05-1070 (AR)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"5-0'0 01070
44445 CAMINO LAVANDA
604-193-030-24 -25290 -
ADDITION - RESIDENTIAL
LOW DENSITY RESIDENTIAL
22714
Titlt'4 4 Q"
Architect or Engineer
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
auG 2Q 2005 D
QUINTA
--------------------------------------------------
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.
Lic
enseClas: - - - - - - - - - - ense Na.: FOOTAGE
Date: V .f ontractor:
OWNER -BUILDER DECLARATION
kreby 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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001.:
(_ 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, 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 contractors) licensed
pursuant to the Contractors' State License Law.).
( ) 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:
LQPGRAIIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/18/05
Owner:
PHILLIPS KENNETH K
44-445 CAMINO LAVONDA
LA QUINTA, CA 92253
Other struct info .
Contractor:
Owner
DITION 2001 CBC
Lic. No.: E FOOTAGE
C
------------------
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 NO Policy Number
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 should become subject to the rkers' compensation provisions of Section
� PO of the Labm-", I sh rthwith com y ith 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 ($100,0001. 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. 1 e to comply with all
city and countyofdinances and state laws relating to building construc ' , and hereby th ize representatives
ofthhis c my y6 enter upon the above-mentioned pro er 'nspec o purposes. \
t:
v
Application Number . . . . . 05-00001070
Permit . . . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . .
234.00 Plan Check Fee
152.10
Issue Date.
Valuation . . .
22714
Expiration Date
2/14/06
Qty Unit Charge
Per
Extension
BASE FEE
45.00
21.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
189.00
Permit ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee. . .
27.08 Plan Check Fee
6.77
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
2/14/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
345.00 .0350
----------------------------------------------------------------------------
ELEC NEW RES - 1 OR 2 FAMILY
12.08
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . .
33.00 Plan Check Fee
8.25
Issue Date
Valuation . . .
. 0
Expiration Date
2/14/06
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
.FAMILY ROOM ADDITION AND FREE STANDING
GAZEBO.August 18, 2005
8:59:54 AM
jjohnson
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . ENERGY REVIEW FEE
15.21
STRONG MOTION (SMI) - RES
2.27
Fee summary Charged Paid Credited
------------- - ------------------------------------
Due
------
Permit Fee Total
294.08 .00 .00
294.08
Plan Check Total
167.12 .00 .00
167.12
Other Fee Total
17.48 .00 .00
17.48
Grand Total
478.68 .00 .00
478.68
LQPMNfIT
Application.Number . . . . . . 05-00001070,
LQPERAIIT
I Bin #,, '
City- of La Quetta
Building &r Safety Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
(070
Project Address: 44 6r6.k� I U LAAJ&P4 Own 'Vsame:
A. P. Number:44 .44,5e,'1&(#A(- o (./SJUit,
41c,4 Vq S -2 6 0 Address:
Legal Description: Lzf- -x+ � "5b City, ST, Zip: L, -
f
Contractor: Telephone: -;
Address: Project Description: FAX �4Z
City, ST, Zip:
Telephone:—xdo-3�;o -a<.-64e-
ygrzw —*M&J�b(tn- a6—zeza
State Lic. # City Lic. #:
Arch., Engr., Designer: t5yx— eovtjfll,
Address:
City, ST, Zip:
Telephone: (740, lame - I Construction Type: Occupancy:
. ... ... ....
-X ..... -X
. . . . . . . . . . . .
State Lic. #: ..... Ploject.type (circle one): NeNv(Ad7) Alter Repair Demo
................ ...................... . . ....
Name of Contact Person: (41*' Sq. Ft.: s-1580, # Stories: # Units:
Telephone # of Contact Person: -74,4/- fy'-9�44L Estimated Value of Project: a
APPLICANT: DO NOT WRITE BELOW THIS LINE
N I
'Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
2-
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, _ieadY0<"4'tions )
Plan Check Deposit
2-
Truss Coles.
Called Contact
Plan Check Balance
Title 24 Calcs.1";
CO
Plans picked up fConstruction
Flood plain plan
Plans resubmitted Vito
Mechanical
Grading plan
2"' Review, ready or corrections/iss e
Electrical
Subcontactor List
Called Contact Pe o�- ;M "
Plumbing
Grant Deed
Plans picked upS.M.I.
H.O.A. Approval
Plans resubmitted LUA
50
Grading
IN HOUSE:-
Review, ready for correctio�/issue)
Developer Impact Fee
Planning Approval
Called Contact Person
A.T.P.P.
Pub. Wks. Appr
Date of permit issue A
School Fees
Total Permit Fees
I Bin #,, '
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/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:
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 345 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 -Bob Sipovac Check No.
Name on the check Telephone 567.2347
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted aron CGIIVfeyPayment Recd $0.00, L_
l�'bver/Undter`-
Signature;'
NOTICE: Pursuant to Government Code Section 66020(d)(1),`tdfs will serve to notify you that the D-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 District(s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy - Accounting
CERTIFICATE OF COMPLIANCE
N�Fs
Desert Sands Unified School District
OKI- n7,X0
47950 Dune Palms Road
< BERMUDA DUNES
Date
8/23/05
La Quinta, CA 92253
RANCHO MIRAGE CJ
INDIAN WELLS
6;
No.
27583
(760) 771-8515
PALMDESEITT
d LAQUINTA y
&SQINDIO
_ yr��
4
Owner
Kenneth Phillips
APN #
604-193-030
Address
44-445 Camino Lavanda
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
Tact #
Study Area
Type
Residential Addition
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1 24
44445 Camino Lavanda
345 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 patios/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:
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 345 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 -Bob Sipovac Check No.
Name on the check Telephone 567.2347
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted aron CGIIVfeyPayment Recd $0.00, L_
l�'bver/Undter`-
Signature;'
NOTICE: Pursuant to Government Code Section 66020(d)(1),`tdfs will serve to notify you that the D-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 District(s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy - Accounting