04-4900 (AR)Tay, 4 44"
BUILDING & SAFETY DEPARTMENT
P.O. BOX 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QU RE 11A 92253 INSPECTION REQUESTS (760) 777-7153
B ILDING PERMIT
ApplicationNue
�. L 04-00004900
Date 6/11/04
Property'Addres
57785 BLACK DIAMOND
APN:
762-370-007- - -
Application de cr ptio
a. ADDITION - RESIDENTIAL
Property Zonin L;
. . LOW DENSITY RESIDENTIAL
Application va
12282
Owner
Contractor
SOUTHERN HILLS DEVELOPMENT
SOUTHERN HILLS DEVELOPMENT INC
55161 SOUTHERN HILLS
81070 CHANTICLEER
DR
LA QUINTA
CA 92253 LA QUINTA
CA 92253
(760) 771-3497
WCC: EXEMPT
WC: EXEMPT
05/31/05
CSLB: 838041
05/31/06
CCC: B
------ Structure Information
NOOK ADDITION
-.----
Construction Type .
. . TYPE V-- NON RATED
Occupancy Type . .
. . . . DWELLG/LODGING/GONG <=10
Flood Zone
NON -AO FLOOD ZONE
Other struct info .
. . . . CODE EDITION
•2001 CBC
FLOOD ZONE
'NO
FIRST FLOOR SQ FTG
152.00
------------------------------=-----------------------------------=--
--------
Permit . . . . . .
BUILDING PERMIT
Additional desc
Permit Fee . . . .
144.00 Plan Check Fee
93.60
Issue Date
Valuation . .
. . 122.82
Expiration Date
12/11/04
Qty Unit Charge
Per
Extension
BASE FEE
45.00
11.00 9.0000
THOU BLDG 2,001-25,000
99.00
---------------7----------------------------------------7-------------------
Permit . . . . . .
MECHANICAL
Additional desc . .
Permit Fee
24.00 Plan Check Fee
6.00
Issue Date . . .
Valuation
0
Expiration Date .
12/11/04
Qty Unit Charge Per
1.00 9.0000 EA.
Extension
BASE FEE 15.00
MECH APPL REP/ALT/ADD .9.00
P.O. Box 1504 -VOICE VOICE (760) 777-7013
79-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 27O D Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.
BUILDING PERMIT DECLARATIONS
SED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am censed u er provisio s of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
C'e. and my Lim is in full force and etf D A
cense Class ns fY
Date L Contractor
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I amempt om 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 permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' 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).):
U 1, 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 sate (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 I am exempt under Sec. . BA P.C. for this reason
Date Owner
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' compen tion 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 in nce carrier and policy number are:
Cartier Poli Number
I certify that, in the performance of thew rk fors is
is permit isued. I shall not employ any person in any manner so as to become subject to the workers'
�15compensation laws of California, an ree t if I s u me to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisi
Date -A-014_ Applicant
WARNING: FAILURE TO SECURE WORKERS' CO EONS COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND OLLA ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, ORNEY'S FEES.
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
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 appli nt, each agrees to, and shall, defend, indemnity and hold harmless the City of La Ouinta, its
officers, agents and employees for any act or omission relat to the work being performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes n and void it wcommenced within 180 dayt from date of issuance of such permit or
cessation of work for 180 days will subject permit to cancel tion.
I certify that I have read this applicatiori and state that the above infati a e to comply all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to a poll ntioned prope for inspection purposes.
ate —1 liegnature (Applicant or Agent): r
E
Page
2
Application Number
04-00004900 Date
6/11/04
-- -------------------------------------------------------------------------
Permit . . . . . .
ELECT - ADD/ALT/REM
Additional desc
Permit Fee . . . .
33.07 Plan Check Fee
8.27
Issue Date . . .
Valuation . . . .
0
Expiration Date
12/11/04
Qty Unit Charge
Per
Extension
BASE FEE
15.00
152.00 .0350
ELEC NEW RES - 1 OR 2 FAMILY
5.32
17.00 .7500
PER ELEC DEVICE/FIXTURE 1ST 20
12.75
----------------------------------------------------------------------------
Special Notes.and Comments
152 NOOK ADDITION TO
EXISTING RESIDENCE
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . ENERGY REVIEW FEE
9.36
STRONG MOTION (SMI) - RES
1.22
Fee summary Charged
Paid Credited
Due
----------------- ----------
Permit Fee Total
---------- ---------- -----
201.07 00 .00
----
201.07
Plan Check Total
107.87 .00 .00
107.87
Other Fee Total
10.58 .00 .00
10.58
Grand Total
319.52 .00 .00
319.52
E
&-ach�e'lla
Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
Project Name: Alto Bn r�alul
Owner's Name: Alton Brann
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVELTWOAMOUNT:
MITIGATION AMOUNT:
COMM/IND. AMOUNT:
DATE,
RECR PT,
CHECK N-
TNITIAIS-
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Address: 57-785 Black Diamond, La Quinta, CA
Project Description: Room Addition
APN:
Tract #:
Date: June 14, 2004
Phone No. (760) 771-3497
Lot #'s:
Type of Development: Residential XX Commercial Industrial
Total Square Feet of Building Area: 152 Sq. Ft.
Certification of Applicant/Owners: The person signing certifies that the above' formation is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized to sign on behayrof the owVekdeveloper.
Dated: 06/14/04 Signature: J V y
**********************************************************************
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
,Rote: Pursuant to AB -181, any room addtion 500 sq. ft. or less
Number of Sq.Ft. 152 is exempt from developer fees..
Amount per Sq.Ft. $ 0.00
Amount Collected $ 0.00
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Business Services
Certificate issued by: Leticia C. Torres, Facilities Clerk Signatur :
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these
Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to
advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other
requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this
time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of
Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up
to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject
of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
14iV:c/mydoci devfc. s.cortificafe ofoompliancc onn tablesfi) USF,doc 1/16/03 T
I
T-vf 4 4 "
Building & Safety Department
78-495 Calle Tampico
PO Box 1504
La Quinta, CA 92253
(760) 777-7012 voice — (760) 777-7011 fax
CERTIFICATION OF BUILDING AREA
STREET ADDRESS OF JOB: 57-785 BLACK DIAMOND
APN: 762-370-007
DESCRIPTION OF WORK: RESIDENTIAL ADDITION
SQUARE FOOTAGE: 152 S.F.
OWNER'S NAME: ALTON BRANN
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
.,APPROVED
" 1,
-0q 13Y I
Coachella Valley Unified School District
83-733 Avenue 55
P0Box 847
Thermal, CA 9227.4
(760) 398 5909
SCHOOL FACILITY FEES COLLECTION HOURS:
8.00 A. M. - 4.00 P. M. Monday - Friday
PLEASE NOTE:
FEES MUST BE PAID IN CHECK OR CASHIERS CHECK. NO CASH.
For questions regarding this letter, please call:
Ed Randall, Counter Technician
(760) 777-7012