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9907-166 (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. /ate 6 Lic. Class Exp. Date flB t 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. ( 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. (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 workerit compensation laws of California, and agree that if I should become subjeEo the workers' compensation provisions of Section 3700 of the Labor Code, I shall fo�rthw�th comply witf K5—e provisions. Vate: J f Z r 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 correc�/.l agree to comply with all City, and State laws relating to the building cons ruction, and hereby authorize representatives of this City to enter upon /thabove-mentioned property for inspection purposes. ature (Owner/Agent)) Y Date' / BUILDING PERMIT PERMITN "07 -Jo DATE VALUATION LOT TRACT s JOB SITS APN ADDRESS .5345 AVET'wIDA NAVAURO 774-131401S OWNER CONTRACTOR / DESIGNER / ENGINEER 'NI.I.A181L, ?":C. NUJI P1.11.,'INC. P.O. OX 10 758 P.O.:i3OX 107SS 4 1',ALM Da:NFRY CA 92'455-07.;i1 PAUVI DrSERT CA, 92255-07: c USE OF PERMIT S N(31A_' FAMILI DWELLNG S€') - PERP 41:1 DOES NCtT :iNw%.I3L'iJ' BLOCK WALL tisR POOL I t '1°RAC C' euva+ S 1ZUC.r1014 1.415.00 1'1VId.GrEfl)./XT10 152.00 ST' GA.1LA0E/CA32P0Kf 540.00 Sb` .ESTII;I,A.TF-D' 0ST OF CONT.8''1'At1j`C'g°Z.fJN 91,140.I€! 11KRAI IT FEE, SUNCK&RY 3 t:ONS'tRUC"HUN fr'VW loo -000-418-000 $60150 Ni 101.a1liil-$Z9-3ii; '1551114 qtr:, HAINICAL MM 101-000.421-000 $60.0 MECTiiICMI FEB 1.01-000-420.000 $129.83 Edi t fA4f 3f DJ�>} tif. 101-000-4W-000 S 133.59 Si tEINt;NiClr Cv }`F. jK} SiD 101-000-24f..fM $4 11 GRAD1140 0: `;3i 101.000-423-000 iNFRASa`Rti ;°IVUR1sF E —ii 225-000.93-312 i.,y6tio5� IP1tI;C;,t 3H PLAN 101-000-441-345 is i5.r3d' Fr?h 'F?1:7101,51T 10i_(X)()_439_318 ;�I f4�- `Fid_►., f,,'<:)�J !'R:C f(;"_1'Ct�T AND Pf,AN CHH(7K $3,464) 10 LESS PRE -PAID HES 4250.00 TOTA A 'IHr1 lYd '1, IcwCEh7 014.1 CSO \ $31210.20 RECEIPT DATE BY/ DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE I INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings( Slab Grade _ r Ducts Return Air Steel Combustion Air Roof Deck/-/ O.K. to Wrap 9�- ' 1 5 Exhaust Fans F.A.U. Framing 30 - Q19 S i Compressor - Insulation o- 5f- i? 57 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Ap Drywall - Int. Lath to -.(Z . 4 g S7 Final—Q = 7 Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings &V -f yr -f E Main Drain Bond Beam tj6 " �� -Qry _57 Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Water Piping 5—i t' Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection f? 7 Encapsulation Gas Piping Gas Test 2- 7 Appliances Final COMMENTS: _ Final Utility Notice (Gas) _+_2__A'4 el 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) �y"•iM'-"Y�" iir,+Y .�,�"�yy�!'�yp ""L,� _ �'�r�I�v..'.+"'�'°t�...Oaz�� ra-�� Building ��- Mailing Address 0 Citlzicpmv;5, -VAy�� r` 5c 2� Contractor Address City c&t� 4 P.O. BOX 1504 APPLICATION ONLY 78-495 CALLE TAMPICO WA29fJ LA QUINTA, CALIFORNIA 92253 State Lic.City 3 -7 3 33 I Lic. Qsa 8 Classif. Lic. # Arch., Engr., Designer Address Tel. City IZip I State I Lic. #' LICENSED CONTRACTOR'S DECLARATION I hereby�affirD that I am license under provisions of Chapter 9 (commencing, with Se tion effec of pivisio'n_ 3 of the Business and Professions Code, and my license is in u�f�c�and effect. 11 Gr A SIGNATURE I DATE OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permil 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 Division3 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 ($500). I] 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 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.) 11 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.) 1-1 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 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 Copy is filed with the city. O 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 thq 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 authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip LDING: TYPE'CONST. OCC. GRP. Number Legal Description /� Project Description A F V7 S 1 Ai & LE FAM I t,4f Sq. Ft. No. No. Dw. Size //5 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. