0008-315 (SFD)LICENSED CONTRACTOR DECLARATION
d 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.
License # Liic.. C, llatss Exp. Date
/ �f
oo /Dale 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
erfoWmance of the work for which this permit is issued.
ave 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 STATRFilND Policy No. 11032314"
(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 of Segtion 3700 of the Labor
Code ,I shall forthwith comply with those -provisions. 1
Applicant l'""""'''p'
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 pro�rttfor inspection purp ses.
<Signature (Owner/Agent) Date��f��
BUILDING PERMIT PERMIT#
�s
3_0`^—"!��"�
DATE q VALUATION LOT
JOB SITE
ADDRESSmob-240 AVENMA I��.A
APN
774-214 �3I2
OWNER
CONTRACTOR/ DESIGNER / EN INEER
mu Ba, INC.
munv1 rr" IA7C.
74.990 J0141 DRIVE, IMIT 2-D
74.990 3CNT DRWE, V3W 2-T1
PA AM D i + f Lia 92260
PALM DESERT CA 42260
(760)340-2726 CB3A 2526
USE OF PERMIT
MC412 FAMILY D•WN2..1.WQ
Sn). PttizMIT DOES NOT INCx.ung HLOCK btALIX OR POOL.
TRACT CONSTRUCTION 1,54.00 SF
PORCHIPA'PIO W.00 SF
. GAUCEr ARPORT (SI) 9,427, 40
511'. 'WOOS) FENCE 200.00 LT'
ESTH"TED COST OF CDNMi7C7`,ION
97,' .20
PERMIT FEE StihU+l ARX
CONSTRUCTION FEE )01-000-418-000 $630.50
PLAN CHECK FEL 101-000,434-316 $521.45
MECHANICAL FEE 101.000.421.000 $33.50
FLXCTRICAL l+f.?L 101-000-420-000 $112.70
PLUMBTNO PEE 101-00009-000 $116,' 9
STRONO MOTION FEL - PIESID 101-000-241-000 $9.74
OWING PEE 101 -W0 -4U-000 $20,00
DEVE1.APER IMPACT PEZ $1,907.00
,
PRECISE PLAN ,� , 101.000-441-345 $100100
�
rk
FEE DEPOSIT � ,� 101-.000-439-318 4250.00
SUB -TOTAL COWIRTl'C a`i )l AND PLAN Ck12?,CK
$3,471.244
%tea PRI:-PAII) FL11W
-$250.00
'fQrAi, Pte' FEES DITE NOW
0,22124
P, s
�,
0-77 a
34 Lyl s
J 1
C
RECEIPT .
DATE =
BY l•� }p*
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
04Z
Steel
Combustion Air
Roof Deck
l�` • 0 0 S
Exhaust Fans
O.K. to Wrap
Framing
_L ZF.A.U.
2 `
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
Z • �� 5
Final
Final
BLOCKWALL APPROVALS
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
400
Encapsulation
Gas Piping
Gas Test
S
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp, Power Pole —0-0
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) 4(
COMMENTS:
I t
Building
Address5x- ))// 411'a
Owner
V
AMailing
ddress
City Zips
-,LM
4 4 "
P.O. BOX 1504
78-495 CALLE TAMPICO
/ l0 LA QUINTA, CALIFORNIA 92253
A0 WDL 10 c .
A
.�.... ��.�. F i LJ, Hv L.0 A 9-t;
Address ME
City Zip Tel. .�
State Lic. City
& Classif. Lic. #
Arch., Engr.,Ffi'? lily IG. V t.E.)JU
Designer p nF-P--;- �It*
Address Tel.
z -,I to A ug w i p>4 r; >,t Or z �t,� 4 - 12 Z -
City Zip State
1 A A 1 1 wl' -b. 2 cl 3 Lic. # ---
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I°am license under provisions of Chapter 9 (commencing with Section
7000) of Divisi�on..3-yof the Busines and Professions Code, and my license is in full force and
effect. s .•�t.i s e,
SIGNATURE �' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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 rile 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 ($500).
I -J 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.)
I 1 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.)
I l I 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
n Copy is filed with the city. 0 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.)
Icertify 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.
Date Owner
NOTICE TO APPLICANT: If, alter 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 it 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 a0plicant Date
Mailing Address
City, State, Zip
;q
1
.3 W
APPLICAON ONLY
ILDING: TYPE'CONST. OCC. GRP.
'.Number
jai Description Lf 1`~ f ���-tk ZJ f k) % ~7
Iject Description
f% Ar-#,\ &.6p 7- A
��a-Ald-ffS 53 590 d&�OO dlb7-4-70
Sq. Ft. A �.. No. No. Ow. ^]
SizeTy" Stories I Units v
New;Iff Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep. -to
Plan Chk. Bal.
Const. 3
Mech. w
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
InfrastructureAur
R �• 4
t
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
i�[►I_l��Ltilq
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 9/12/00
No. 20981.
Owner NameMumbil, Inc.
No, 54-240
City La Quinta
Tract #
Type of Development
Comments
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Street Avenida Herrera
Lot #
Single Family Residence
APN # 774-214-012
Jurisdiction La Quinta
Permit #0008-315
zip 92253 '
Square Footage
Log #
Study Area
1548
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 1,548 or $ 3,173.40 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project mayrynow be issued
Fees Paid By CC / Valley Independent Bank / Bill Howard Telephone'-'
Name on the check ^F J
1
By Dr. Doris Wilson t
/"Z''!
Superintendent
Fee collected /exempted by Annette Barlow
Signature
Payment Received $3,173.40
Check No. 225390
10TICE: 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
ibove 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
.ollect 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
11
I Lj-�11 w,ff
At 4
Lot 13, Block 282 of Santa Carmelita at Vale La Quinta, Unit #26, as per map recorded in Book 2
Page 50 of Maps, in the Office of the County Recorder of said County.
SELLER/TRANSFEROR STATES THAT PROPERTY ADDRESS IS:
APN #774-214-012-8, La Quinta, CA 92253
SHOWING TITLE VESTED IN:
Mumbil, Inc., a California Corporation:
U
v
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.
APPLICANT
BILL HOWARD
SITE ADDRESS 54-240 Avenida Herrera
APN 774 - 214 - 012
LEGAL: LOT
CHECKED BY:
13
BIN NO.: CASE NO.: 2000-286
BLOCK 2 UNIT 6 S.C.@V.L.Q.
Grecs Trousdell
DATE:
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.
Al or -t 91 -c -
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
P°def Colors
V a o o
0
G Materials
Architecture
d� T
p
j
Other Requirements: '00P
PQPR�� o
6�
E00