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0002-430 (SFD)LICENSED CONTRACTOR DECLARATION I' here'by 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 Ft�.afessionals Code, and my License is in full force and effect. License'# Lic. Class Exp. Date 537333 A 13 HTC 08/31120( L©ate 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 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. (A., 1 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 S`IA,PE FUND • Policy No. 1103281-99 (This section need not be completed if the permit valuation is for $100.00 or less). ( ) I certifyrthat 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 worke'compensation laws of California, and agree that if I should become Sub' to the workers' compensation provisions of Section 3700 of the Labor C ' e, I shall forthwith comply with those provisions. ,Date: i :. E . Y Applicant—o �r 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. SI'gnature (Owner/Agent)'" "','."` Date ' BUILDING PERMIT DATE 1 VALUATION $93.1019,60 LOT PERMIT # @➢9113"L-4:S� ' 0 TRACT LI!' 241 JOB E 53-625r PlVENID#�NAN'ARRO APN ADDRESS 7-74-13"MADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER i`vlUhril3tL, INC. MUM81L, INC. 74-990 JONIT DRIVE, UN7' 2-.1) 74-9- JONI DR11%,T, ili3iT.2-D PAL&I DESERT" CA 92260 PALM DESERT CA 92260 06q)340-27,26 M11 2526 I IRF OF PFRUIT STNGLE FAMILY DWELLING 'CR.AC r CONSTRUCT1 N PORC`H/!? 4:t 153 GARA.GE(CARPOR'T' 5 FT. WOOD FENCE 1,430..110 3F 146.00 ST 'u: ,00 SF J.00 LF RECEIPT _ I DATE I BY i I DATE FINALED I INSPECTOR L.oT nMATED COn Or' CGiN'ii'Iili Uf105,1 93,019.€1) PERMITFEE SUMMARY CONSTRUC TON FEE 101-000-41 8-000 gr113 0 PLAN CHECK FFM 101-000-439-318 S'111.9t.1 MIKM41CAL, FEE 101.-000421--000 S kA).E:0 F -UR. 1RICAL KE 101-000-420-000 $1:'5.0 11 PLMMING FEE 101-000-•119-000 $110.75 STRONG MOTION I FE - MUD .101-000-341-000 59330 GRADING FEE 101-000-423-000 S20.00 URVELOPNR S1'viPACT i?EE $1,X0'7.00 MEME PLAN, MI -000-4411-345 $100.60 FEE -DEPOSIT X101-000-439-318 425000 n ' PASPRCONSTRUCTION AND K AN Ci:�ECK. E-PMD LESS PRE -PAI ,� PEES 4250,00 MAR 2 9 2000 p ER111IT 1"'EF-S DUE NOW 53,2.06.56 y1TOTAL 1t RECEIPT _ I DATE I BY i I DATE FINALED I INSPECTOR P�. INSPECTION RECORD i OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs_ Underground Ducts Forms &Footings Ducts Slab Slab Grade Return Air Steel Combustion Air Roof Deck - xxj S Exhaust Fans CK to Wrap _r-_23 -co $ % F.A.U. Framing Insulation -"2- 5-6v g?, 5e _dO 57 Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath t - 3p -e-v S Drywall - Int. Lath — 0,-9 _ Final 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 I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Neater Final Water Piping 4 Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 1- ID - OD Encapsulation Gas Piping Gas Test Appliances Final Final _ 5� Utility Notice (Gas) 124 4!ew 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 Utility Notice (Perm) 7 -to - O COMMENTS: Building Address Owner r ��y Add ras o /s 62, � uu��e •d P.O. BOX 1504 APPLI AA ION ONL S 78-495 CALLE TAMPICO LAQUINTA, CALIFORNIA 92253 QODY' x/30 �� 5 CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION ' I hereby of fr 1hAj I am'icensetl under provisions of Chapter 9 (commencing with Section 7M, omlvl Ion 3 of the Busine s antl Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION # I hereby affirm that 1 am exempt from the Contractor's License Law for th ,following reason: (Sec. Bu 7031.5, siness and Professions Code: Any city or county whichtrequires 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 (5500). 17 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 buflding 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.) I l 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 properly who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) i 1 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 r7 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 the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the it 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. BUILDING: TYPE'COONST. / OCC.. GRP. A.P. Number 7 / /113 13 C/ —0` A Legal DescriptionZ,0 6 4 Project Description BY: ITe3'1 o Z?Z N, Contractor V v� C I t---- r \`Addtr,Q) . Sox 10-759 Cit Pv��'� Zip q�Z�S Tel . 