06-2905 (AR)55575 Medallist Dr
06-2905
P.O. BOX 1504 VOICE -(760) 777-7012
7$495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/21/06'
Application Number: dK0=6-0OA' 0290-5 Owner:
Property Address: 55575 MEDALLIST DR- M/M R CASELLS
APN: 767-510-010 - - 55575 MEDALLIST DR
Application description: ADDITION - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL D
Application valuation: 14850
AUG g 2006 "
Contractor:
Applicant: Architect or Engineer: SCOTT'S CONSTRUCTION SRVC I CITY OF `AQU1%TA
82092 TAHQUITZ AVENUE FIMANC E '
INDIO,-CA 92201
(760)347-3407'
Lic. No.: 879930
- LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with .I hereby affirm under penalty of perjury one of the following declarations:' _
Section 7000) of Division 3 of the Business and Professionals Code, and' my License is in full force,and 'effect.. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B License No.:. 879930 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
f►_ issued.
" /Date' 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are: .
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the - . Carrier STATE FUND ' Policy Number 229-0015425
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to - _ Icertify that, in the performance of the work for which this permit is issued, I shall not employ any, -
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California,
permit,to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the. Business and Professions Code) or 3700 of the Labor Code hall forthwith comply with those provisions.
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).: te: '' + scant:
(_ 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 WARNING: FAIL RE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN -
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). - APPLICANT ACKNOWLEDGEMENT
( ') I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is'hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed _ 1 . Each person upon whose behalf this application is made, each person at whose request and for .
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, ;
I am exempt under Sec. , B.&P.C, for this reason - 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 underorfollowing issuance of this permit. -
Date: Owner: 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, orcessation of.work for 180 days will subject .
.CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the. I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state ws relating to building construction, and hereby authorize representatives
of this co ty to enter upon the ova -mentioned property for i action purposes.
Lender's Name: - ( . I -
• 2L • 106§i ure (Applicant or Agent):
Lender's Address:
LQPERMIT .
Application.Number . . . . 06-00002905
Permit BUILDING PERMIT
Additional desc .
Permit Fee 162.00 Plan Check
Fee
105.30
Issue Date Valuation
14850
Expiration Date 2/17/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
13.00 9.0000 THOU BLDG 2,001-25,000
117.00
Permit ELECT - ADD/ALT/REM
Additional desc
Permit Fee . . . 22.70 Plan Check
Fee
5.68
Issue Date . . . . Valuation
0
Expiration Date 2/17/07 .
Qty Unit Charge Per
Extension
BASE -FEE
.15.00
220.00 .0350 ELEC NEW RES - 1 OR 2 --FAMILY
7.70
Permit MECHANICAL
Additional desc r
Permit Fee 24.00' Plan Check
Fee..
6.00
Issue Date . . . . Valuation
0
Expiration Date 2/17/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH APPL REP/ALT/ADD
9.00
Special Notes and Comments
convert patio to living space. 220,sq.
ft.August 21, 2006 1:40:38 PM jjohnson
----------------------------------------------------------------------------
Other Fees ." . . ENERGY REVIEW FEE
10.53
STRONG MOTION (SMI)
- RES
1.48
Fee summary. Charged Paid Credited
Due
Permit Fee Total 208.70 .00
.00
208.70
Plan Check Total 116.98 .00
.00
116.98
Other Fee Total 12.01 .00
.00
12.01
Grand Total 337.69 .00
.00.j
337.69 _
LQPERDIIT -
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Bin #
City of LaQ O uinta
Building & Safety.Division .
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: MeJo/iS Dit "
Owner's Name: t sells
A. P. Number:
Address: sS 5 7f'
Legal Description:City,
ST, Zip: 2ZS
u
_
Contractor: S s
Address: 'I(Z
Telephone: t
Project Description: L' Osc e i
City, ST, Aldro ZY'
v 2 ♦ k
Telephone: -%o3
State Lic. # : e71930
City Lic. #:
Arch., Engr., Designer: 57
Address: /✓
pt
City, ST, Zip:aueie A2 Z
Construction Type: Occupancy:
Telephone: .. OOO s
State Lic. #: s 7195 8
Name of Contact Person: SCO y-
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:#Stories: # Units:
Telephone # of Contact Person: . 397— 3 qO
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE c!/%&c
# Submittal
Req'd
Rec'd
TRACKING. "61/0 PERMIT FEES
Plan Sets
/
Plan Check submitted Item Amount
Structural Calcs.
Reviewed, ready focorr ons S Plan Check Deposit
Truss Cates.
Called Contact Perso (%S Plan Check Balance
Energy Cates.
Plans picked_up g Construction
Flood plain plan
Plans resubmitted D - Mechanical
Grading plan
2"' Review, ready for correcti srssue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up 45
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
"dReview, ready for correctionsfi e Deve) 4a t (55()
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue 6 Mcjrc
D.
School Fees
O
Total Permit Fees
.
rn S,e,•'"",
5
•C (cS OCA.
M r.vC
GQu v.
CoaA Ila Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760)'398-5909 — Fax (760) 398-1224
Project Name:
This Box For District Use Only
DEVELOPER FEES PAID
AREA: •
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMMAND. AMOUNT:
DATE:
RECEIPT: _
CHECK H: I '
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Owner's Name: Castell Residence
Project Address: '55-575 Medallist Dr. La Quinta, CA 92253
Project Description: Room Addition
APN: 767-510-010 Tract #:
Type of Developmenti Residential XX
a
Date: 08/28/06
Phone No. -
Lot #'s:
Commercial Industrial
• Total Square Feet of Building Area: 220 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: 08/28/06 Signature:' l J JJ- vA-
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 Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Note: Pursuant to AB -181, any- mobilehomes being replaced,
Number of Sq.Ft. 220 sq. ft. or relocated within the same school district are exempt from
Amount per Sq.Ft. $ 0.00 developer fees. Any additions of 500 sq. ft. or less is also
Amount Collected $ 0.00 exempt from developer fees. (Unless additions are on a
structure that is under construction.)
Building Permit Application Completed: Yes/No
• ' By: Carey M. Carlson, Asst. Supt., Business Services
Certificate issued by: Maria L. Angulo, Facilities Secretary Signature:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND TATE E T OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1„1997, requi s that t 's Di riot 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- ay 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 subje
of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
L9: :4 r 1}docs!dev.t'ees: eriificate efcimtpliance i:orm tahleiTO USLi.doc . 1/16/03 T
ii