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AR (04-3388)n o� BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).77777012 OF TY�9 78-495 CALLE TAMPICO FAX (760) 77.7-7011 LA QUINTA, CALIF.6RNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT, Application Number . . . . 0-4-0.0-0-0-3-3-8-8— Date ,4/28/04 Property Address �4-9_5-8:4=MONTANA WY APN: 649= 5-1-0-002=4`6 -28912 - Application description ADDITION - RESIDENTIAL Property Zoning . . . . LOW DENSITY.RESIDENTIAL Application valuation . 21189 Owner Contr,actor ADAMS HERBERT HAROLD SPARKS CONSTRUCTION, INC ' *NOT.ON FILE P.O. BOX 1716 UNKNOWN CA 99999 LA QUINTA CA 92253 (760) 771-1941 WCC: STATE FUND WC: 0460007338 01/01/05 CSLB: 674074 07/31/05 CCC: B -------------------------- Structure Information ------------------=------ Construction Type.. TYPE V = NONRATED Occupancy Type DWELLG/LODGING/CONG <=10 Flood Zone . . . . . NON -AO FLOOD ZONE .Other struct info . . . . CODE EDITION 2001 CBC # BEDROOMS 1.00 FIRST FLOOR SQ FTG '.272.00 .Permit . . . . . IBUILDING PERMIT ,.._ Additional desc Permit Fee 225.00 Plan Check Fee 146.25 Issue Date . . . . Valuation 21189 Qty Unit Charge Per Extension BASE FEE 45.00 20.00 9.0000 THOU BLDG 2;-001-25,00.0 180.00 Permit MECHANICAL Additional desc Permit Fee 47.00 Plan Check Fee 11.75 Issue Date . . . . Valuation 0 'Qty Unit Charge,, Per Extension BASE FEE 15.00 1."00 9..0000 EA MECH FURNACE <=100K 9..00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16'.50 1.00 6.5000 EA MECH VENT FAN 6.50 r � � P.O. BOX 1504 • VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0(4 -- Applicant: (fApplicant: Applicant's Mailing Address: Date: Arch' or Engine Architect or or Engineer's Address: Lic. NO... BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (comm ncing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. � /License Class cense No. p % r /bate I o O Tactor OWNER -BUILDER DLARA ON I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for he 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 Contractors' 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).): U 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 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 or 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.). (, 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.). U I am exempt under Sec. , B.8 P.C. for this reason Date Owner WORKERS' 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 f issu d. My ers' c9�pensation insyrance carrier and policy numb�L,re: Carrier f1�'�i� '� % icy Number O �(o / e 3 S I certify that, in the performance of the work for which this permit is issued, I'hall 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 becomes subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST Off�k COMPENSATION, DAMAGES AS PROVIDED FOR IN SECT'ON 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I 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.). Lende's Name Lender's Address 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 Ouinta, 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 to building construction, and hereby authorize representatives of this county to enter upon a above=PP1¢nti ned propert on purposes. 4i'onature (Applicant or Agent): Pt a= Page 2 Application Number 04-00003388 Date 4/28/04, Permit . . . . ELEC-NEW RES"IDEN:TIAL Additional desc Permit Fee 24.52 Plan Check Fee 6.13 Issue Date Valuation . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 272.00 .0350 ELEC NEW RES - 1 OR 2• FAMILY 9.52 ----------------------------------------- Permit . . . . . . PLUMBING Additional desc Permit Fee . . 