07-3221 (AR)P.O. BOX 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number!Z�---—07 00003221_
Property Address: 79200 CAMINO AMARILLO
APN: 604-192-018-54 -24517 -
Application description: ADDITION - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 100000
Applicant:
Architect or Engineer:
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
JEFFERS BRIAN S
79-200 CAMINO AMARILLO D
LA QUINTA, CA 92253
Contractor:
1ST ATRIUM INC
P.O. BOX 3882
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/14/08
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:
LQPEPUNI 11'
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 that the abninf is correct. I agree to Comply withall
city and county ordinances and state laws relating to buildingnd hereby authorize representatives
of thi u r upon t e above-mentioned propertytoposes.
te: Si .lure (Applicant or Agent): UJNA- -
DESERT, CA 92261
PALM
Lic- No.: 836088
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and fess ionals Code, and my License is in full force and effect.
_ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B C53 License No.: 836088
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ate: ntractor:
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier EXEMPT Policy Number EXEMPT
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
1 certify that, in the performance of t ork for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as ecome su 'ect to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should be ubject o the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 f the L bar Code, I shy hwith mply with those provisions.
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).:
ate: 1 1 plicant:
(_ 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
WARNING: FAILURE TO SECURE WORK S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS f$1 00,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
( 1 I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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:
LQPEPUNI 11'
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 that the abninf is correct. I agree to Comply withall
city and county ordinances and state laws relating to buildingnd hereby authorize representatives
of thi u r upon t e above-mentioned propertytoposes.
te: Si .lure (Applicant or Agent): UJNA- -
Application Number . . . 07-00003221
Permit . . . . . ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . . 41.85 Plan Check Fee 10.46
Issue Date . . . . Valuation 0
Expiration Date . . 10/08/08
Qty Unit Charge Per Extension
BASE FEE 15.00
767.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 26.85
----------------------------------------------------------------------------
Permit .
Additional desc
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT
639.50
10/08/08
Plan Check Fee . . 415.68
Valuation . . . . 100000
Qty Unit
Charge
Per
Extension
BASE
FEE
414.50
50.00
-----------------------=-----------------------------------------------------
4.5000
THOU. BLDG
50,001-100,000
225.00
Permit . . .
. .
MECHANICAL
PLB WATER HEATER/VENT
7.50
Additional desc
.
EA
PLB WATER INST/ALT/REP
3.00
Permit Fee
and Comments
52.50
Plan Check Fee
13.13
Issue Date
676 SQ.
FT.
Valuation . . . .
0
Expiration Date
10/08/08
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
3.00
----------------------------------------------------------------------------
6.5000
EA MECH
VENT FAN
19.50
Permit .
Additional desc
Permit Fee
Issue Date
Expiration Date
PLUMBING
79.50 Plan Check Fee . .
Valuation . . . .
10/08/08
19.88
0
Qty Unit
Charge
Per
Extension
BASE FEE
15.00
9.00
6.0000
EA
PLB FIXTURE
54.00
1.00•
7.5000
EA
PLB WATER HEATER/VENT
7.50
1.00
3.0000
EA
PLB WATER INST/ALT/REP
3.00
----------------------------------------------------------------------------
Special Notes
and Comments
REM / ADDITION
676 SQ.
FT.
ADDITION WITH
LQPERINITT
I
Application Number
07-00003221
----------------------------------------------------------------------------
Special Notes and
Comments
INTEROR REMODEL TWO
BEDROOMS AND
MASTER
BEDROOM ADDITION.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . .
ENERGY REVIEW
FEE
41.57
STRONG MOTION
(SMI) - RES
10.00
Fee summary
-----------------
Charged
----------
Paid Credited
------------------------------
Due
'Permit Fee Total
813.35
00
.00
813.35
Plan Check Total
459.15
.00
.00
459.15
Other Fee Total
51.57
.00
.00
51.57
Grand Total
1324.07
.00
.00
1324.07
LQPIiRD11T
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road Q BERMUDA DUNES r
C40 RANCHO MIRAGE (�
Date 4/15/08 La Quinta, CA 92253 NJ INDIAN WELLS
Vi PALM DESERT ,y
No. 29998 (760) 771-8515 v LA OUINTA
QINDIO y�
0
Owner
Jeffers
APN # 604-192-018
Address
79200 Camino Amarillo
Jurisdiction La Quinta
City
La Quinta Zip
Permit #
Tract #
No. of Units 1
Type
Residential Addition
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 79200 Camino Amarillo 767 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments (Corrected misspelling on city form from Amerillo to Amarillo)
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiost walkways, 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 $2.97 X 767 S.F. or $2,277.99 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 CC/Bank of America - Arnie Perthus Check No. 420904443
Name on the check Telephone
Funding Residential
By - Dr. Sharon P. McGehee
Superintendent
Fee collectec
Signature
e. - ' f
Payment Recd
=Overe-
$2,277.99 � � ./Undr--
:v
.i'+
NOTICE: Pursuant to Government Code Section 66020(d)(1), this 'll rve 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 ~ 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 colied 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
Letter of Transmittal
To: City of La Quinta Today's Date.gOf,
Your Files
' '
78-495 Calle Tampico City Due Date :
Jog
Checking
La Quinta, Ca 92253 Project Address:
❑
Attn:
Plan Check #:
07 - 37-2,1
Submittal: ❑ ist
❑ 4th
❑ 2nd
❑ 5th
K 3`d
❑ Other:
We are forwarding:
_--e
By Messenger ❑ By Mail (Fed Ex or UPS)
❑ Your Pickup
Includes: # Of
Descriptions: Includes:
# Of
Descriptions:
Copies:
Copies:
❑
Structural Plans
,�
Revised Structural Plans
❑
Structural Calcs
�- �_
Revised Structural Calcs
❑
Truss Calcs
❑
Revised Truss Calcs
❑
Soils Report
❑
Revised Soils Report
❑
Correction List
❑
Approved Structural Plans
Redlined Structural Plans
❑
Approved Structural Calcs
,�-
Redlined Structural Calcs
❑
Approved Truss Calcs
❑
Redlined Truss Calcs
❑
Approved Soils Report
❑
Redlined Soils Reports
❑
Other:
Comments: "!:ArUCAlAT�
PV.MC4., n",
Thank vou!
This Material Sent for:
❑
Your Files
❑
Your Review
❑
Checking
Other:
❑
By: b_}m, m; f224
Palm Desert Office: ❑ # (760) 360-5770
Washington Office: ❑ # (760) 404-9556
] Per Your Request
/❑l Approval
❑ At the request of: