05-0725 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00000725
Property Address:
80423 OAK TREE
APN:
775-081-089- - -
Application'description:
ADDITION - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
10342
T4wt 4 4 Q"
Applicant: rchitect or Engineer:
D
JUy d 2 2005 �1 �
CITY IFO obwTA
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------f------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of vision 3 of t e siness and Professionals Code, and my License//'syr I effect.
License as � `G cense o.: B b
�te: 66 tractor ..
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she 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).:
(_ 1 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 and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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 or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/09/05
Owner:
HORWITCH, M/M WILLIAM
80423 OAK TREE
LA QUINTA, CA 92253
Contractor:
EDWARDS CONSTRUCTION, BOB
51455 DESERT CLUB DRIVE
LA QUINTA, CA 92253
WCC: VIRGINIA SURETY
Lic. No.: B
------------------
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.
7► I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
tok Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier 00500027012 01/01/0ISDlicy Number 684857
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 Lab r.'Co I r comply wit hose provisions.
/ Applicant: c
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this 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 application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 county ordinances and state laws relating t u ing c struyt+eP, and hereby out orize representatives
of this
c un to enter upon the above-mentioned pr p r fo{ ins �c ur oses.
t6ate nature (Applicant or Agentl:
Application Number . . . . . 05-00000725
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . 126.00 Plan Check Fee 81.90
Issue Date Valuation . . . . 10342
Expiration Date 11/05/05
Qty Unit Charge Per Extension
BASE FEE 45.00
9.00 9.0000 THOU BLDG 2,001-25,000 81.00
-----------------------------------------------------------------------------
Permit . . . ELECT - ADD/ALT/REM ,
Additional desc .
Permit Fee . . . . 19.48 Plan Check Fee 4.87
Issue Date Valuation . . . . 0
Expiration Date 11/05/05
_Qty Unit Charge Per Extension
BASE FEE 15.00
128.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 4.48
• ----------------------------------------------------------------------------
Permit . . MECHANICAL
Additional desc .
Permit Fee . . . . 24.00 Plan Check Fee 6.00
Issue Date Valuation . . . . 0
Expiration Date 11/05/05
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 9.0000 EA MECH APPL REP/ALT/ADD 9.00
Permit . . . PLUMBING
Additional desc .
Permit Fee 21.00 Plan Check Fee 5.25
Issue Date Valuation . . . . 0
Expiration Date 11/05/05
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 6.0000 EA PLB ROOF DRAIN 6.00
-------------------------------- --------------------------------------------
Special Notes and Comments
128 SF. ADDITION TO EXISTING HOUSE
------------------------------------------ I ---------------------------------
Other Fees . . . . . . ENERGY REVIEW FEE 8.19
STRONG,MOTION (SMI) RES 1.03
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit.Fee Total 190.48 .00 .00 190.48
Plan Check'Total 98.02 .00 .00 98.02
Other Fee Total 9.22 .00 .00 9.22
Grand Total 297.72 .00 .00 297.72
LQPERNIIT
C69chRla Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMMAND. AMOUNT:
DATF.,
RF.CRIPT'
CHF.CK N-
INITIAIS
.CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Residence is at PGA Date: May 11, 2005
Owner's Name: A & M Construction Phone No.
Project Address: 80 423 Oak Tree La Quinta, CA
Project Description: Addition
APN: 772-280-013
Tract #:
Lot #'s:
Type of Development: Residential XX Commercial Industrial
Total Square Feet of Building Area: 128 sq. ft.
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer.
Dated: May 11, 2005 • Signature:
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project
17620 65995 Approval
Number of Sq.Ft. 128
Amount per Sq.Ft. $ 0.00
Amount Collected $ 0.00
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Business Services
Agreement Existing Not Subject to Fee
Prior to 1/1/87 Requirement
Note:
Ak. ny addition .that is 500's ft: or less<is ezem f from:
Develo' er FeesrJ- ��
Certificate issued by: Elvira Mattson, Office Technician Signature
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these
Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to
advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other
requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this
time or in whole -or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of
Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up
to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject
of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
PGA WEST..
RESIDENTIAL ASSOCIATION, INC. "
April 26, 2005
Mr. & Mrs. William Horwitch
80-423 Oak Tree
La Quinta, CA 92253
Dear Mr. & Mrs. Horwitch:
The Architectural Committee has reviewed and approved your request for an addition to
the master bedroom at your. 80-423 Oak Tree residence with the following stipulation:
• Please provide copies of City of La Quinta permits prior to commencing work.
• Upon completion, please provide a copy of the signed City of La Quinta
Building Inspection Card.
During our phone conversation this morning, you confirmed that a licensed roofing
contractor will be installing foam roofing on the addition.
We reserve the right to make a final inspection of this change to make sure that it.
matches the original request. An approval is based only on the aesthetics of your
proposed plan and should not be taken as any certif cation as to the construction
worthiness or structural integrity of the proposed change.
We want to reiterate that the maintenance of the addition is solely the responsibility of
the homeowner and wilt not be the responsibility of the Association. This provision is
recorded with the County of Riverside and runs with the land.
We appreciate your cooperation in submitting this request for approval. If you have -any
questions, please contact me at (760) 771-1234, ext. 15.
Sincerely,
Kelly McGalliard
Operations Manager
For the Architectural Committee
KM/bvf
cc: Architectural Committee'
54-320 Southern Hills, La Quinta, California 92253-5665, Telephone 760-771-.1234 FAX 760-771-5125