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14-0568 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 14-00000568 Property Address: 79363 LIGA APN: 772-130-061- - - Application description: ADDITION - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 70853 Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION '440 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:, B License No.: 843039 1' 16, Date: u r. 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)": (_),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 a'nd 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.)... (_) I am exempt under Sec. _ , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY 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: LQPERMIT Owner: HOLST DAVID 79363 LIGA LA QUINTA, CA 92253 ( Contractor: BOYD CONSTRUCTION, MICHAEL 69298 SAW GRASS ROAD CATHEDRAL CITY, CA 92234 (760)849-5123 Lic. No.: 843039 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/20/14 D ° JUN - ;3 2044 , A fi ----------------------------------------------- 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 EX •MPT Policy Number EXEMPT 41 certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner sous to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section . - 3700 of the Lab o Code, I shall forthwi comp�withse provisions. Date 2 Applicant:r WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVERAGES 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 theDirectorof 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, indemnity 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 daysfrom 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 thattheabove informatio is correct. I agree to comply with all city and county ordinances and state laws relating to building construction nd ereby thorize representatives of this county to enter upon the above-mentioned pr 9 pertyifor inspectio ur s D`at V%/- Signature (Applicant or Agent):,, Application Number 14-00000568 Permit . . . Additional desc . . Permit Fee . . . . Issue Date Expiration Date . Qty Unit Charge LQPERMIT PLUMBING 2013 23.84 Plan Check Fee .00 Valuation . . . . 0 12/17/14 Per Extension Structure Information - Construction Type . . . . . TYPE V, UNPROTECTED Occupancy Type . . . . . DWELLG/LODGING/CONG <=10 Other struct info . . . . . CODE EDITION 2013 / 2010 EN # BEDROOMS 1.00 FLOOD ZONE no . GARAGE SQ FTG 64.00 ---------------------------------------------------------------------------- IST FLOOR SQUARE FOOTAGE 245.00 Permit . . . ROOM ADDITION 2013 Additional desc . . Permit Fee . . . . 181.61 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/17/14 Qty Unit Charge Per Extension 1.00 120.1200 LS MISC ROOM ADDN, 1ST 100 SF 120.12 1.00 61.4900 ---------------------------------------------------------------------------- EA MISC ROOM ADDN, ADDL 500 SF 61.49 Permit . . . ELECTRICAL 2013 Additional desc . Permit Fee 143.00 Plan Check Fee .00 Issue Date - Valuation . . . . 0 Expiration Date 12/17/14 Qty Unit Charge Per Extension 1.00 143.0000 ---------------------------------------------------- LS ELEC NEW RES, FIRST 1 KSF ------------------------ 143.00 Permit . . . MECHANICAL 2013 Additional desc .. Permit Fee 11.92 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/17/14 Qty Unit Charge Per Extension 1.00 11.9200 ---------------------------------------------------------------------------- EA MECH APPL REP/ALT 11.92 Permit . . . Additional desc . . Permit Fee . . . . Issue Date Expiration Date . Qty Unit Charge LQPERMIT PLUMBING 2013 23.84 Plan Check Fee .00 Valuation . . . . 0 12/17/14 Per Extension Application Number . . . . . 