AR (07-1854)P.O. BOX
/ I
Applicant: j Architect or Engineer:
.BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
LAZICH RESIDENCE
56-905 MOUNTAIN'VIEW
LA QUINTA, CA 92253.
(760)771-6071
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 and Professionals Code, and my License is in full force and effect.
LicenseEll 1' _ License No' .594043
Date: >/ °- �0 `�J Contractor: \
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 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 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, 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
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
Contractor:
�7C'S CONSTRUCTION &
48236 VISTA DE NOPA
LA QUINTA, CA 92253
(760)564=5811
Lic. No.: 594043
LJ
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/02/07
NT GAG
C t QUINTA
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.
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
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
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 te workers' compensation provisions of Section
3700 of the Labor CC df0r with co1plyth those provisions.
ApplicaAt-. ', G
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, agentsand 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 the above-mentioned property for inspection p ses.
�/ % ti —
• Date: r7 ��/Signature (Applicant or Agent): " I�yCJ�C
LICENSED �—
LA QUINTA, CALIFORNIA 92253 •
Application Number:
000185 !'
07=0 4
.. Property Address:
56905 MOUNTAIN VIEW'•
APN:
762-350-003- -
Application description:
ADDITION - RESIDENTIAL
Property Zoning:
LOW DENSITY, RESIDENTIAL . -,
Application valuation:
20000
Applicant: j Architect or Engineer:
.BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
LAZICH RESIDENCE
56-905 MOUNTAIN'VIEW
LA QUINTA, CA 92253.
(760)771-6071
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 and Professionals Code, and my License is in full force and effect.
LicenseEll 1' _ License No' .594043
Date: >/ °- �0 `�J Contractor: \
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 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 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, 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
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
Contractor:
�7C'S CONSTRUCTION &
48236 VISTA DE NOPA
LA QUINTA, CA 92253
(760)564=5811
Lic. No.: 594043
LJ
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/02/07
NT GAG
C t QUINTA
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.
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
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
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 te workers' compensation provisions of Section
3700 of the Labor CC df0r with co1plyth those provisions.
ApplicaAt-. ', G
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, agentsand 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 the above-mentioned property for inspection p ses.
�/ % ti —
• Date: r7 ��/Signature (Applicant or Agent): " I�yCJ�C
LICENSED �—
. Application Number . . . 07-00001854
------ Structure. Information 136SF ADDITION/V-NR/RES-3 .[CONV.]
-----
• ,.Other struct info lt CODE EDITION. -2001/2005
FLOOD ZONE NO
" .1ST FLOOR SQUARE FOOTAGE
136.00
"Permit . . . . BUILDING PERMIT
' Additional desc .
Permit Fee . . . 207.00' Plan Check Fee
134.55
Issue Date` Valuation '.
20000 .
Expiration Date 1/29/08
Qty Unit Charge Per
Extension
BASE 'FEE
45:00
18.00. 9.0000_THOU BLDG 2,001-25,000-
162.00'
Permit ELECT -.ADD/ALT/REM
Additional desc .
Permit Fee 27.75 Plan Check Fee
6.94
Issue Date Valuation . .
0,
- Expiration Date 1/29/08
Qty Unit Charge Per
Extension.
BASE FEE
15.00
17.0.0 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
12.75 '
Permit MECHANICAL
Additional desc .
Permit Fee 19.50 Plan.Check:Fee
4..88
Issue. Date . . . Valuation . .
0
Expiration Date 1/29/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 4.5000.EA MECH VENT INST/ DUCT ALT
'4.50
--------------------------------------------------------------
Special Notes and Comments
136SF ADDITION/V-NR/RES-3
[CONVENTIONAL] 2001', CBC, CMC, 2004
CEC, 2005 ENERGY..THIS.PERMIT DOES NOT
INCLUDE.BLOCKWALLS. July 24, 2007,
11:08:35.AM AORTEGA
--------------------------------------------
Other Fees ENERGY REVIEW FEE
13.46
STRONG MOTION (SMI) - RES
2.00
LQPERMIT - -
-
Application Number
07-00001854
: -"- -:,-F.ee summary,'...
Charged
Paid
Credited
Due
- - Permit Fee`Total
--
254..25
---- - - - - --
.00
---- - - - - -- -
.00
--
254.25
Plan Check Total
146.37
.00
.00
146.37
Other Fee Total
15".46
00
00
15.46
Grand Total
416.08
00
.00
416.08
1
.
r
Biti #
Zai
City of La Quinta
Building at Safety Division
P.O. Box 1504, 78-495. Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit,#
IQ
Q
Project Address:' Q S ( J (� (�
Owner's Name:.
