04-6047 (AR)Tihf 4 4 a"
BUILDING & SAFETY DEPARTMENT
1504 (760),777-7012
kLLE TAMPICO FAX (760) 777-7011
A, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number
0.4-_00006047 1 Date
1/27/05
Property Address
. . . . 53240 AVENIDA RAMIREZ-
APN:
774-052-012-13 -000000-
Application description
. . . ADDITION- RESIDENTIAL
Property Zoning . . .
. . . . COVE RESIDENTIAL
.Application valuation
. . . . 15616
Owner
Contractor
GREEN MARIA L
OWNER
53-240 AVE RAMIREZ
LA QUINTA
CA 92253
------ Structure Information
273 SQ. FT. ADDITION
-----
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
FLOOD ZONE NO
1ST FLOOR SQUARE FOOTAGE
273.00
----------------------------------------------------------------------------
Permit . . .
BUILDING PERMIT
Additional desc
Permit Fee . . . .
171.00 Plan Check Fee
111.15
Issue Date . . . .
Valuation . .
15616
Expiration Date
7/27/05
Qty Unit Charge
Per
Extension
BASE FEE
45.00
14.00 9.0000
THOU, BLDG 2,001-25,000
126.00
----------------------------------------------------------------------------
Permit . . . . .
ELECT - ADD/ALT/REM
Additional desc
Permit Fee
24.56 Plan Check Fee
6.14
Issue Date . . . .
Valuation
0.
Expiration Date
7/27/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
.273.00 .0350
ELEC NEW RES - 1 OR 2 FAM=LY
9.56
Permit . . . . . .
MECHANICAL
Additional desc
Permit Fee . . . .
24.00 Plan Check'Fee
6.00
Issue Date . . . .
Valuation
0
Expiration Date . .
7/27/05
Qty Unit Charge Per Extension
P.O. BOX 1504
78-495 CALLE TAMPICD
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Oq- &0 4 7
Hppimant's Mailing Address:
" J• , e
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
Architect or Erigineer.
Architect 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 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 pernk to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 8 (commencinwith S)
and Professions Code) or that he or she is exempt therefrom and the basis for the al of Division 3 of the Business
applicant to a civil penalty of not more than five hundred dollars ($500).): . Any g ection 7000
alleged exemptionviolation of Section 7031.5 by any applicant for a permit subjects
Of4 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 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.).
U 1, 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.).
U 1 am exempt under Sec. , BA P.C. for this reason
I e
V 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 pefformenoe
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 perfor mance of the work for which this pemdt 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 an
compensation laws of California, and agree that, if I should become subject to the workers' com person m any manner so ec io become subject to the workers'
forthwith comply with those provisions. // compensation provisions of Section 3700 of the Labor code, 1 sha0
WARNING: FAILURE TO SECURE WORKERS' COMI76NSATION 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 COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
1 herebyaffirm under CONSTRUCTION LENDING AGENCY
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 VA
Lender's Address
IMPORTANT APPLICANT ACKNOWLEDGEMENT
Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this a
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
ication
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold hamdess the City u s Quints, 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 will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct I agree to comply with all city and county ordinances and state laws relating to bulldin
construction, and hereby authorize representatives of this county to enter upon the above-mentioned propejp for ins
j� pection purposes. g
Dat C/� ignatum (Applicant or Agent):
Page
2 .
Application.Number . . . . . 04-00006047
Date
1/27/05
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH APPL REP/ALT/ADD
9.00
----------- -----------------------------------------------------------------
Permit .. . . . PLUMBING
Additional desc
Permit Fee 18.00, Plan Check
Fee
4.50
Issue Date . . . . Valuation
. .
0
Expiration Date 7/27/05
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 .3.0000 EA - PLB GAS PIPE 1-4 OUTLETS
3.00
Special Notes and Comments
273 SQ. FT. ADDITIONI/27/05 2:51:47 PM
JJOHNSON
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ENERGY REVIEW FEE
-
11.12
STRONG MOTION (SMI)
- RES.
1.56
Fee summary Charged Paid Credited
Due
Permit Fee Total 237.56 .00
:00
237.56
Plan Check Total 127.79 .00
.00
127.79
Other Fee Total 12.68 .00
.00
12.68
Grand Total 378.03 .00
.00
378.03
FR -OM COUhIRYW I DE HOME LOANS (FR I) FEB 25 005 11 :37/ST. 11 ::36/No,.6811516800 P i
City of La Quints
Calle Tampico
La Quinta, CA 92253
Re: 53240 Avenida Ramirez
La Quinta CA 92253
ti
To Whom It May Concern:
I Maria L. Green is giving authorization to my daughter Windy Marie Green to obtain the
Permit to our addition in our house located at 53240 Avenida Ramirez., La Quinta CA
92253.
