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04-3409 (AR)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760) 777-7012 78-495 CALLE TAMPICO FAX (760).777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS.(760) 777-7153 BUILDING PERMIT Application Number . . . . . 04-00003409_: Date 4/12/04 Property Address . . . . '80030 CEDAR CREST ; APN: 762=051-013 - Application description . . . ADDITION - RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL Application valuation 35000 Owner Contractor LEE BENEDICT YOON GI CBR ENG CONTRACTOR 80030 CEDAR CREST 54015 SOUTHERN HILLS LA QUINTA CA�92253 7, LA QUINTA CA 92253 -`" (760.) 771-2278 WCC STATE.FUND WC: 1542568. .08/01/04 _ CSLB: 504183. 01/31/05 CCC:.A B -H-IC - - - - - -. Structure Inf ormaton=.�61 SQ.. FT.. GARAGE .CONN . TO .BlTH ROOM ----- Construction ---- Construction Type TYPE V NON RATED Occupancy Type . . . . . . DWELLG/LODGING/LONG <=10. Flood Zone . ... NON -AO FLOOD ZONE Other struct-info . . . . CODE EDITION 2001 FLOOD ZONE NO FIRST FLOOR SQ FTG .61.00 -------------------------------------------------------------------------------- Permit . . . . . BUILDING PERMIT Additional desc Permit Fee 317.00 Plan Check Fee 206.05 Issue Date Valuation 35000 Expiration Date 10/12/04 Qty Unit Charge Per Extension BASE FEE 252.0.0 10.00 6.5000 THOU BLDG 25;001-50,000 .65.00 Permit . .... . . . ELECT ADD/ALT./REM Additional desc•. Permit Fee . . . . 32.12 Plan Check Fee.. 8.03 Issue Date Valuation 0 Expiration Date 10/12/04 Qty Unit Charge Per, .Extension BASE FEE 15.00 61.00 .0200 ELEC GARAGE OR -NON-RESIDENTIAL 1.22 20.00. .7500 PER ELEC DEVICE/FIXTURE 1ST 20 15.00 ����P.O. BOX 1504 � VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 440INSPECTIONS:(760) 7.77-7153 BUILDING & SAFETY DEPARTMENT Application Number. 041' Date:. moi- / el C) Applicant: Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: S 04s i -S' tvas� fti S 7' G 2-s-3 I� Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 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 LiceteGa is in fu roe and effect nse ass --license No.- -//71 o. -/"r 1 0'-/ nUador I % j� (r POlyl A- OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that 1 am exempt from the Contractors' 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 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 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 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, howeyer, 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.). U 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.). C-) I am exempt under Sec. , B.& 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 self4nsure for workefs' compensation, as provided for by'Section 3700 of the Labor Code, for the performance of the work for which flus permit Is issued. j jz:-.I ve 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 My workers' compensation �insyrence Cartier and�olicy number a .,Carrier o U ti """y Number __LIS !/ 2 -,-6 _ I certify that, in the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, It I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, l shall forthwith comply with those provisions. iA,nnli.nt e- L? /P G (01JI-I /)-4e-- 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 ($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 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.). Lenders Name Lenders 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 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. 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city a my ordinances and state laws relating to building construction, and hereby authorize representatives of this county to ante n the abov ntio props r ins ct' n purposes. �f /n ature (Applicant or Agent): Application Number . . . . . 04-00003409 Page 2 Date 4/12/04 Qty Unit Charge Per Extension 2.00 .4500 EA ELEC DEVICE/FIXTURE >20 .90 --------=------------------------------------------------------------------- Permit. . . . . . . MECHANICAL Additional desc Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation . . . . 0 Expiration Date 10/12/04 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH APPL REP/ALT/ADD 9.00 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc . . Permit Fee . . . . 45.00 Plan Check Fee 11.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 10/12/04 Qty Unit Charge Per Extension BASE FEE 15.00 5.00 6.0000 EA PLB FIXTURE 30.00 ---------------------------------------------------------------------------- Special Notes and Comments 61-SQ.FT. GARAGE CONVERSION TO BATH ROOM AREA -----------'------------------=---------------------------------------------- Other;Fees . . . . . . . . . ART IN PUBLIC PLACES -RES .00 ENERGY REVIEW FEE 20.61 STRONG MOTION (SMI) - RES 3.50 Fee summary Charged Permit'Fee Total 418.12 Plan Check Total 231.33 Other Fee Total 24.11 Grand Total 673.56 Paid Credited Due ---------- ---------- ---------- .00 .00 418.12 .00 .00 231.33 .00 .00 24.11 .00 .00 673.56 Coachella Valley Unified School District P.O. Box -847, Thermal, CA 92274 ;760) 398-5909 — Fax (760) 398-1224 This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT LEVEL ONE AMOUNT: LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMM/IND. AMOUNT: DATE: RECEIPT: CHECK a:. INITIALS: CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: Date: ARril 14. 2004 Owner's Name: Benedict Lee Phone No. Project Address: '80-030 Cedar Crest La Quiuta. CA Project Description: addition APN: 762-051-013 Tract #: Type of Development: Residential ffi Commercial Total Square Feet of Building Area: Lot #'s: 61 sq. ft. Industrial 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 � to ized to sign on behalf of the eloper. Dated: �/— /L/ — O Y 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 17620 65995 Approval Number of Sq.Ft. 61 Amount per Sq.Ft. $ 0 Amount Collected $ 0 Building Permit Application Completed: Yes/No By: Carey M. Carlson Asst. Supt., Business Serv. Agreement Existing Not Subject to Fee Prior to 1/1/87 Requirement Note: any addition that is 500 sgft and under is -exempt from developer fees. Certificate issued by: E1 V 1 Pa" MattS011 Signature: Office Technician NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this 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/mydocs/devfees/certificate of compliance 09/30/02