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14-0515 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO }' LA QUINTA, CALIFORNIA 92253 �. Application Number: 14-00000515 Property Address: 81695 BROWN DEER PARK APN: 767-540-006- - Application description: ADDITION - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 25000 Tiht 4 4 Q" Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION 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 I lss: B License No.: 915143 Date4& Contractor OWN/ -BUILDER DECLARATION I hereby affirm under penalty of petitthat I am ex mpt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Busin s 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.). I _ 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. , BAP.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: LQPERMIT Owner: RANDY EIFLER 81695 BROWN LA QUINTA, CA ( DEER PAR 92253 Contractor: SURF TO SAND GENERAL 74355 PAROSELLA STREE PALM DESERT, CA,92260 (760)218-3535 LiC. No.: 915143 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/30/14 ----------------------------------------------- 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 EXEMPT Policy Number EXEMPT _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agreethat, if I houId become subject to the workers' compensation provisions of Section &700 of the Labor ode, I shall forthAtk comply with those provisions. Date • Applicant: WARN G: AILURE TO SECURE RKERS' COMPENS ION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI L PENALTIES AN CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION 0 THE COST 0 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 null and void if work is not commenced within 160 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 t [the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to%uilding construction, and hereby authorize representatives of this county t enter upon the above-mentioned pro rty for in�irposes. Date: B Signature (Applicant or Agen P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 14-00000515 Property Address: 81695 BROWN DEER PARK APN: 767-540-006- - - Application description: ADDITION - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 25000 Tit!t440" Applicant: Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION 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 I s: B License No.: 915143 Date l Contractor OWN •BUILDER DECLARATION I hereby affirm under penalty of peri that I am ex pt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Busin s 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 (5500).: 1 _ 1 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 _ 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.). I—) 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: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/30/14 Owner: RANDY EIFLER 81695 BROWN DEER PARK LA QUINTA, CA 92253 (760)346-2856 Contractor: SURF TO SAND GENERAL CONTR INC 74355 PAROSELLA STREET PALM DESERT, CA 92260 (760)218-3535 Lic. No.: 915143 ----------------------------------------------- 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 EXEMPT Policy Number EXEMPT _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I h0uld become subject to the workers' compensation provisions of Section .700 0f the Labor ode, I shall forthAft comply with those provisions. Date Applicant: WARNAGAILURE TO SECURE RKERS' COMPENS ION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI L PENALTIES AN CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 15100,000). IN ADDITION O THE COST 0 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 Ouinta, 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 t t [he above information is correct. I agree to comply with all city and county ordinances and state laws relating to%wilding construction, and hereby authorize representatives ofthis county t enter upon the above-mentioned pro rty for ins a ti rposes. Date: B Signature (Applicant or Agen Application Number . . . . . 14-00000515 Permit . . . ROOM ADDITION 2013 Additional desc . Permit Fee . . . . 181.61 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration Date . . 12/27/14 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 12/27/14 Qty Unit Charge Per Extension 1.00 23.8300 LS ELEC FIXTURES, FIRST 20. 23.83 ---------------------------------------------------------------------------- Permit . . . MECHANICAL 2013 Additional desc . . Permit Fee . . . . 47.67 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/27/14 Qty Unit Charge Per 'Extension 1.00 11.9200 EA MECH APPL REP/ALT 11.92 1.00 35.7500 EA MECH CONDENSER/COMP 35.75 ---------------------------------------------------------------------------- Permit PLUMBING 2013 Additional desc . . Permit Fee . . . . 