 92270-4758
Tel / Fax (760) 568-2967
; C``District:Renew=.C/ eek%iS,
This checklistris'to be.used for review of.sing le;fam!y-'dwellings in the RC.(Cove Residential)
District. It,in'eludes.:all,requirements 'of the RC District, and 'most •building=related City Code
and plan check regbirerjmertts. it also";includes. othe' r applicable zoning code' sections which
also apply in the 'RC `district.
APPLICANT:
CONSTRUCTION
ADDRESS:
CHECKED BY: PLANNER:
BIN NUMBER: - PLAN, CHECK- DATE
•
REQUIRED ITEM:., . 4: Y N� ,, CO;MMENTMORRECTION
Permit:epplicationlform and fee
Plan check deposit fee paid
Proof of title (Grant 'Deed) or consent
APN & Leg6i description
Two complete. plan sets including: '+•
Site plan
Floor plan .
Landscape/fencing: plan
Elevations:
Exterior color%material samples
Grading/drainage. plan.y/�
.
Contractor's `License provided?
Subcontractor's hst provided? `
M1'
Workman's Compensation Certificate?:
City Business License provided?
CMD •connection receipts . -
v
School fee.receipt7
A , REQUIRED;ITEM,}H-.Y,.
� N.
;.:� -.-COMMENT/CORRECTION
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Gross livable area 2!.1,2.0.0 S.J.
Bedrooms net :1.0' x 10'."":clear minimum
Provide required_ I of bathrooms
Garage net 2Q' x-20' clear minimum, with 4'
add'I for equipment•.areas.
Complies with required- setbacks for:
Front (20' 1(_�
Rear 0 0'►
Side .(5' int., 1.0.' street side)
Garage (swing -up door, 251,
Garage (roll-up,door,;.20')
'Mechanical equipment:
e�
Clay or'concrete tale roof,':,,
Cement plaster exterior walls
Roof-mounted'mechanical• screenings,,
Propane tanks screened by fence/wall?
IA
Structure heights 17'
`zdY1'
Fencing ;type, location, etc., 'per -manual •..
Combined,retair i* 'rden w It. height
.. !h'`rfl flG p
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v.v:: }:::..;{y':;rn't{C::}::{:wn:.v:\•r}:::::: m:: nvw::}:•}:n:•:{vr' j:i4:i:
Complies with`'Landscape Manual requirements
3 trees'. @ 11/2 caliper' interior lots)
i5 trees,@ 1'/z caliperlcornet lots)
Illuminated address numbering'"
Exterior lighting"complies-,with Outdoor Light
Control Ordinance:.,
Complies. wiih Se9tion.s.50:060 �ArchitectiirW Projections:
Chimneystack,,vents, etc. don't -exceed .
3' above max ':height ' '