3��-Z�- State Lic. & Classif. S 3 � 3 33 City Lic. # aS a c No. Dw. Units Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION ' I hereby of fr 1hAj I am'icensetl under provisions of Chapter 9 (commencing with Section 7M, omlvl Ion 3 of the Busine s antl Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION # I hereby affirm that 1 am exempt from the Contractor's License Law for th ,following reason: (Sec. Bu 7031.5, siness and Professions Code: Any city or county whichtrequires 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 (5500). 17 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 buflding 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.) I l 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 properly who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) i 1 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 r7 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 the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the it 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. BUILDING: TYPE'COONST. / OCC.. GRP. A.P. Number 7 / /113 13 C/ —0` A Legal DescriptionZ,0 6 4 Project Description ZONE: BY: Minimum Setback Distances: Front Setback fron Center Line Rear Setback frorr Rear Prop. Line Sq. Ft. No. Size �, Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ IN3PECTOR Issued by: Dates 1 Permit ii •5F V.Ii a. S Validated by: r Estimated Valuation A PERMIT < AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback fron Center Line Rear Setback frorr Rear Prop. Line Side Street Setbadk from Center Line Side Setback frorra Property Line FINAL DATE IN3PECTOR Issued by: Dates 1 Permit ii •5F V.Ii a. S Validated by: Signature of applicant Date -` t �' _J Mailing Address Validation: City, State, Zip - - 10 ' �- WHITE = FINANCE YELLOW = APPLICANT PINK a BUILDING DIVSION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 _ Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 3/29/00 APN # 774-134-016 No. 20236 Jurisdiction La Quint& Owner NameMumbil; Inc. Permit # No, 53-625 Street Avenida Navarro Log # City La Quinta Zip 92253 Study Area s Tract # Lot # 6 Square Footage 1450 Type of Development 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 2.05 X 1,450 or $ 2,972.50 the property listed above and that building v permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By CCNalley Independent Bank/Joseph Casey Telephone `760-564,-4821 Name on the check IT r By Dr. DonI•s Wilson > Superintendent Fee collected /exempted by Mary Ann L. Bora Payment Received`'., ,$2;472.504 Check No. 218115 Signature NOTICE: Pursuant of Assam y Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protes9the fees or other payment identified. above will begin to run from the date on which the building or Installatlon 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 Districtf s)(s) behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for ail waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt . Copy - Accounting t, 4 ''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, in order to determine the•applicability of compatibility issues'or need to require the filing of Master Design.Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your correction list. Please, attach additional explanations as necessary. • 4t 4 APPLICANT MULBIL,- Inc. SITE ADDRESSra; 53-625 Avenida Navarro lyyw J, !1fYbbs�� 4 APN- - BIN NO.: CASE NO.: 2000-1§1 LEGAL: LOT 14 , BLOCK Z4 UNIT 2-3 S _C.@V.L.Q. CHECKED BY:*'. Stan',Sawa DATE: a 1% • 00 Inform the assigned Building plan checker upon your assignment to this case.' The CDD Executive Secretary maintains a logbook to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Compatibility Review Case logged and number assigned Verify legal and APN information r - • Consistent with MDG on file (as applicable O MDG,filing required (5 filings since 9/3/98)„ 'Consistency with street/surrounding area: Colors C�JL !-� �f roy��. !A Jo r5 j aYG 4 Materials 0� Architecture Other Requirements: KjgL IO r Certificate of Occupancy City. of La Quinta' Building and Safe ty 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 incompliance with the various ordinances of the City regulating building construction or use.. For the following: BUILDING ADDRESS: -53-625 AVENIDA NAVARRO Use Classification: SFD Bldg. Permit No.: 0002-430 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: MUMBIL INC. Address: 74-990 JONI DRIVE, UNIT 2-1) City: PALM DESERT, CA 92260 By: STEVE TRAXEL 'rte Date: 08-25-00 Building Official POST IN A CONSPICUOUS PLACE