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04-7363 (SFD)� s 9&,ye . tie BUILDING & SAFETY DEPARTMENT � P.O. Box 1504-: - - OFTI�'78-495 CALLS TAMPICO - (760),777-7012 FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . .004-00007363 Date 12/29/04 Property Address . . 5r245 AVENIDA RUBIO APN: 773-044-030- - - Application description . . . DWELLING•- SINGLE FAMILY DETACHED Property Zoning . . . . . MEDIUM DENSITY RES Application valuation . . . . 38576 Owner Contractor ---------------------------------- ------------ --------------------- QUILL PAUL DOUGLAS -- Owner. *NOT ON FILE UNKNOWN, CA.99999 e � FEB 0 4 1005 CITY OF IA ' - P.O. BOX 1504 C&f 4 4 " 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: _674/ Applicant: Applicant's Mailing Address: OAY Architect or Engineer. VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: it •44 d Arcnrtect or Engineer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 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 Contractors' State License Law for the following reason (Sec 7031.5, Business and p s 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 time pemmk to fde a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 70 00) 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 Ow applicant to a civil penalty of not more than five hundred dollars ($500).): ( j 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 or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or i 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 nmprovement a 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 f contractors) licensed pursuant to the Contractors' State License Law.). /� U I am exempt under Sec. , BA P .t-J6r this reason n WORKERS' 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 pernit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number I certify that, in the performance of the work f r which this permit is issued, I shall not employ an compensation laws of California, and that, if I should become sut>jeo the workers' compensation ym person m any manner so as to become subject to the workers' forthwith comply with those provis ZI ,,// Pensation provisions of Section 3700 of time Labor Code, l shat WAKNINUYFAILURE 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 COMPENSA, SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. TIONDAMAGES AS PROVIDED FOR IN I hereby affirm under penaltyof CONSTRUCTION LENDING AGENCY 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 v APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety or A permsubj1. Each person upon whose behalf this application is made, each person at whose request anto d for whose beneficonditions and work snperformed under or s set forth on this application to any pemdt 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 Le Quints, its officers, agents and employees for any act or omission related to the work being performed under or following issuance o/ 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 perhit to cancellation. I certify that I have read this application and state that the above infomma ' ms rrect. I agree t plywith all city and construction, and hereby authorize rep re ntatives of this county to er u n the above -me o ad p rty for spection purunty poses. and state Iowa relating to DuUding p rposes. ate - ignature (Applicant or Agent): r----------------------------------------------- s r: Application Number . . . . . 04-00007363 ---------------------------------------------------------------------------- ------ Structure Information GUEST HOUSE ----- Construction Type . . . TYPE V NON RATED Occupancy Type . . . DWELLG/LODGING/CONG <=10 Flood Zone . . . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 CBC # BEDROOMS 1.00 .FIRE SPRINKLERS NO GARAGE SQ FTG 60.00 .PATIO SQ FTG 425.00 NUMBER OF UNITS 1.00 1ST FLOOR'SQUARE FOOTAGE 555.00 -----------=---------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 343.00 Plan Check Fee 222.95 Issue Date . . . . Valuation . . . . 38576 Qty Unit Charge Per Extension BASE FEE 252.00 14.00 6.5000 THOU BLDG 25,001-50,000 91.00 ---------------------------------------------------------------------------- Permit . . . . . Additional desc Permit Fee Issue Date . MECHANICAL 39.50 Plan Check Fee Valuation . . Qty Unit Charge Per Extension BASE .FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00" 1.00 ------------------ 6.5000 EA ------------------------------------------------- MECH VENT FAN 6.50 Permit . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 50.63 Plan Check Fee 12.66 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 555.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 19.43 60.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 1.20 1.00 ---------------------------------------------------------------------------- 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 Permit . . . . . . PLUMBING Additional desc Permit.Fee . . . . 9.1.50 Plan Check Fee 22.88 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 6.0000 EA PLB FIXTURE 24.00 1.00. 15.0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3:0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER -SYSTEM 9.00 -----------==-----=------------------------- Application Number 04-00007363 ---------------------------------------------------------------------------- Permit PLUMBING Qty Unit Charge Per Extension 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 1.00 15.0000 EA PLB GAS METER ---------------------------------------------------------------------------- 15.00 Permit . . . . . GRADING PERMIT Additional desc Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments 555 SF. GUEST HOUSE WITH 425 SF. PATIO COVER PER APPROVED PLANS ----------------------------------------------------=----------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES .00 ENERGY REVIEW FEE 22.30 STRONG MOTION (SMI) - RES 3.85 Fee summary Charged Paid ------------------------=-- Credited Due -------------------- Permit Fee Total 539.63 .00 ---------- .00 539..63 Plan Check Total 268.37 .00 .00 268'.37 Other Fee Total 26.15 .00 -.00 26.15 Grand Total 834.15 .00 .00 834.15 -/ / CITY OF LA QU.INT-A SUB -CONT , CTOR �IS L JOB ADDRESS S12q 5 A�'eint-q 0. �bia PERMIT NUMBER i OWNER Gu BUILDER This form shall be posted on the job with the Building Inspection Card at all timesin a conspicuous place. Only persons appearing on this list or their employees a authorized to work on this iob. Anv 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 Comments Detached Guest House At the present time, the Desert Sands Unified School D'Is d does not collect fees on garages/carports, covered patiostwalkways, residential additions under 5 00 square feet; detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.24 X 555 S.F. or $1,243.20 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 Cash - Paul,Quill Check No. Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted S aro . CGilvr y r` Payment Recd 50.00 1,243.20 Over/Under 7 Signature NOTICE: Pursuant to Govemenf✓ mCode Section 66OWd)(1), this will serve to 6_* you that the 90 -day approval period in which you may protest the fees o' r other payment identified above will begin to run 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 if Duplicated, Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy - Accounting