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12-0603 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00000603 Property Address: 78180 HACIENDA LA QUINTA APN: 646-280-007- - - Application description: REMODEL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 25000 Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION I4 . fG�itiGv BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that 1 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. License Class: License No.: Date: 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 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 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 1 1, 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 contractorls) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.C, for this reason /hate: caner: / CONSTRUCTION LENDING AGENCY 1 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: vi L,QPERMIT Owner: HIGHENBOTEN, CARL & SHEILA VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/27/12 Contractor: D U Owner FA U 0 2 72 012 , CIN OF LA QUINTA FINANCE DEPT. ----------------------------------------------- '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. _ 1 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 Policy Number 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 tha if I should become subject to the workers' compensation provisions of Section 3700 of th r Code, I shall forthwith comply with those provisions. ate: plicant: WARNING: FAILU 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 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 o is county to enter upon the above-mentioned property for inspection purposes. Date: nature (Applicant or Agent): Application Number . . . . . 12-00000603 ------ Structure Information EXISTING 4091 SF SFD ----- Construction Type . . . TYPE V, UNPROTECTED Occupancy Type . . . . . . DWELLG/LODGING/LONG <=10 Flood Zone . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2010 ---------------------------------------------------------------------------- # BEDROOMS 3.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 252.00 Plan Check Fee 163.80 Issue Date . . . . Valuation . . . . 25000 Expiration Date . . 2/23/13 Qty Unit Charge Per Extension BASE FEE 45.00 23.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 207.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 75.00 Plan Check Fee 18.75 Issue Date . . . . Valuation . . 0 Expiration Date . . 2/23/13 Qty Unit Charge Per Extension BASE FEE 15.00 20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 15.00 100.00 .4500 ---------------------------------------------------------------------------- EA ELEC DEVICE/FIXTURE >20 45.00 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 51.00 Plan Check Fee . 12.75 Issue Date Valuation . . . . 0 Expiration Date 2/23/13 Qty Unit Charge Per Extension BASE FEE 15.00 .8.00 4.5000 ---------------------------------------------------------------------------- EA MECH VENT INST/ DUCT ALT 36.00 Permit . . . PLUMBING Additional desc . . Permit Fee . . . . 147.00 Plan Check Fee .36.75 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 2/23/13 LQPERMIT Application Number 12-00000603 Permit PLUMBING Qty Unit Charge Per Extension BASE FEE 15.00 21.00 6.0000 EA PLB FIXTURE `126.