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: (
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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. #;
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Arch., Engr., Designer:^W-C7-M
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Address: nwm1✓1 t
City., ST, Zip: fAtAlq PMK) ON, Lz
Telephone: 0 8.0 p1
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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