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback frorr Center Line t Rear Setback from (Rear Prop. Line + r' Side Street Setback from Center Line + t Side Setback from 3roperty Line ZIA FINAL DATE INSPE Issued by: Date cyPermi Validated by: JUN Validation: g k QUINT WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION 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 7%9/99 APN # -774-134-015 No. 19027 Jurisdiction La Quinta Owner NameMumbil, Inc. - Penmit #. No. 53-605 Street Avenida Navarro L.,g # City La Quinta zip 92253 Study Area Tract # BLK241U23 Lot # 5 Square Footage 1,415` 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 be amount of , 1.93 X 1,415 or $ 2,730.95 the property listed above and that',bu.tldmg^ . • t; Permits and/or Certificates of Occupancy for this square footage in this proposed project ma Y.navbe iss ed 'I - Fees Paid By ccNIB/Nlumbil Telephone -340 ?726 -1 Name on the check -c By "Dr. Doris ILI Superintendent Fee collected /exempted by 7uanita Green Signature Payment Received $2,:30.95 Check No. 198103 NOTICE: Pursuant 6t A#embly 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 dale on which the building or installation peril for this project is sssued or on which they are paid to the District(s) or to am:other 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 �y y:n f FROM JDHOWARD'MD/SANDY H. FAMILY PHONE NO. Jun,;''17 1999 09:39AM P1 d539-1 Esc._13T.O. _ = RECORDING REQUESTED BY Q a F - �� aeconnr:: :• �, � W d U 8 mi ,,�cc ftCOR T:lu: oNSU WNCCYOAMD WMEN AECONOED MAIL TO 'Q 52 �y �.''Ac g? N 00 J MAME JAMES D. HU9ARD,M.D.,INC. W d Q H_ ' 5725 Corso Di Napoli 'Tw T s Long Beach, California, 90803 UCITY ►-'r STATE a ~ L SPACE ABOVE THIS LINE FOR RECORDER'S USE ®, GRANT DEED (Individual) THE UNDERSIGNED GRANTOR01 DECLARE(s) TRANSFER TAX is s:6- .0 Q Computed on tul(va11�!_Lprrnperty conveyed, or _._. Q . computed on full value kss value of liens or encumbrances remaining at time of sale, and FOR VALUE RECEIVED WALTER JITNER, A MARRIED MAN AS HIS SOLE & SEPARATE PROPERTY AS TO A ONE-HALF INTEREST AND R. REESE MYERS AND JAIL MYERS, L HUSBAND AND WIFE AS TO A ONE-HALF INTEREST ,`.GRANT(S) to Il James.•D. Howard, M.U., trustee of the James D. Roward, M.D., Inc. Money Purchase Plan Trust Trust the below described real property in the state of California. county of Riverside city' of ha Quints Lots 5 in Block 241 of Santa Carmlita at Vale La Quinta, Unit No. 23, j� "J as per map recorded in Book 20 page 25 of maps in the'office of .the}Recorder 2-3 D of said County. j (fife _jW_ Alt r r0 IM TauParcdNo. 774-134--01`5 and 774-134-016 - -- - ----- February 3, 1989. _ _�elDxted -- STATE OF CALIFORNIA _ COUNTY OF... Qa -rj On _ --�_c _.! — , before me. iht UDaerti . a No Publicand for said State, personally appeared �.�J1e R `C t T tv e personally known to me (or proved to me an the basis of satisfactory evidence) to be the penon(s) whose natne(s) is/ are subscribed to the within instrument and acknvwledted to me that he/she/they ex- ecuted the same. WITNESS my h nd of i ' Seal• sipature -. 7 OFFICIAL SEAL BECKY BOLTON Notary PWIC-Cut 48 SANTA BARBARA ot7tJNTY my Conan. Eo. si+w I. tit) (This area for official notarial --l) C40 310 248 CP 97591 C •�-��- R Di ri - Pl nniv" F , ; o be used b CDD staff for review of single family dwellings n f e,R,C (Cove This form is t Y _ .��. Residential) District, in order to determine the applicabitity of compatibility issues or ~need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to . Building & Safety as your correction list. Please attach additional explanations as necessary. APPLICANT: Mumbil Inc. PROJECT .ADDRESS: 53-605 Ave. Navarro APN: LEGAL: LOT , BLOCK - , UNIT , S.C. @ V.L.Q. CK'D BY: GREG TROUSDELL BIN N CASE NO. 99-82 ..CHECK -DATE:. orf y Infor assi uilding plan checker upon your assignment to this case. The CDD G,.o�ittixtp �Prretary maintains a loa book to track applications and assign case numbers. Case logged and number assigned Verify legal and APN information Consistent with MDG on file las applicable) MDG filing required 15+ filings since 9/3/98) Consistericy -with-street/surrounding area:. Colors Materials Architecture 2c,�✓ c..,,,o �s OTHER REQUIREMENTS: The zoning code, architectural and landscaping manuals, and/or assigned inspector should be consulted where uncertainties arise. The completed checklist shall be maintained in the Building .& Safety address file. n City. of La Quint& 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: 53-605 AVENIDA NAVARRO Use Classification: SFD Bldg. Permit No.: 9907-166 Occupancy Group: 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: 12-9-99 Building Official I POST IN A CONSPICUOUS PLACE I