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 3.0000 EA PLB FIXTURE DRAIN/VENT ---------------------------------------------------------------------------- REP/ALT 3.00 • Special Notes and Comments REMODEL TO EXISTING RESIDENCE. TYPE V -B CONSTRUCTION, R-3 OCCUPANCY. "DEN SHALL NOT BE UTILIZED AS A BEDROOM OR SLEEPING ROOM CRC R302.5.1" 2010 CODES ----------------------------------------------------- ---------------------- Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 16.38 HOURLY PLAN CHECK 252.00' STRONG MOTION (SMI) - RES 2.50 Fee summary Charged Paid Credited -------------------- -----_---- Due --------------------------- Permit Fee Total 525.00 .00 .0.0 525.00 Plan Check Total 232.05 .00 .00 232.05 Other Fee Total 271.88 .00 .00 271.88 Grand Total 1028.93 .00 .00 1028.93 LQPERMIT Bin # P City of La Quinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permir # LPQ 1-" Project Address: Owner's Name: ` ` 4 � j. 46A Ha; J4� A. P. Number: "l Q a(J Address: --78 �e U E-4Dt'6- Legal Description: (r��`1 79 2-1 Contractor: �� 1 City, ST, Zip: ET- CQ-uC d ( CA ,:, y -,; • ,.:>:;,.: Telephone: / Address: Project Description: City, ST, Zip: Telephone:'" = '`'':: fr ,ram`'` State Lic. # : City Lic. #: ;gfwgr., Designer: Ea�;, F17C4t-��Irs� Address:27 .-6 �iZ C'd e�� 05 S t� City, ST, Zip: Lf-'/ T--;F-5F� 61 e�2221 Telephone: `: '9c `" '' " '"" �� E.: State Lic. #: Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: ( # Units: J Telephone # of Contact Person: W 0 '74Z,85j; Estimated Value of Project: Q[F�7 01 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets 2 Plan Check submitted 31 � .Item Amount Structural Cales. Z Reviewed, ready f cvrmtions Plan Check Deposit Truss Cales. Called Contact Person '.>� Plan Check Balance Title 24 Cales. Z Plans picked up (Q ` Construction Flood plain plan Plans resubmitted Y �� 2 Mechanical Grading plan X'! Review, ready for correction issue I Electrical Subcontactor List Called Contact Person Gt -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 / V Total Permit Fees The Management Trust MONARCH GROUP DIVISION DILUA LA QUIIVTA HOMIDWAMS ASSOCL4770M August 14, 2012 Carl L. Highgenboten, "M.D. Via email only: RE: 78180 Hacienda Architectural Request Dear Dr. & Mrs. Highgen' The Architectural Committee has:reviewed and approved your architectural submittal for: 1. The removal of the 2u4 floor casita and the restoration of the original,roof line; 2. Resetting the street step back to become a part of the other steps closer to the house;. 3.. Replacement, of the iron gates with wooden gates/doors. Please have Marianne forward a copy of your building permit for the files. Your patience and cooperation with the architectural review process is appreciated. If you have any questions, please feel free to contact us. sincerely, Direction of the Board of Directors Galla, CCAM.. unity Aa sociation.Maaager l 38755 Berkey Drive, Suite &.Palm Desert CA 92211 amNecnm6Pa0Mmn+erroMde ' PN: 760.776.5100 FAX:760.776.5111 www menagemenUrtist com w P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING do SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-701: FAX (760) 777-701 Disclosures & Forms for Owner -Builders Applying for Construction Permits DJMUff—I moncT To PROPiZM OWNER Dear Pnpe ty Owner An mon fora been viWitteo in yaa� name lisiin� 1 -as the bnildw of tine pepott As��at d 1/ �� 73 1>Ife ase psi y v�hh an Owns -Builds Aelmowtedgm,ent sad. IsBocmatiea Vetdivatim Forms fA malas You onsr=of yor and p=66 d* you may incur by htvbg dd&patwit .i= - P A in ym ttr M as the 0,nee43uikler. we wW not ism a bodldkg puu* maw yeat-have read, iaf#avd yam. __ of ea* signed, and returned this form to us at our ofadal adds as indicated, An agent of the owner curvet e4ecute an aotl unless you, the Property owner, obtain the prior approval of the permitting authority. sAM VOWAOM t?SC TONS Road � each MOW r6 you � or ver4fy dws mfirmaum AOk 4f 1- I understand a hegneat practice of unlicensed persons is to have the Property owner obtain an "OwoecBuik building permit that arun000rsly implies that the Property owner is providing his or her awn labor road Mftnd PessODdly- an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed pe and his or her employm while workmg on my property. My hom eowncr's inswaam may not provide covenge for d iryurics. I am willWY acting as an Owner -Builder and am aware of the limits of my insurance coverage for igiurioa tD woo on my property. J_2. I understand building, permits are not required to be signed by propertyowtners unkss they are respomibk fa re eoestruetion and anot hiring a licensed Conttactor to assume this ility. 