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11-0978 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 11-00000978 Property Address: 77511 CALLE ARROBA APN: 774-155-022-2 -000000- Application description: REMODEL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 34332 Tuvl'4 4 Q" Applicant: Architect or Engineer: a ra Q LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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. 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 Shat a or she is exempt therefrom and the basis for the'alleged exemption. Any violation of Section 7031.5 by a applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ( 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.). (_) I, as owner of the property, am exclusively contra ' with licensed contractors to construct the iect (Sec. 7044, Business and Professions Code: Contract 'State License Law does not apply an owner of property who builds or improves t on, and who con racts for the projects w' Wa con tors) lic pursuant to the Contractors' a License Law.). (_) I am exempt under Sec. , B.&P.C. r this re e: �Lner: I hereby affirm under penalty of perjury that ere is a construction lending age mance of the work for which this permit is issued (Sec. 3X97, Civ. C.). Lender's Name: Lender's Address: LQPERMIT Owner: VARGE, RICHARD LEE PO BOX 2190 MIDDLEBERG, VA 20118 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/23/12 . 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 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 b subject i alifornia, and agree that, if 1 should orae o the workers' compensation isions of Section 3700. of the Labor C rthwit omply with t se p isio Z's WARNING: FAILURE TO SECAE WOR'IFERS' COMPENSA IS UNLAWFUL, ALL SUBJECT AN EMPLOYER T CRIMINr4 PENALTIES AND CIVIL FINES UP TO D THOUSAND DOLLARS ($100,000). IN ADDITION/f0 THE COST OF COMPENSATI ;S AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CO E, INTEREST, AND ATTOR 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. ch erson upon whose behalf this application is made, each person at whose request and for whose bene i 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 w' bject permit to cancellation. certify that 1 have read this application and state t the abov ormation is correct. I a e to c ly with all city and county ordinances and state laws re ' g to buildi g con ton, and hereby au orize presentatives of this county to enter upon the above -menti ed prope f spec ' purpos to S' ature (Applicant or Agent): l Application Number . . . . . 11-00000978 ------ Structure Information 470SF RECONSTRUCTION/VB/RES-3/CL A -FR ----- Other struct info . . . . . CODE EDITION 2010 ---------------------------------------------------------------------------- # BEDROOMS 2.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee 317.00 Plan Check Fee 206.05 Issue Date . . . . Valuation . . . . 34332 Expiration Date 7/21/12 Qty •Unit Charge Per Extension BASE FEE 252.00 10.00 6.5000 -----"---------------------- THOU BLDG 25,001-50,000 ------------------------------------------------- 65.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . . Permit Fee . . . . 46.45 Plan Check Fee 11.61 Issue Date Valuation . . . . 0 Expiration Date 7/21/12 Qty Unit Charge Per Extension BASE FEE 15.00 470.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 16.45 20.00 .7500 ---------------------------------------------------------------------------- PER ELEC DEVICE/FIXTURE 1ST 20 15.00 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 39.00 Plan Check Fee 9.75 Issue Date Valuation . . . . 0 Expiration Date 7/21/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50' 3.00 6.5000 ---------------------------------------------------------------------------- EA MECH VENT FAN 19.50 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 67.50 Plan Check Fee 16.88 Issue Date . . . . Valuation . . . . 0 Expiration Date 7/21/12 Qty Unit Charge Per Extension LQPERMIT Application Number . . . . . 11-00000978 Permit . . . . . . PLUMBING Qty Unit Charge Per Extension BASE FEE 15.00 6.00 6.0000 EA PLB FIXTURE 36.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP, 3.00 2.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 6.00 --.-------------------------------------------------------------------------- Special Notes and Comments 470SF ADDITION [416SF RECONSTRUCTION AND 54SF ADDITION].WITH 560.SF PATIO [175SF SIDE/292SF REAR/87SF ENTRY] VB/RES-3/CLASS A -FR [ENGINEERED] THIS PERMIT IS TO RECONSTRUCT PORTION OF DEMOLISHED RESIDENCE DUE TO PREVIOUSLY PERMITTED REMODEL/ADDITION [PERMIT NO: 07-26221 THAT WAS NEVER COMPLETED AND TO PERMIT HABITABILITY OF DWELLING. CODE CASE: 10-4423 (MR] 2010 CALIFORNIA BUILDING CODES. January 20, 2012 4:44:41 PM AORTEGA -------------7--------------------------------------7----------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 2.00 ENERGY REVIEW FEE 20.61 STRONG MOTION (SMI) - RES 3.43 Fee summary Charged Paid Credited ------------ Due --------------------------------------------- Permit Fee Total 469.95 .00 .00 469:95 Plan Check Total 244.29 .00 .00 244.29 Other Fee Total 26.04 .00 .00. 26.04 Grand Total 740.28 .00 .00 740.28 LQPERMIT Bin # Permit # ,I. oq1$ Project Address: �� City of res Quinta Building 8I Safety Division P.O. Box 1504, 78-495 Calle-Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet p r L>! !