Any questions please call me at
Thank you
aria .
v
�
City of La Q CIli1to
Building a Safety Division
Perm # P.O. Box 1504, 78-495 Calle Tampico
�(f La Quinta, CA 92253 - (760) 777-7012.
r.. l Building Permit Application and Tracking Sheet
Project Address: 5" 3 246 e, tit ' tf'Z 0%%-ner's Name. +
icdc`4 L FF'y
A. P. IJumbcr: 774--o52 Address:
Legal Description: City, ST, Zip: �� � 2 2 S 3
X Contractor. c� FTcic5-?Z1_ phone: (op r; tl —
x Address:
Project Description: (4i'0V
� City, ST, Zip: L ,
X Telephone:
%(. State Lic. # : City Lic. #:
Arch., Engr-, Designer (' D C
Address:
IRS
O
Cit), ST, zip: G=L Z3b
Telephone• ZO .i7 26 5-db/a,:= .;
-�:�' - ^ ; Construction Type: Occupancy:
State Lic. roject type (circle one)\ New Add'n Alter Repair Demo
A Name of Contact Person:� ��
t'� e Sq. Ft.: / Stones: # Units:
x Telephone # of Contact. Person:
roject:
q? APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Rec'd TRACKING
PERMIT FEES
Plan Sets Plan Check subminedOR*
�. _.Stru tural Calcs:
uem Amount
_ .....: ..:......<Y
Reviewed; ready for correck
cctioas i Plaa ChDc
:. 4, posit
Truss Calcs Called Contact Person
Plan Check Balance
Energy Calm Plans picked up
S O{� Construction
Flood plain plan Plans resubmitted .
J.21)(A
Grading plxv 2' Review, ready foorrection �srue
,} PAP Electrical
Subcoataetor List „ .Called Contact Pmon".pGj�`a !'! �� Plumbic
......... .......... g
Grant Deed Plaas#picked up
.. _..._ �� S.M.1.
H.O.A. Approyal' - f' � r
_rl+ !l) Plans tesubmitied t
1 111.3 Grading
IN HOUSE: -_f _ ......•..•....—Revieri•,Iready foreorr ctioa_ usue Developer Impact Fee
Planning Approval '+
Called Contnet�Ptrsoa,w ...., .. '� A.I.P.P.
Pub..�i'ks�. Apprr I el? 'Date of permit iss rl
t
School Fees E"1tils , ..............
AJ2 Gr
.. _ .� J% #_(_i:S �:! !lw�Dl:'lf.�. Vs'it;i "rte � . �•'Ci�I: � V L I
----_ ......«t or.a, l/ _ Total Pt iTa Ftts '
r-1,' pf';sw�it�; 9 7 T
9��' �� � R-F� �-/i /off �'� �► y l�-ti' .
1s�u snr" T 60
w
J
PLAN CHECK SUB
READY FOR CORR
CALLED OWNER.//
PLANS PICKED UP
PLANS RESUBM
REVIEWED, READY
CALLED OWNER ...
DA6 E ISSUED........
MITTED /„/,,,NN/„,
ITfED
ECTIONS,,,,,,,,,,,,;
IIIININIINIIN11111111/
Y
............................
it
N'•
;
s °
.............
z�
TO ISSUE;,,,,,,,,
.........................
�.
...........................
1
�Zi R (� QL/lv5 Csrfcf ?3
Asp P
Y
it
N'•
;
s °
i
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Date 2/25/05 La Quinta, CA 92253
No. 26928 (760) 771-8515
���FiEos�
-_ C
BERMUDA DUNES
RANCHO MIRAGE
r INDIAN WELLS '.
PALM DESERT y
dt�(�.� LA QUINTA
(,�.
fS INDIO
Owner
Maria L. Green
APN # 774-052-012
Address 53240 AVenida Ramirez
Jurisdiction La Quinta
City
La Quinta Zip 92253
Permit #
Tract #
Study Area
Type
Residential Addition
No. of Units 1
Lot # No. Street S.F.
Lot '# No. Street S.F.
Unit 1
53240 Avenida Ramirez 273
Unit 6
Unit 2
'3
Unit 7
Unit
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 patiostwaltways, 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:
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 273 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. - Windy Green Check No.
Name on the check Telephone 771-3921
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
fey Payment Recd 0.00
C Over/Under
n
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will se a to notify 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 issaed, 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
OWNERBUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the b-ailder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are persoaally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name. .
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licen,-ed'as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer, and you are subject
to several obligations include State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and thesexisks are Especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contracts are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractcr, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owr.er/Builder" building
permit, erroneously, implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own -work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State L,cense Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm :hat you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253 .
(760) 777-7012
FAX: (760) 777-7011
r 0 A_ /I • II 4
OWNER'S
S3' a410
PROPERTY ADDRESS
04- &0417
PERMIT NUMBER(S) .