9,3- I understand as an "Owner -Builder" I am On responsible party of reoosd on the permit. I understand flet I may P myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or b+or nun instead own. 4.1 understand Contractors are required by law to be licensed and bonded in California. and to list their license numl permits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the tot o my construction is at least five hundred dollars ($500 including labor and mated I may be considered an "e under state and federal law. )' y ar . [ understand if I am considered an " o4 empl yet" udder state and %deral taw, I must re ww with the state aniW,..fj t, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to uaeaq compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious risk 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family r stiukures cannot legally build them with the intent to offer them for sale, unless all work is performed by subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is I under eontmet with 2 i;e•w _A .y U 8. [understand mi as an Owner-$u17der if I sell the property for which this pert is issued, I may be held liable for any ial or personal 6#uries steed by any subsequent owners) that result from any latent construcdon decocts in the workmanship or maftials. 9. I understand I may obtain more information regarding my obligations as an -employer frota iha homial Ii+dveauea DSeivloe, the United States Small Business Administration, the California Department of Bmfit Paymetft. and die California ivision of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSM at I- 800-32I-CSLB (2752) or w'ww.c.slb.ca.gov for more information about licensed contractors. C-10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and 6naneialty responsible for proper construction activity at the following address: '�,• jkk�able agree that, as te party buy and flaaaciall laws and Y responsible for this proposed ooffitruction activity, I will abide by all coquireatarts that govern Ower -Burma as well as employers. 12. I agree to notify the issuer of this form immediately of any addition, &bilious, or changes twasy of tba Wkmatiou 1 have provided on this form Licensed coatracxons are regulated by laws designed to protect the public. If yea voeter►ct with someone who does not have a limense, die Cowman, State License Board may be unable to usiot you with any duawid cos: YOU may sustain as a result of a complaint Your only remedy apuvg unlicensed Contracwrs may be invivil coact. his alert for You to *A if aa; tin cawed Con waw a esiployce of td iardividnat of ifrm is i*ced while wwlkinq on Yow property, You may be betel W* for daoragP& If you obtain a permat as Owaa-Bird r and wi* to bin Comwim you wiM ba unponulde for yedrying Vh4wof Cat arose COICUUMM are pnVelty Heeend and the XWO of dreit Wed= iamAm ere covera'a, Before a building perndt eon be Isoued, fids foraa must be completed and sigaid by the property owner sad returned the agency rapoadMe for Intif,trier f. - Nom A cW of Ulan rVFWV *wow Is ms's; AMMO§ firm nh o l er v sig n "09"k b the ��7 is MtrhW to be prMwWd Wim *v perorit is inn" As wry} dw pmpa Si WAM of property owrM hk IA. U 1'A h 6 f ii by 4 YI Note: 77se following Authorization Foran is required to be completed by the property owwter only when da*wd an agent of the property owner to apply for a construction permit for the Owner -Builder. a .v,. c awc r.