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13-1650 (AR)41� P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00001650 Property Address: 49875 LAGO DR APN: - 658-270-020-20 -3941 - Application description: ADDITION - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: ,. 40000 Tav14,j4Q" Applicant: Archjtec or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- UCEN CONT OR'S DECLARATION I hereby affirm under penalty of perjury that I icensed u de provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business rofession Is ode, a my License is in full force and effect. Lr License Class: Br/ Contractor: 280103 •�'���1 T Date: OWNER•BUILDER DECLARATION I hereby affirm under penalty of perjury t t 1 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).: (_) 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 I am exempt under Sec. , B.&P.C. for this reason 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: Lender's Address:I LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/05/14 Owner: MICHAEL & DINA DARGIS 49-875 LAGO DRIVE - LA QUINTA CA LA QUINTA, CA 92253 ��--- Contractor: J t� GEMETTE CONSTRUCTION I. -)� n 0 ;- 74300 HIGHWAY 111 f i.3 PALM DESERT, CA 92260 (760) 346-3248 t e1'fyk, Lic. No.. 280103 �;;lzr' ?�'•-... ._ __ ----------------------------------------------- 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. 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: Car er STATE FUND PolicyItoh 37738 I certify that, in the performance of h whis permit is issued, I shall not employ any person in any manner so as to a meworkers' compensation laws of California, and agree that, if I should be o subjompensation provisions of Section 3700 of the Labor Code, I sh hwWAPse provisions. Datee*' '� � & Applicant: WARNING: FAILURE TO SECURE WORKE COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001- 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 n nd void if w kis not commenced within 180 days from date of issuance of such permit, ce sation of or for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above i for ation is c rrec . I ag a comply with all city and county ordinances and state laws relating to building con t ction, and h r y au r e epresentatives of this county to enter upon the above-mentioned property for i ction purpos Date: Signature (Applicant or Application Number . . . 13-00001650 Permit . . . ROOM ADDITION 2013 Additional desc . Permit Fee . . . . 181.61 Plan Check Fee .00 Issue Date Valuation. 0 Expiration Date 8/04/14 Qty Unit Charge Per Extension 1.00 120.1200 LS MISC ROOM ADDN,'IST 100 SF 120.12, 1.00• ------------------------- 61.4900 EA MISC ROOM ADDN, ADDL 500 SF '----------------------------------------------=---- 61.49 Permit . . . ELECTRICAL 2013 Additional desc . Permit Fee . . . . 23.83 Plan Check Fee .00 Issue Date . . . Valuation . . . . 0 Expiration Date 8/04/14 Qty Unit Charge Per Extension 1.00 --------------------------------------=------------------------------------- 23.8300 LS ELEC FIXTURES, FIRST 20 23.83 Permit MECHANICAL 2013 Additional desc . Permit Fee . . . . 11.92 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 8/04/14 Qty Unit Charge Per Extension 1.00 ---------------------------------------------------------------------------- 11.9200 EA MECH APPL REP/ALT 11.92 . Permit . . . PLUMBING 2013 Additional desc . . Permit Fee . . . . 11.92 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date 8/04/14 Qty Unit Charge Per Extension 1.00 11.9200 EA PLBG FIXTURE/TRAP 11.92 ---------------------------------------------------------------------------- r Special Notes and Comments CLOSET AND MORNING ROOM ADDITION 234 SQ. FT. February 5, = 2014 8:11:11 AM jjohnson. --------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 20.00 PLAN CHECK, ELECTRICAL 23.83 LQPERMIT LQPERMIT Application Number 13-00001650 -------.------------------------------------------------------- Other Fees . . . . . PLAN CHECK, ROOM ADDITION 185.90 PLAN CHECK, MECHANICAL 4.77 PLAN CHECK, PLUMBING 11.92 STRONG MOTION (SMI) - RES 4.00 Fee summary ----------------- Charged Paid, Credited Due •Permit Fee Total ---------- 229.28 ---------- .00 --------------------' .00 - 229.28 Plan Check Total .00 .00 .00 .00 Other Fee Total 250.42 .00 .00 250.42 Grand Total 479:70 .00 .00 479.70 LQPERMIT Bin # 3C 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 Permit # I Project Address: 4PI615 Lmc) vNvt Owner's Name: (.GI G J�A NA VAtZ(jo A. P. Number: Sg �71� GAddress: I 1615 �A60 V{ V Legal Description: City, ST, Zip:t A QU1 IVT►,) GVH c[ZZ 53 Contractor: /4 M telephone: ( :•;�::>::....�»•:::::::.�<.•::s,.�:»:.;:».:s.:::..<.>.;:<:.::-.<::::<::>.:::>.:<::.: f Address: Project Description: City, ST, Zip: MAM MT tT/ a'.V,& O 6k6i�T I tq N Az-ew AM 10 N Tele hone: State Lic. # : City Lic. #; t,-rr2 Arch., Engr., Designer:^W-C7-M Lj (6 /Us Address: nwm1✓1 t City., ST, Zip: fAtAlq PMK) ON, Lz Telephone: 0 8.0 p1 ��.9 �� ::;::.::>::;.: x.::<>:>;;:::,..,:;:,<:.: «z:;::;::<;:>: g, <y:;ii:•'e`ii�i•:iJii%iSf:::^:i;:;/ �.;F••ij �?: iijt:i:i:ii:. s>:<:;<:r<:;;;.<;:<::•>:;<:>:•;;:>< Type: Construction Type: Occupancy: State Lic. # Project type (circle one): New Add, n Alter Repair Demo Name of Contact Person: MOM:5 �, '( Sq. Ft.: 2'lj� # Stories: #Units: Telephone # of Contact Person --j -5-bb . om I Estimated Value of Project: i Q Qd0 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted 1 Item Amount Structural Calcs. Reviewed, ready for corrections APlan Check Deposit Truss Calcs. Called Contact Person �, Plan Check Balance Title 24 Calcs. Plans picked up mo � Toyat-,,-, Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for correction/issue Electrical Subcontactor List Called Contact Person 5 Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- "d Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue VSchool Fees IN Total Permit Fees 1RI=L DEC 2 0 ZU13 CITY OF LA QUINTA COMMUNITY DEVELOPMENT . CERTIFICATE OF COMPLIANCE J��DSo Desert Sands Unified School District 47950 Dune Palms Road Q BERMUDADUNES O V) RANCHO MIRAGE Q Date 2/5/14 La Quinta, CA 92253 INDIAN WELLS r �j. PALM DESERT No. 31971 ' (760) 771-8515 L INDINTA QIN0 .y Owner Dargis Res APN # 658-2'0-020 Address 49875 Lago Drive Jurisdiction La Quanta City La Quinta Zip Permit # Tract # No. of Units 1 Type Residential Addition Lot #- No. Street S.F. Lot # No. Street S.F. Unit 1 49875 Lago Drive 234 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 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the fohowing 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 234 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 - George Gemette Check No. Bank Name/Recipient of Certificate Telephone Funding Exempt By Dr. Gary Ruth.eliford Superintendent Fee collected /exemp d y aroc I Vrey Payment Recd _ T $0.0C -" 'OverfUvidPr Signature I11 0 1 C �. NOTICE: Pursuant o Government Cod ection 66020(d thi 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 run from the da a 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