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RER (06-4230)P.O. BOX 1504 4 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 1-06=00004230 �� Owner: Property Address: '57205 MERION LOMBARD APN: 762-031-013- - - „� 57205 MERION Application description: REMODEL - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 100 Contractor: Applicant: Architect or Engineer: TOPMAN BUILDERS P.O. BOX 10202 PALM DESERT, CA 92255 (760)772-7296 rJ LiC. No:: 455121 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 Division 3 of the Business P essionals Code, and my License is in full force and effect. License Class: B C29 C53 LicenseNo.: 455121 Date: -8.t ontrac OWNER -BUILDER DECLARATION I hereby affirm under penalty of p at 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 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 Coder 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.). (_) 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.). ( ) I am exempt under Sec. , B.&P.C. for this reason i Date: Owner: 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.). Lender's Name: f At Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/08/06 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION 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 maintainworkers' 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 and policy number are: Carrier CLARENDON Policy Number 01KR-0030-842 _ 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 s I1.fo with comply with those provisions. - plica t: t WARNING: FAI URE TO SE RE WOR RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO 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 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 c svucti n, and hereby authorize representatives of thiscountyto enter upon the above-mentioned property for is ecti purposes. ate: 12'3---' ature (Applicant or A nt): LQPERAIIT Application Number . . . . . 06-00004230 • Permit . . . ELECT -.ADD/ALT/REM Additional desc.. Permit Fee . . . . 16.50 Plan Check Fee 4.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 6/06/07 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 1.50 Permit . . . PLUMBING Additional desc . Permit Fee •. . . , 18.00. Plan Check Fee 4.50 Issue Date Valuation 0 Expiration Date 6/06/07 Qty Unit Charge Per Extension BASE FEE 15.00 r 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 Special Notes and Comments RELOCATE -EXISTING POOL EQUIPMENT PER C/D APPROVED PLAN Fee summary Charged Paid Credited Due Permit Fee Total 34.50 .00 .00 34.50 Plan Check Total 8.63 .00 .00 8.63 Grand Total 43'.13 .00 .00 43-.13 LQPERAIIT Bi" # City of La Quinta Building u 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: r/C>� Owner's Name: A. P. Number: Address: 7 /-GRIDN Legal Description: City, ST, Zip: ' Contractor: Telephone:. y Address: Project Description: City, ST, Zip: Telephone: State Lic. # : City Lic. #: ' Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # nits: Telephone # of Contact Person:A t f .7L9 4-S Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING. PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. - Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan god Review, ready for corrections/issue Electrical Subcoutactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''" Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees z Total Permit Fees 3• Bin # City of La nuinta Building u Safety Division P.O. Box 1504, 78-495 Calle'Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 1 -` Project Address:' 7- ZOs . ��,/� A. A. P. Number: Owner's Name: 6,M4449 Address:57 zc;5 Legal Description: Contractor: L/j��q,; 6i-67;eC?C7-1z)A_ City,'ST, Zip: L"q ��.F,,A /10Zs:3 Telephone: Address: �� . �` Z %vL 5A /a/e—' Project Description: City, ST, Zip: Telephone:f� -9 State Lic. # : City Lic. #: Z-414- /<State Arch., Engr., Designer: Address: // City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: �%},;Z Construction Type: Occupancy: Project type (circle one): New ..Add'n Alter Repair Demo Sq. Ff.: # Stories: # Units: 77�� Telephone # of Contact Person: �7Z L%.• J. e 2 Y Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd :. Rec'd TRACKING. , PERMIT FEES Plan Sets Plan Check submitted 1 Item Amount Structural Cates. Reviewed, ready for `l rection Pian Check Deposit Truss Calcs. Called Contact Person i Plan Check Balance Energy Cates. Plans picked op Construction Flood plain plan Plans resubmitted Mechanical Grading.plan 2" Review, ready for eorrec 0 Electrical Subcoutactor List Called Contact Person '6 Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for.correctionslissue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. ApprDate of permit issue p School Fees Total Permit Fees 5 d CERTIFICATE OF COMPLIANCE Desert Sands Unified School District z4�cj 5�yo 47950 Dune Palms Road BERMUDA DUNES r' 90) RANCHO MIRAGE d Date 9/15/06 La Quinta, CA 92253 INDIAN WELLS PALM LA QUINTA y No. 28903 (760) 771-8515 �' INDIO0 Owner Raymond & Michelle Lombard APN # 762-031-013 Address 57-205 Merion Drive Jurisdiction La Quinta City La Quinta Zip 92253 Permit # Tract # Study Area Type Residential Addition No. of Units Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 57-205 Merion Drive 245. Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/Walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, 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 245 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-Joe Adair Check No. Name on the check Telephone 784-5824 Funding Exempt By Dr. Doris Wilson Superintendent Fee collected /exem by Patri Barbuzza Payment Recd $o.00 Ovei/Under Signature NOTICE: Pursuant to Government Code Section20(d)(1), this will serve to notify you that the 90-day approval period in which 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 -. jccounting