>na a v"r�I&VL o rva'�na.r Faccluding the Noticeto Property Owner, the excWtion of which I waderstaad is my persomal respotaribility, I lureby who the followuog perrtou(s} to ser as my s) to apply f Permit for my project, or, sign, rind file On documents necessary to obtain an Owaet-Budd �" Scope of Construction Project (or /Dmcription of Work). � t ✓Yb�G I 1l i �' l h vii , 3 b -A lit r 0 r rn 6 Project Location or Address: _ 1 �� I l-1 �i 1 i {tel ��L I ✓ L di g Li 1 ✓l T 2t, Name of Authorized Agent: fl -4 n n g ALA ,(7)? I-V rl Tel No Address of Authorized Agent: 509.66 W A �, h i n V it I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out tb inforaaation and certify its accuracy. NOW A COPY of the owner's driver's bone, form notarization„ or other wrificatic aoaeptable to the agency is regnrired to be presented when die permit is issued to verify the property owner's siVktture. Property Owner's Signature: _ Date: Mi. "To CITY OF LA (WINU'gUB-CONTRACTOR LIST JOB ADDRESS 0 P --a 61 e- 0 d -A, PERMIT NUMBER OWNER- R qhqem- by �e, Pl BUILDER -1 4) 11 hAe—h k), WO . employees are authorized to work This form shall be posted on the lob with the Building Inspection Card at all times in cbnsp71Cu1ous_ place.- O� ersons appearing on this list or their ye on this job. Any changes t' t I will o this list must. be approved by the Building Division prior to -commencement of work. Failure to comply * I result in a stoppage of 'Work an.Wor the voidance of building Dermit. For each anolicable trade. all information reauested below must be COMDleted bvaoolicant. "On File" is not an acceptable response. Trade I Classification Contract" _ brs:.Co nVen" city.-Bu*9 Company Name Classification (e.g. A. 8, -C-8) License Number .(xxxxxx) Eip. Date x 6 lxx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date ixxlxx/xx) License Number 1Xxxx) Exp. Date (Xk/XXIXX) EARTHWORK (0-12) . TiA4-Ak1;,5 6-kr-4nWa-L,< 00 -2- 4, 0 /*/31 /1 612 0,61-7401- 1-oll I/' la. /C 3 '1,6,7 "I -b) 114 CONCRETE IC -8)_ L V1 &'W(W i 10 0 0 idltPt 6 t, 10 0 1 - 1) 2. 9 A ffe W '?/;v -Mlih 1000,V7 'V-10 h A - FRAMING ;(G 61: STRUCTL.."STEEL W;i dt& 6 lee 1 6 f/ 661,14 14111 A 1- 6e r76 'ad( 71-1-11) 9 7- -6 3 MASONRY` tC.29) M PLUMBING 10-36)' id y --w P) kw -b 1 n m s qq Ibi h ru 1M 317 WK. MASTER (C-35) V11 V11040741 D rM e (6 3 DRYWALL (C4), VAC (P-20)' S -i mmoyi6 Ale -100 e, -ul od 000oq56 -////g 3 '/;z -7 ?hfhz. 'ELECTRICAL W --tor :-..;: t -70 10 -r- t 01c o vV �i e. p)v pt M - nl /i a 1,q 113 ftQQFING1C11=101 :-PHEET METAL 60411 F �2TINQ 194 5);. No cx �1 le, -7 V� 1 Aymncin li4 ri 1 4-760 4,100 n/tv GLAZING (C-17);! INSULATION' (C-21. SEWAGE C-41) PAINTING (C-33) 13LC V1 Cftep+l [10 CVIV .40 YA �qf t, 43•v 54,14& rk yi� 000qlj� 1,V h EiRAMIC TO (C-54 b,�J\Chr— -71 -2, 0 P A h 009 706 llw/15 CABINETS (C-6) C Mr, M001 vx -15,111 Wi 0 It 4. A Me i(cp yi tAYi eh 4o6 111-3 o' h FENCING (C-13) LANDSCAPING (C.27) POOL 3) V 0_ M RO V 16 _7r V1 1 q 1-5/3, h4 khle, 0v2!D'_JJJ*1d I qoiQ40� 13 Burt Hanada From: Denise Poeltler < Sent: Friday, December 14, 2012 1:02 PM To: - Burt Hanada Cc: Subject: HIGHGENBOTEN APPROVED DRAWINGS Categories: Temp Assignment Hello Burt, Let this serve as my permission to have additional print sets made from the City's original stamped, approved set for the Highgenboten Remodel located at 78-180 Hacienda Way in LQ CC. Please call if you have any questions. Thanks for your help. Denise -R. Poeltler, PE - The Flying Buttress (760) 772-4411 0 r - I Burt Hanada From: Rob Pitchford < Sent: Friday, December 14, 2012 12:42 PM To: Burt Hanada Cc: Marianne Nouskajian; Denise Poeltler Subject: Highgenboten Plans Hey Burt, Please allow Marianne Nouskajian to make whatever copies she needs to replace the stamped job site set for the Highgenboten Addition & Remodel at 78-180 Hacienda Way in La Quinta. Please call if you have any questions. Thanks, Rob Pitchford 1'