23.84 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/27/14 Qty Unit Charge Per Extensions — 1.00 11.9200 EA PLBG ROOF DRAIN 11.92 ° 1.00 11.9200 EA PLBG WATER INST/ALT/REP 17. 92, -----------------------------------------------------------------------Y-- -- Special Notes and Comments ,; c OFFICE AND WINE ROOM ADDITION. June 27, 2014 8:22:11 AM jjohnson. w ' !_ k ---------------------------------------- --------- --- - Other Fees . . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.001`• •moi' s LQPERMIT Application Number y---------------------------------------------------------------------------- 14-00000515 Other Fees . . . . . . . HOURLY PLAN CHECK 105.00 On$ PLAN CHECK, ELECTRICAL .60 PLAN CHECK, ROOM ADDITION 185.90 PLAN CHECK, MECHANICAL 28.60 PLAN CHECK, PLUMBING 11.92 STRONG MOTION (SMI) - RES 2.50 Fee summary ----------------- Charged ---------- Paid ---------- Credited -------------------- Due Permit Fee Total 276.95 .00 .00 276.95 Plan Check Total .00 .00 .00 .00 Other Fee Total 335.52 .00 .00 335.52 Grand Total 612.47 .00 .00 612.47 LQPERMIT Bin # Oty of La QuInta Building 8r Safe Division Safety P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # - � �� Project Address:00 (- �� �j�t7(U ��-Owner's Name: �'� i F_kk B r be A. P. Number: "7C I— S 4 V - aO � Address: � -(�S W©U%� Legal Description: Contractor: StTelephone: City, ST, Zip: 614 �Q C Address:7Y6Y tosel I- Project Description: City, ST, Zip:-Q�T �7 ,Telephone: State Lic. # : City Lic. #; A PR 2' 8 2014 ., Designer: vo5 Ft r -IM OF EA Address: -77-67,7, t5aU Y i C _W5 Qtj!NTA COMMUNmr DEVELOPMENT City., ST, Zip.-eN lr ' \T�l� j};� :i'Y.4n.Y'?.v: pYYrirvY:4.v •b: T76¢ State Lic.?T:. f ; .rd .M 4._ Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.:e770� AV190# Stories: l # Units: Telephone # of Contact Person: �� 28 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted % Item Amount Structural Calcs. Reviewed, ready for corrections 5L Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 21" Review, ready for correction /issue C Electrical Subcontoctor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. &T H.O.A. Approval Plans resubmitted I Grading L IN ROUSE:- '"' Review, ready for correctionsfissue Developer Impact Planning Approval Called Contact Person IN A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees y 00 Coachella VdJnified School District 83-733 Avenue 55, Thermal, CA 92274 (760) 398-5909 — Fax (760) 398-1224 This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT LEVEL ONE AMOUNT: LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMM/IND. AMOUNT: DATE: RECEIPT: CHECK#: INITIALS CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: M & M Randy Eifler, Date: June 30, 2014 Owner's Name: Phone No. Project Address: 81-695 Brown Deer Park, La Quinta, CA 92253 Project Description: APN: 767-540-006 Type of Development: Room Addition Tract #: Lot #'s: Residential XX Commercial Industrial Total Square Feet of Building Area: ' 304 SQ. Ft. Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer., Dated: 4,V Signature: *********** ******************** �BEENOR SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABPROJECTHA 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 Note: Pursuant to AB -181 any room addition of 500 Sq. Ft. Number of Sq.Ft. 304 or less is Exempt from Developer Fees. Amount per Sq.Ft. EXEMPT Amount Collected 0.00 Building Permit Application Completed: Yes/No By: Elsa F. Esqueda, Director of Facilities and Maintenance Certificate issued by: Leticia Torres, Facilities Analyst Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires tha his D' riot 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- ay 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. V:cinivdocs,`devlees./certificatuol•compliancc Perm updated 3-2007 11/2010 Uk PGA WEST. FAIRWAYS ASSOCIATION April 9, 2014 Randy and Susan Eifler Re: Architectural Application — 81695 Brown Deer Park Dear Homeowner: The Architectural Committee has reviewed your request to enclose the side.patio area to form additional living space. I am pleased to inform you that the Committee has approved the application as submitted . subject to the submittal of Final plans and the license and insurance .information for your.contractor. Enclosed is Exhibit C — the Compliance Review Request form. Please complete this form after the work is completed and return it by mail or fax to the address below so the completed project can -be inspected. . If you have .any questions, please contact Cassie Gerti at 760-776-5100 Ext. 6345 or email Cassie.GegZ@,Manag_ementtrust.com Sincerely, For the Architectural Committee eGA WEST Fairways Association McDpnald, CCAM, PCAM Enclosure: Exhibit C — Compliance Review Request cc: Lot File Architectural Committee Post Office Box 1690 - La Quinta, Califothia 92247 - Phone (760) 776-5100 - Fax (760)776-5111 - www.pgawestfairways.com