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05-2486 (AR)4 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 0.5-0.00.0.24.86 _ �-44Y20 CAMINO LAVANDA-1 IL 60-47180=060=11--25290 - ADDITION - RESIDENTIAL LOW DENSITY RESIDENTIAL 6430 Tuyl 4 4 a" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: ARNE PERTRUS D e P.O. BOX 3882 PALM DESERT, CA Other struct JUL 131005 CITYO LLA Architect or Engineer Fllllef ~ ------------------ 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 m; I.irense is in fell 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 Contractor's 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 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 arX,.a11-plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 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 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 .l. (_ 1 I am exempt under Sec. , B.&P.C. for thi eason 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 Contractor: Owner 92261 info . 2001 CBC VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 C Date: 7/12/05 -------------------7--------------------------- WORKEf1'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 number are: Carrier � Policy Number �`f'Lrertify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so aa7e subject to the workers' compensation laws of California, and agree that, if I should ubj tothe workers' compensation provisions of Section 3700 of the Labor Code, 1fo h comply with those provisions.. WARNING: FAILURE 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 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 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 buil ons ction, and hereby authorize representatives of this county to an upon the above-mentioned prope -./---- ion purposes. Date W �gnature (Applicant or =gen tr Application Number . . . . . 05-00002486 Permit BUILDING PERMIT Additional desc . Permit Fee . . . . 90.00 Plan Check Fee 58.50 Issue Date . . . . Valuation 6430 Expiration Date 1/08/06 Qty Unit Charge Per Extension BASE FEE 45.00 5.00 9.0000 ---------------- ------------------------------ THOU BLDG 2,001-25,000 -------------------------- 45.00 Permit . . . ELECT - ADD/ALT/REM. Additional desc . Permit Fee . . . . 20.99 Plan Check Fee 5.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/08/06 Qty Unit Charge Per Extension BASE FEE 15.00 171.00 .0350 ' ---------------------------------------------------------------------------- ELEC NEW RES - 1 OR 2 FAMILY 5.99 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . - 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation . . 0 Expiration Date 1/08/06 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 ------------------------------------------------------- Special Notes and.Comments --------------------- CONVERT 3 RD. GARAGE TO BEDROOM.July. 12, 2005 10:05:45 AM. jjohnson . ---=------------------------------------------------------------------------ Other Fees ... . . . . . ENERGY REVIEW FEE 5.85 STRONG MOTION (SMI) - RES .64 Fee summary Charged Paid Credited ----------------- Due - Permit Fee Total -------- ---------- ---------- 143.99 .00 ---------- .00 143.99 Plan Check Total 72.00 .00 .00 72.00 Other Fee Total 6.49 .00 .00 6.49 Grand Total 222.48. .00 .00 222.48 LQPERMIT IQs LQPERAIIT Application Number . . . . . 05-00002486 Date 7/13/05 No. 27419 Owner Rene Perthus Address 44-120 Camino Lavanda City La Quinta Zip 92253 Tract # Type Residential Addition CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # Study Area No. of Units W��FIEvs-�� -4 < BERMUDA DUNES r RANCHO MIRAGE INDIAN WELLS ti d PALM DESERT y iLA IN 0 O Ty�ca 604-180-060 La Quinta 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 44120 Camino Lavanda 171 Unit 6 Unit 2 Unit 7 Unit 3 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 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: 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 171 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 - Arne Perthus Check No. Name on the check Telephone 880-6606 Funding Exempt �_K• WTJ a 1, Superintendent Fee collected /exempte y Sha r n cGi vrey ,,z Payment Recd _ $0.00 7 71 over/Undi;r7 Signature C- '�- : a , NOTICE: Pu ant to Government Code Section (d)(1), this will serve 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 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 DistrictCs) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy - Accounting