14-00000568 Permit . . . ... . PLUMBING 2013 Qty Unit Charge Per Extension 1.00 11.9200 EA _ PLBG FIXTURE/TRAP 11.92 1.00 11.9200 EA PLBG WATER INST/ALT/REP 11.92 ---------------------------------------------------------------------------- Special Notes and Comments , BEDROOM & UTILITY ROOM ADDITION TO GUEST CASITA. 245 SF LIVING, 64 SF UTILITY. 2013 CODES 2010 ENERGY.ARCHITECT: CHARLES GARLAND C11991 ---------------------------------------------------------------------------- Other Fees . . . ... . . . . BLDG STDS ADMIN (SB1473) 3.00 HOURLY PLAN CHECK 175.00 PLAN CHECK, ROOM ADDITION - 185.90 STRONG MOTION (SMI) - RES 7.09 Fee summary Charged Permit Fee Total 360.37 Plan -Check Total .00 Other Fee Total 370.99 Grand Total 731.36 LQPERMIT Paid Credited Due .00 .00 360.37 .00 .00 .00 .00 .00 370.99 .00 .00 731.36 I rJ Bin # tG City of La Quinta Building 8L Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Applic� tion and Tracking Sheet . Permit # 1 - w ProjectAddres- s .3 3 , eA tOwner's Name: . cc, A. P. Number: 77 6 V3 (]U 2_ ✓ Address: _ L Legal Description: L 0 T /J -2 -21-S-10 (2 City, ST, Zip: C 0�1 U t „) f L ,S 44t I 0 TeleP h ne _ — L o J�Address: 6 q-2 q P "ect Description: City, ST, Zip: Ct ZZ eI • Te hone• ;;i Z� P � � 1 MState-LiE. # A Q City Lic. #: Or yI Arch., Engr., Designer: 5 Address: uh (ttvD City, ST, Zip: Telephone: le one: P xx Construct'on T y: pe. Occupancy: State Lic. #: ProJecthPa�ci tele one):: New Add+ n Alter Repair r De mo Name of Cotitacf Person: Mt' k (� G L 4Sq. Ft.: # Stori s: # Units: :Telephone #;of ContacfPe sr on: (�— b=9 9- . Z Estimated Value of Projbct: Q V APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted p Item Amount Structural Calcs. Z Reviewed, ready for corrections 5 IL Plan Check Deposit Truss Cales. Called Contact Person S Plan Check Balance. Title 24 Calcs. Plans picked up ,M 1:1 �� Construction Flood plain plan Plans resubmitted Mechanical Grading plan god Review, ready for correctio /issue �� ctrical Subcontactor List Called Contact Person n Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue kE5-t2.Cj nr School Fees Total Permit Fees v l '! 5/Z8 -3 o---5 d� toll' 1'14 St -OAC. ARP bill Sal►. �.�.Ar�- mo� ��w. �-�- , 1 CITY OF LA QUINTA SUB -CONTRACTOR_ LIST 3 BUI_LDEfi �`�T� �� S1_V-)(2 ' 1 L3k) --JOB-ADDRESS QI-----�t—`-(� m._ _ _ PERMI_T._NUMBER__L S( S_OWN,ER f-6.& , l_T� �'�Z�uS _ This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance. of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Company Name 0 vl.t"' Classification License Number (e.g. A, B, C-8) (xxxxxx) Exp. Date Carrier Name (xx11/xx/xx) (e.g. State Fund, CalComp) it Policy Number ` Exp. Date License Number Exp. Date (Format Varies) (xx/xx/xx) (xxxx) (xx/xx/xx) c �F z 2 0 � f!"L � U/ � � I t -� I V / � � 7 I ` / of I I E Date 6/20/14 No. 32153 Owner David Holst Address 79363 Liga City La Quinta Zip Tract # Type Residential Addition Lot # No. Street Unit 1 79363 Liga Unit 2 Unit 3 Unit 4 Unit 5 Comments CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 S.F. 245 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 Q BERMUDA DUNES RANCHO MIRAGE INDIAN WELLS PALM OESERT y LA QUINTA , QINDIO SP APN # 776-130-021 Jurisdiction La Quinta Permit # No. of Units 1 Lot # No. Street S.F. 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 following reason: t 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 245 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 - Michael Boyd Check No. Bank Name/Recipient of Certificate Telephone Funding Exempt BY Dr. Gary Rutherford ,. �*.• Superintendent Fee collected /exem d b < Payment Recd ' p Y S aro Gil e Y $o.00 �� :-� �_.0ver/Or der Signature U602 NOTICE: Pursuat to Government Code Section(d)(1), this will se e o notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to runthe date on whic a 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