0106-007 (SFD)LICENSED CONTRACTOR DECLARATION
I he.rgW,affi-kim under penalty of perjury that I am licensed under provisions of
Chac>•
•pter 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 33
AD WO- ""—>
Date= ��. }r * Signature of Contractor Imo"""'
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 COMPENSATION DECLARATION
1 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 performanc'of'the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No. •
11TA119 FUND
(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 o 3700 of `the Labor
Code, I shall forthwith comply with thhose,prowsions)Sction
{
Date:•* ?_ Applicant
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 puposes.
Signature (Owner/Agent) "`'�-""~--�••r-- Da e
r
/BUILDING PERMIT PERMIT#
DATE, f' VALUATION LOT 010&007 TRACT
1 C3 '811K 192 V 19
JOB SITE ......+.
APN
ADDRESS
5-4-480 KVXXTDA JUAXXZ
774-111-009
OWNER
CONTRACTOR / DESIGNER / EN INEER
74-9,90 JK-?i°?LDNW-F, Ugrt 2-D
f 4.9.910,'C)NI DRIV-P, GOND:° 2-D
'RA1,11AD1r=RT CA 92260
P.I XM F.,8WL CA 92260
(760),W-2726 C:ib7(i 2526
- •
USE OF PERMIT
an) F m:11ia mts'NaI' UY4.wrix iiZLI,. cK wAi..i.fp+Y3biltir-A Calc.
APPROACH D.RdiQWAY (DURACAt R 0104-029
'PRAC<T CONSTRUCa'IO'JP 1,430.00 SIS
POR.M&'ATIO 140.00 SY
K&AR40EIC;ARPORT (0) 1042,30
5 Irr. 'WOOD s+mas11F 300.00 i.Y
- COST 0.1' C4��>qSTRUCnOR
921939410
y�••yy��rr vvp •�., �y y, /, ^�rL1�6ys.A�-VY,s1XV,�.TED
14 •:Ce�YYA..c.[I .Y7�0:l�iil}`.W]�6&A.ii 7G
CONST F.U�p^eeiC[i P���AAFlit 1y01u0- 1¢Qtoryry-t43%? W&W
1.C••1y{1[0
.. PI;.�*S7`T t",.i�l7:h-,R� I�i:,Ui -' D�I^tJ3ddi."pV�7•'? ¢� �311=,5.+�1�
FRE U.6-1 P031 T 101.000-X139-3 21 ••3;t:1UPIIf
kR:?.C31RYr°.Tr.A L r k.•It 7 01-000•-4,I.-tO0 $62.0D
FUMbRiAL cC 101-000-42,0-000 $110,11
I'L f ltil0 ING FM 101-000-419-000 $110.75
STWNG MOTION RX, REMD 101-000-241-000 %9129
0R.AS.IA?C3 )TI; 1.t�1:-f3UC�•�523.1i0� $2D.i9+3
D.F.H.1,0PER IMPACT F $1,907.00
MECiS'E• F1.01 $160.00
)VI-Wjj, T. CO � s C'J�?`02�,'t .f12�t1r!<Jg,�','$;.�.}�al!S E #31•'��LyK L� }� ��
u RAIN PR%F,
$3,432,509
Ir�MN,I.�,L'JG:.��7
J U L — 3 2001 . •����'�4� xa��.��
l I�
CITY OF LA QUINTA
FINANCE DEPT
�� •.,,
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
/
Ducts
Slab Grade
_
{/,?�{
Return Air
Steel
Roof Deck
O f
Combustion Air
Exhaust Fans `
O.K. to Wrap
Framing
�/ _
F.A.U.
Compressor
Insulation
(p -'°j�p p
5—j
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
lIl``40
_
Final m
r v1
BLOCKWALL APPROVALS
Final
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
Water Piping
_
���' B
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection8/�f/bl
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
/Z/l�f
9�[
Final
COMMENTS:
Final
Utility Notice (Gas) �u
ELECTRICAL A PROVALS
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 �L
Utility Notice (Perm)
P.O. BOX 1504 " YDS
Building
..�� 78-495 CALLE TAMPICO APPIICA O ONL`
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing -- BUILDING: TYPE'CONST. OCC. GRP.
Address?. O A.P. Number 11H r m--®oc\
Cit Zi II / y,
. 1-711-71Tel. (� Legal Description �'� t \
Contractpr 1� t 1 Project Description
Address
r�
City Zip Tel..
State Lic. City
B:Classif. 33 Lic. # Sq. Ft. ' i ! �"3� No. No. Dw.
-: Arch., Engr.
w+ Size "{ \ (J Stories f Units
"Designer t�,% New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address ^ Tel. �_� /� (—v
5'2- iso t'V 510 (2�� ± (,�'
City, f� Zip State Sscxmo , s d( _02
#
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 Estimated Valuatio
I hereby affirm that I am exempt from the Contractor's License Law for the following f i'1T
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a fI V lJ
permit to construct, alter, improve, demolish, or repair any structure, prior to'fts Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/
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 Plan Chk. Dep. /
subjects the applicant to a civil penalty of not more than five hundred dollars (5500). t ,
I-1 I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. \.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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, Mech.