� � R%L g � Owner's Names l�CJ i A. P. Number: � — � Address: QD � >c A-1 J y ` l _5--_'57 0 :2-¢ 7,-7y— Legal Description: GCS 'T 3 1 " 4J16 O :1d>/ City, ST, lap: .J f ! Address: 0 �= ✓L T� Telephoncj yv ' �% 2 —�� a N O : �."';:x� L•L 1 Z, C Y Project Description: City, ST, Zip: a ` Telephone: v, x cam';; ; «' s S°a> State Lic. # : City Lic. #: Arch., Engr., Designs: Address: City, ST. Zip: Telephone: .. _ k A�„ : Construction Type: OccupfficY: _�N: ,-moi �'• .. ' 44 Project circle one): New Add'n Alter Repair Demo H �s`. `�y 1 tYPe i )' State Lic. #: Name of Contact Person: t C "t A ✓1• i7 /�-1/Zl� r� Sq. FL: # Stories: # 7Un7its Telephone # of Contact Person:s-'fp Estimated Value of Project:: �-- 1000 APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rec'd TRACKUVG PERMIT FEES Plan Sets Plan Check submitted Iter► Amount Structural Cala. Reviewed, ready for corrections Plan Cheek Deposit Truss Cales. Called Contact Person Plan Check Balance Title 24 Cates. Plana picked up 3/Il Construction Flood plain plan Plans resubmitted Grading plan 2"' Review, ready t correetionsf c lj K'jpl Electrical Subcontattor List Called Contact Person / %a Plumbing Grant Dad Plans picked cep II I1� S.M.I. H.O.A. Approval Plans resubmitted �Z18' 1� Grading IN HOUSE:- Review, ready fo orrectio ne Developer Impact Fee Planning Approval Called Contact Perron ti A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees a`''4wsl - Vic -OR, ,t - er.W. jaae-, ieiPG 1244m1- NL A,PP �C.Ivz pit fly ftMft*'bf'�L Aftt • t�• tt /res l� flims Awepo; U CERTIFICATE OF COMPLIANCE ,33 .0 Desert Sands Unified School District 47950 Dune Palms Road Q BERMUDA DUNES O � RANCHO MIRAGE CJ Date 1/23/12 La Quinta, CA 92253 INDIAN WELLS PALMOESERT No. 31194 (760) 771-8515 LA QUIN A �y ,IQINDIO y� C Owner Richard Varge APN # 774-155-022 Address 77511 Calle Arroba. Jurisdiction La Quinta City La Quinta Zip 92253 Permit # Tract # No. of Units Type Residential Addition Lot # No. Street S.F.- Lot #.. No.. Street S.F. Unit 1 77511 Calle Arroba Unit 2 Unit 3 Unit 4 UniV5 Comments - 54 Unit 6 Unit 7 Unit 8 Unit 9 Unit -10 - At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under. 500 square feet, detached accessory. structures (spaces that do not contain facilities.for living, sleeping, cooking, eating orzanitation) or replacement.mobile homes. A 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 54 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- Richard Varge Check No. Name on the check Telephone 540/272-7012 Funding Exempt By" Dr. Sharon P. McGehee Superintendent Fee collected /exempted bypat cia Barbuzza Payment Recd ` $o.5-5 7_7 . r Over/Under Signature ,r. NOTICE: Pursuant to Government Code Section 8020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to r 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 without embossed seal Embossed Original - Building Department Applicant -Copy - Applicant/Receipt Copy - Accounting P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures &Forms for Owner -Builders Applying for Construction Permits W-ORMTr NOTICE TO PROPERTY OWNER Dear Property Owner. Ari. application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at We are pnviding you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until yowhave read, Initialed your umderstauding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OVA'S AC1Q20V i;EDGl %'W AND VERIFICATION OE OORKAUQN DfItIE/GTlO1V5: Read and initial each statement below to signify you understand or verify this Kormation. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while wonting on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers �^ 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.. 7�✓ 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own/ V�� 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on peand contracts. 75. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value ofmy construction is at -least five hundred dollars ($500), including labor.and materials, I may be considered an "employer" unde state and federal law. V ` 6. [understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compens tion for. each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. . I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residentia ltructures cannot .legally build them with the intent to offer them for sale, unless all work is performed by license+ subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performe, under contract with a licensed general building Contractor. V� 8. I' understand as an Owner -Builder if I sell the propertyfor which thispermit is issued, I may be held liable for any financial; or. personal injuries sustained. by any subsequent owner(s) that result from any latent construction defects in the WO hip or materials. .. V9. I understand .I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the. United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CS -LB) at 1- (� 800 21-CSLB (2752) or www.c.sib.ca.gov for more information about licensed contractors. 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 financially responsible for proposed construction activity at the following address: I agree that, as the party legally and financial responsible for this proposed construction activity, I will abide by all 77" e laws and requirements that governOwner-Builders as well as employers. 12. 1 agree to notify the issuer of this, form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license,. the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to: understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property; you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to Dire Contractors, you will be responsible for verifying whether or not those Contractors are_p_coperl'y_licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuittg; %e.p:ermit. Note: A c 'P Y. of the property owner's driver's l e, form notsr*aiton, or other verification acceptabte}o�ie agency u requiro be presentedwhen the permit is issued to verefy the property owner's signature. �� / If 11/ Signature of Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agents) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable>to the agency is required to be presented when the permit is issued to verify the property owner's signature.. Property Owner's Signature: _ Date: