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RER (05-4533)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 05-00004533 Property Address: .53485 AVENIDA MENDOZA APN: 774-092-024-12 -000000- Application description: REMODEL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 11195 Applicant: Architect or Engineer: n�IP BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: RIVERA TERESA JANE *NOT ON FILE UNKNOWN, CA 99999 ontractor: ESERT STAR BUILDERS INC 4854 VELIE WAY STE 11 ALM DESERT, CA 92260- 760)346-2112 2260760)340-2112 ic. No.: 855505 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/10/05 ------------------------------------7-----------------------------------=------------------------ LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION 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.: 855505 . /1.rr for by Section 3700 of the Labor Code, for the performance of the work for which this permit is 4/ yt� V 1�/U • ��CJ��J .t� issued. Date—: —� Contra r: (�(� '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 I hereby affirm under penalty of perjury that I 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 sheds 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 the 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 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 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 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 - I hereby affirm under penalty of perjury that there is construction lending agency for the performance of the work'for which this permit is issued ISec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPER.N11T insurance carrier and policy number are: ' Carrier STATE FUND Policy Number 22930168 `rte_ 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 Labor Code, I shall forthwith comply with thoseprovisions ��-G S��( � kar'S Date: !��'�,♦ Apt , 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 ($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 nullandvoid 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 constructiojandreb authorize repre entatives of this county to nter u on the above-mentioned proper r inspection Dater Signatcant or Agent):JIaLm1J&AL11 LQPERAHT Application Number 05-00004533 Permit BUILDING PERMIT - ADA INV FEE Additional desc . Permit Fee . . . . 270.00 Plan Check Fee 87.75 Issue Date. Valuation . . . .11195 - Expiration Date 4/08/06 Qty Unit Charge Per Extension' BASE FEE 90.00 10.00 18.0000'THOU. BLDG 2,001-25,000 180.00. ------------------------------------------=--------------------------------- Permit . . . ELECT -.ADD/ALT/REM Additional desc . Permit Fee . . . . 23.93 Plan Check Fee 5.98 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/08/06 } Qty Unit Charge Per Extension BASE FEE 15.00 255.00 .0350 ELEC NEW RES - 1 OR 2 ----------- FAMILY.. 8.93 --------------------------------------------- Special Notes and Comments Enclose existing front entry .to living space. 255 square feet. Investigation fee applied for work started without permit. October 10,.2005 AM straxel _ --_--6_53_11 --------------f----------------------------------- - -------------- Other Fees . . . . . . . . . STRONG MOTION (SMI) - RES 1:11 Fee summary Charged Paid Credited ----------------- Due ---------- -------------------- Permit Fee Total 293.93 ..00 ---------- .00 293.93 Plan Check Total 93.73 .00 00 93.73 Other.Fee Total 1.11 .00 .00 1.11 Grand Total 388.77 ..00 .00 388.77 LQPERAHT Bin #` s- s33 City. of La Qulnta Building u Safety. Division Permit #P.O. Box 1504, 78-49S Calle Tampico 1-s Quints, CA 92253'- (760) 777-7012 + Building Permit Applicati Project Address: on and Tracking Sheet • ' Ow'ner's Namc: A. P. Number: fe Address: Legal :Description: Cit},, ST, Zip: �`A 2 25' 3 Contractor: i ytL AddeTelephone r ss: _ Project Description: t City, ST, Zip: 2 Telephone: e o� �i e . State Lic. # City Lic. Arch., Engr., Designer:. Address: t "till, UaL City, $T, Zip: D Telephone: 0 3Yo z1�Z Construction s truc tt 0 nT} P c: �Oc c u Pan StateLtc. #• c• ..- r t✓ a P roJect t}pe (circe one):. Ne%�Name of Contact Person: AAlter Repair Demo Sq. Ft.: 7_1L #Stories: Telephone # of Contact Person: # Units.. . D— 00—�y% ".�iYoZlt Estimated Value of Pr �7 �d APPLICANT: DO, NOT WRITE EELOW THIS LINE # Submittal Re9'd Recd "t TRACKING' PERMIT FEFS Plan Sets Plan Check submitted, Structural Calcs, tem Amount Reviewed, ready corrections TtussCatcs. Plao Check Deposit .Called Contact Person Title 24 talcs: 7j Plan Check Balance Planspicked up 11 Flood plain plan g Z % Construction Plans resubmitted Grading plan T'Lcchanical 2" Rcvicw, ready fo correcli s/issue 1IlP'K Subcontactor List Electrical Called Contact Person Grant Deed Plumbing Plans picked, up I1.0 -A. a S.M.I. pproval Plans.resubmiticd INIIOUSE;_ o) Grading Revii w eaid% for corrections/issue /0 Planning Approval !� 0 Developer Impact Fee Called Contact Person S ees/a Pub. Wks. Appr AJT.P. Date of permibissue �0 School Fees !� Total Permit Fees City La Quinta Zip 92253 Permit # Tract # Study Area Type Residential Addition No. of Units Lot # No. Street S.F. Unit 1 53 485 Avenida Mendoza 255 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Lot # No. Street S.F. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered pabos/walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooldng, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 255 S.F. or $0.00 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 Exempt -Dawn Kulesh Check No. Name on the check Telephone 340-2115 Funding Exempt By Dr. Doris Wilson Superintendent t + ; Fee collected /exe pted by P ricia Barbuzza Payment Recd O.oO + E Ff Over/Under ° r. IX, et�,� 'r Signature r� r 'rt NOTICE: Pursuant to Government Codeon 66020(d)(1), this will serve to notify you that the 90 -day approval period in wtiioti you' may protest the fees o r 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 J CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road < 'BERMUDA DUNES O Date 10/10/05 La Quinta, CA 92253 Cr RANCHO MIRAGE 0 r INDIAN WELLS No. 27749 (760) 771-8515 Ci PALM LA OUINTA y �U'S OINDIO Owner James Sheer APN # 774-092-024 Address 53-485 Avenida Mendoza Jurisdiction La Quinta City La Quinta Zip 92253 Permit # Tract # Study Area Type Residential Addition No. of Units Lot # No. Street S.F. Unit 1 53 485 Avenida Mendoza 255 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Lot # No. Street S.F. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered pabos/walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooldng, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 255 S.F. or $0.00 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 Exempt -Dawn Kulesh Check No. Name on the check Telephone 340-2115 Funding Exempt By Dr. Doris Wilson Superintendent t + ; Fee collected /exe pted by P ricia Barbuzza Payment Recd O.oO + E Ff Over/Under ° r. IX, et�,� 'r Signature r� r 'rt NOTICE: Pursuant to Government Codeon 66020(d)(1), this will serve to notify you that the 90 -day approval period in wtiioti you' may protest the fees o r 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 1, MIR