39.00 Plan .Check Fee 9.75 Issue Date Valuation 0 Qty Unit' Charge Per Extension BASE FEE 15.00 4.00 6.0000 EA PLB FIXTURE 24.00 Permit GRADING PERMIT Additional desc Permit -Fee 15.00 Plan Check Fee ..00 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per. Extension BASE FEE 15.00 1.00 .0000 HND GRADING 101-1000 .00 Special Notes and Comments 272 S.F. ATTACHED MONTANA 1 GUEST SUITE Other Fees . ... . . . -ENERGY REVIEW FEE 14.63 STRONG MOTION (SMI) - RES 2.11 Fee summary Charged Paid Credited Due Permit Fee Total 350.52 .00 .00 350.52 Plan Check Total 173.88 .00 00 173.88 Other Fee Total 16.74 .00 .00 L'6.,,74 Grand Total 541.14 .001 .00 541.14 01/16/2003 12:26 Alin # Permit # 7607777011 LA QUINTA PAGE 01/01 City of La Quinta "�� 0 - Building sr Safety Division P.O. Box 1504, 78-495 Calle Tampico J�P L Quinca, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet X P=Address:"—Sg `C/4Y. �vner's Namc: D D�s€(t ae �/ rt A. P. Number: `t' -f/ p e7 p 7 4N0 Address: Legal Description: jye>rG-( 2�g (Z (� Cin, ST_ Zip: �c` G4 ? 'L 3 Contractor: cleohon Address: Project Description: City, ST. Zip: ! cJi 7- 4- ® -4k Telephon 157 1� v14 P S J S "-g/ C �t State Lic. # : (.. 7 C' 7 City Lic. R' -42-4i `77 C, 0 0 eL Arch., Engr.. Designer: / Address: 0 City. ST. Zip. Telephone: nstruction Tv Pc Co Occu a p nc% State Lic. 4: Project Type (circle one): NcN% Add' Alter Repair Dcmo Name of Contact Person: /��, i 5�4,¢/L,� j SG. Ft.: 6� Stories: Units: Telephone ;+ of Contac; Person: ( /oe 1.?7/ —/ l( �/ Esti 11; I f P ' Submittal Plan Sets Structural Calcs. Truss Cales. Title 24 Calcs. Flood plain plan Grading plan Subcontactor List Grant Deed H.O.A. Approval IN HOUSE:- Planniag Approval Pub. '%vks, Appr School Fees Total Permit Fees mite a ue o rolect. APPLICANT: DO NOT WRITE BELOW THIS LINE d Rcc'd TRkCKING PERMIT FEES Plan Check, submitted Item Amount Reviewed. ready for corrections Plan Check Deposit Called Contact Person Plan Check Balance Plans picked up Construction Plans resubmitted' ?Mechanical 2"4 Review. ready for corrections/issueElectrical . Called Contact Person Plumbing Plans picked up Plans resubmitted Grading 3'0 Revicw, ready for correctionsfissur Developer Impact Fee Called Contact Person Date or permit issue Total Permit Fees CERTIFICATE OF COMPLIANCE��Fl�sc Desert Sands Unified School District z4G'c2�0 1 71 47950 Dune Palms Road ¢ BERMUDA La Quetta CA 92253 V) RANCHO MIRAGE CJ., Date 5/6/04 > wDIAN WELLS 760 771-8615 d PALM DESERT ' NO. 25860IN ' ) LA QUINT. ��' Owner TD Desert DevelopmentAPN # 649-510-007 Address Jurisdiction La Quinta,;. - city Zip Permit # Tract # Study Area Type Residential Addition No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 49584 Montana Way 272 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Guest House Addition At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions4 under 500 square feet, detached accessory structures (spaces that do not contain' facilities for living, sleeping, cooking, eating or sanitation) or replacemeitimobile homes. It has been determined that 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 Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of - $2.24 X 272 S.F. or $609.28 have been paid for 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. Fees Paid By, CC/Palm Desert National Bank -Judy Halpain Check No. 089253 Name on the check Telephone 760/771.19.41 Funding' Residential' ; By., Dr. Doris Wilson Superintendent Fee collected /exempted by a n MCGilvfey' Payment Recd ~$609.28 Over/Under, Signature NOTICE: Pursuant to Government Code'Section 66020(d)(1), t i ill 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 issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building'Department/Applicant Copy - Applicant/Receipt _ , Copy -;Accounting