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 Electrical
of proving that he did not build or improve for the purpose of sale.)
I'I 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
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 S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
I'! I am exempt under Sec. B. & P.C. for this reason
Driveway Enc. I U AY
Date Owner Infrastructure -
WORKERS' COMPENSATION DECLARATION OF LA QUINT
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of EPi
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) ,
Policy No. Company
f7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 73?
CERTIFICATE OF EXEMPTION FROM -REMARKS �-
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: It, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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
Iagree 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. Validated by:
"Signature of applicant Date
Mailing Address Validation:
City, State, Zip
WHITE = FINANCE YELLOW =APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 7/3/01
No. 22214
Owner NameBill Howard
No. 53-680
city La Quinta
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Street Avenida Juarez.
APN # 774-111-009
Jurisdiction La Quinta
zip 92253
Tract # BLK192U19 Lot # 16 Square Footage
Type of Development Single Family Residence
Comments
Permit # 0106-007
Log #
Study Area
1450
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 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
2.05 X 1,450 or $ 2,972.50 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
f LT v
Fees Paid By CC / Valley Independent Bank - Bill Howard Telep&ne 750-340-2726
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected/exe ted by Annette Barlow Payment Received $2,972.50
Check No. 249650
Signature
';Z- -
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that 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 installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
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
Fidelity National Title Company
72171 Highway 111 Suite 201 • Palm Desert, CA 92260
(760) 776-5770 0 FAX (760) 779-0394
SALE ESCROW INSTRUCTIONS
Date: April 24, 2001
Escrow No.: 42631 -CB
Escrow Officer: Cathy Boyd
Buyer(s) will deposit with escrow an initial deposit in the amount of ..........
Prior to the close of escrow, Buyer will hand you the balance of down payment
(plus closing costs, if applicable) the sum of ..........................
TOTAL CONSIDERATION ......................................
AND, on or before May 21, 2001, Escrow Holder will be handed additional funds
required to enable Escrow Holder to comply with these instructions, which Escrow
to use when in a position to procure/issue a CLTA Standard Policy - 1990 Form c(
of Title Insurance from Fidelity National Title Insurance Company with a liabili
covering the following described property located in the City of La Quinta, County
of California:
Lot 16, Block 192 of Santa Carmelita at Vale La Quinta, Unit #19, as per map reg
Pages 33 and 34 of Maps, in the Office of the County Recorder of said County.
ti
SELLER/TRANSFEROR STATES THAT PROPERTY ADDRESS IS:
APN #774-111-009-8, La Quinta, CA 92253
SHOWING TITLE VESTED IN:
Mumbil, Inc., a California Corporation
FREE FROM ENCUMBRANCES EXCEPT:
1. Current general and special taxes for the fiscal year in which this escrow closes, and taxes for the
ensuing year, if any, a lien not yet due and payable;
2. The lien of supplemental taxes, if any, assessed pursuant to the provisions of Chapter 3.5
(commencing with Section 75) of the Revenue and Taxation Code of the State of California;
3. Bonds and Assessments with no delinquent payments, if any;
4. Covenants, conditions restrictions, reservations, easements and rights of way now of record, if
any;
PROBATIONS:
Prorate as of Close of Escrow, on the basis of a 30 day month:
- Taxes
CONSUMMATION of this escrow is CONTINGENT UPON THE FOLLOWING:
ADDITIONAL INSTRUCTIONS:
1. PRELIM APPROVAL: This escrow and buyer's and seller's obligations herein are contingent upon
the buyer's approval of the items in the Dreliminary rnnnrt to whirti-h.�.A-'� � � • �- _ =---
2Z
RC DISTRICT - PLANNING REVIEW FORM
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Deparftnt as part of your correction
list. Please attach additional explanations as necessary. qs��NoFO'9'c,
s
APPLICANT Mumbil Inc. SFpTn
SITE ADDRESS
53-680 Avenida Juarez
APN 774 - 111 - 009 CASE NO.: 2001-478
LEGAL: LOT 16 BLOCK 192
CHECK AND APPROVED BY: Michele Rambo
UNIT
19
DATE:
S.C.@V.L.Q.
Inform the assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Verify legal and APN information
Consistent with MDG on file (as
applicable
MDG filing required (5 filings since
9/3/98)�\1a
C%lst -.0000
Architectural variety within 200 feet of
the surrounding area:
Colors
Materials
Architectural design features
���t�00�
Qel
x
CPS
Other Requirements:
11
Certificate of Occupan''
C)
City of La Quinta (G�
Building and Safety Department �
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that; at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 53-680 AVENIDA JUAREZ
Use Classification: SINGLE FAMILY DWELLING- Bldg. Permit No.: 0106-007
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: MUMBIL INC.
Building Official
Address: 74-990 JONI DRIVE
City: PALM DESERT, CA 92260
r
.By: KIRK KIRKLAND
Date: DECEMBER 19, 2001
POST IN A CONSPICUOUS PLACE