A. P. Number:
Address: 13 p
— c O w .
Legal Description:
Contractor: ..
City, ST, Zip: �(� Q,v t N 1 C4_ e( Z Z5 3
-
Telephon . � (06 � Y 6--b-
City, ST, Zip:
Project Description:
�) —O
Telephone:
State Lie. # :
City-Lic. #:
Arch., Engr., Designer: �S O d lco Z
Address: 14 ' (S 5 2 Stftl� FRAW C-1
z(�
City, ST, Zip: ow I�� C ( 2.Z 5-3
Telephone: Cj (� _ (P71,3`6 II
State Lie. #: G S 5
Name of Contact Person:
Construction Type: V H Occupancy:
Project type (circle one): New A 'a to Repair Demo
Sq. Ft.: l� (o
# Stories:.
# Units:
Telephone # of Contact Person: `j (a c{ – 6 `l °J
Estimated Value of Project: O b O O r
APPLICANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIMG ,
PERMIT FEES
3
Plan Sets
Plan Check submitted
Z
Item
Amount
Structurdl Calcs.
Reviewed, ready for corrections
Ian Check Deposit
Truss Calcs.
Called Contact Person/
ININ[Plan
Check Balance
Energy Calcs.
Plans picked up
✓
Construction
Flood plain plan.
Plans resubmitted
Mechanical
Grading. plan'
2"' Review, ready for correcti ass
Electrical
Subcontactor 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
i
1191 72
1
Total Permit Fees
ii♦ y �/loRa
- ,
• •
Coachella Valley Unified School District This Box For District use only .
83-733 Avenue 55, Thermal, CA 92274 DEVELOPER.FEES PAID
(760) 398-5909 - Fax (760) 398-1224
AREA:.. -
AMOUNT -
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
:.MITIGATION AMOUNT:
COMMAND. AMOUNT:
DATE:
RECEIPT:
CHECK #:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Bill Lazich 08/02/07
Owner's Name: Bill Lazich Phone No. 760-771-6071
Project Address: 56-905 Mountain View; La Quinta, CA 92253
Project Description: Room Addition to Existing Single Family Residence
APN: 762-350-003 Tract #: ` Lot #'s:
Residential. iXX . Commercial Industrial
Total Square Feet of Building Area: 436 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: 08/02/07 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 Agreement Existing Not Subject to Fee
17620 65995. Approval Prior to 1/1/87. Requirement
Note: Pursuant to AB -181 any Mobile Homes being replaced
Number of Sq.Ft. 136 sq. ft. or relocated within the same school district are exempt from'
developerfees. Also under AB -181 any room addition that s
Amount per Sq.Ft.' $ 0.00 500-sq.ft. or_less.is-exempt.from developer_ fees.
Amount Collected $ 0.00
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Business Services
Certificate issued by: Leticia C. Torres, Facilities Analyst Sign e:
NOTICE OF 90. DAY PERIOD FOR PROTEST O ES AND STA T OF FEES
Section 66020 of the Government Code aserted by Assembly Bill 3081, effective January 1, 1997, requires that is 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.
MV:c/niydocs/devfees/certificate ofconipliance form tablesTO USE.doc 1/16/03 T
7 *AA
FAIRWAYS ASSOCIATION
June 12, 2007
Mr. & Mrs. Bill Lazich
P.O. Box 1352
La. Quinta CA 92253
Re: 56-905 Mountain View
Architectural/Landscape Application -
Master Bedroom Expansion
Dear Mr. & Mrs. Lazichc
At the June 4`h, 2007, Architectural/Landscape Committee meeting the committee reviewed the submitted plans t
and has given conditional approval for the installation to proceed.
Note:
• Approval of your plans by the Architectural/Landscape Committee does` NOT include any right of access
by your contractor to your Jot through the golf course. To request permission to access your lot through the
golf course, please contact the legal department at KSL Desert Resorts (760-564-8023) regarding a
temporary access license. Access without written permission could be deemed criminal trespass.
• All plant and building materials must be placed on the homeowner's property. NOT IN THE _STREET
• Property Restoration - if access to rear of property is necessary all walls and landscaping must be restored to their
original condition upon completion of your project. .
Final approval will be given. upon completion of the project and compliance review..
If you should have any questions in regard to this correspondence, please do not hesitate to contact the Association
office at, anytime.
Sincerely,
PGA WEST Fairzea)6 Assoaation
Aro'n=wal/Landsca e Corrorz;ttee
ARCH/ncp
Cc: Ray Rooker:
File
Post Office Box 1690.• La Quinta, California 92247 • Phone (760)776-5100 Fax (760) 776-5111