12-0553 (AR)I,_ .- -.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:12-00000553
Property Address:
80395`CAMARILLO WY
APN:
777-330-036- -
Application description:
ADDITION - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
35000
Tavl °F 4v Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
A U 6 0 3 z721,
CITY OF LA
FIN4NCE
--------------------------------------------------
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.
License CCl�lassss,.::� B L' se No.: 810010
Date:/ �[r[a ontractor: 'W d
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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
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.).
(_) 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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:
DZIAKYK GLEN
Contractor:
CALIFORNIA TECHNOLOGY BLDRS
83750 CITRUS STREET, STE #5
INDIO, CA 92201
(760)238-6854
Lic. No.: 810010
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/03/12
-----------------------------------------------
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- E}��MPT 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 should become subject to the workers' compensation provisions of Section
��37%f00 of the Labor Code, I ort ith cc m ly with those provisio
ate: &y'�T_7i licant:
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 building construction, and hereby authorize representatives
D�oft is county to enter upo he above-mentioned property for ins ction purposes.
: I nature (Applicant or Agent): c/�l9 `t f
Application Number . . . . . 12-00000553
Permit . . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee
19.48 Plan Check
Fee
4.87
Issue Date . . . .
Valuation
. . . .
0
Expiration Date
1/30/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
128.00 .0350
----------------------------------------------------------------------------
ELEC NEW RES - 1 OR 2
FAMILY
4.48
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
317.00 Plan Check
Fee
206.05
Issue Date . . . .
Valuation
. . . .
35000
Expiration Date
1/30/13
Qty Unit Charge
Per
Extension
BASE FEE
252.00
10.00 6.5000
------------------------=---------------------------------------------------
THOU BLDG 25,001-50,000
65.00
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . .
19.50 Plan Check
Fee
4.88
Issue Date
Valuation
. . .
0
Expiration Date
1/30/13
Qty Unit.Charge
Per
Extension
BASE FEE
15.00
1.00 4.5000
----------------------------------------------------------------------------
EA MECH VENT INST/ DUCT ALT
4.50
Permit . . .
PLUMBING INV FEE
Additional desc .
Permit Fee . . . .
72.00 Plan Check
Fee
9.00
Issue Date
Valuation
. . . .
0
Expiration Date
1/30/13
Qty Unit Charge
Per
Extension
BASE FEE
30.00
3.00 12.0000
EA PLB FIXTURE
36.00
1.00 6.0000
EA PLB WATER INST/ALT/REP
6.00
----------------------------------------------------•----------------------=-
Special Notes and Comments
ADDITION TO EXISTING
SFD. 128 SF TOTAL
(80SF BATHROOM + 48SF
STORAGE). TYPE V -B
LQPERMIT
Application Number . . . . . 12-00000553
------------------------------------------- --------------------------------
Special Notes and Comments
CONSTRUCTION, R-3 OCCUPANCY. 2010 CODES.
8/01/2012: GROUND PLUMBING INSTALLED
PRIOR TO PERMIT ISSUANCE. INVESTIGATIVE
FEE ASSESSED TO PLUMBING PER CRC R108.6.
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN
(SB1473)
2.00.
ENERGY REVIEW
FEE
20.61
STRONG MOTION
(SMI) - RES
3.50
Fee summary Charged Paid
-----------------
Credited
Due
------------------------------
Permit Fee Total .427.98 .00
----------
.00
427.98
Plan Check Total 224.80 .00
.00
224.80,.
Other Fee Total 26.11 .00
.00
26..11
.Grand Total 678.89 .00
.00
678.89
I
- LQPERMIT -
f
Bin #
C1ty-0 f. La Quinta
Boll 909 ar safety DW&f 4
Perinit #-
P.O. Box 1504,18-495 Calle Tamplw
-
4.QLdnta, CA 92253 - (760) 777-7012
B(IlIcUng Permit ,A.6PJ1qt1onand Tracking Sheet
pwjecttlddtess: Q .."5015 CA 9P W. Owner's Name
.A& P. Number. Add=40 39!5
1-??- 310. 031P, (AWAILLP WAM
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Legal
4gal Desaiption: CiV.sr, Zip:LA& (A
Contractor:
ontractor. Telephone.
Addrew'. I JtP4De=ipfion:APPMDW
City, 4T, 2p:
Telephone:
State Lie. # -ic. 1k.
la Lie EE.
Amfi� 13W., Desipwi Lon ft,
'Addi-m-78 L5- CAUt— i!4�TAW f 105
City, ST. Zip: bA 040 r CA
Telephone 'S Comsbvetion Type . -Y Occupancy M_
_t W
State Lic.#: cd ripe (pie one): New Alter Repair Demo
i Name of Contapt Pczwan:FL. # Sterii.-# jn1tA:
J!gA *7
Telephone # of Contact Person: on: Iffia VOTUO of PMjaCt
APPLICANT. DO NOT WRITE BELOW THIS. LINE
N Submittal Reed '-Reed TRACENG PERM TFM-
Plan Sets Plan Check submitted- Amount
Structutal COM Reviewed, raft for corrections Cj PLMChcckD4pwit.
Trust Calve. coed C=ftd Person Plan check Salute.
Plan
Tide U Cdci. rlans plaid lip ConsdrMcdozi
C,
Flow Plain plan Flaus resubmitted Mechanical
- 7. rm:
Grading plan
Review. —dyfor wnulfteuCowt
L-11 ]KIftbital
Subcoutactor fist
Grant Deed
Caned Contact pMon
Plans Ottked up
Plumbing
WIN bou—
H.WAL Approval
V" Mus resubmitted
Gradlug
#i EJOUSIL.-
Rcytcw; ready for cerrcctio!jLm
'
ucvdoper Impact FeeA
PlanningApproval.
called Contact PermaL
8i
tr Vf12. - �1
Pub. Wks. Appr -
Date of ptrwit issue
ffv
Saw fees
Lb\
Total Permit Fees
MAY 1'8 2.012
By_
Coachella Valley Unified 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:
COMMAND. AMOUNT:
DATE:
RECEIPT:
CHECK #:
INITIALS
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Mountain View Countr,-y Club,
Owner's Name: Glen & Zenia Dziadyk
Project Address: 80-395 Camarillo Way, LaQuinta, CA
Project Description: Addition to existing SFD
APN: 777-330-036
Tract #:
Date: June 28, 2012
Phone No.
Lot #'s:
Type of Development: Residential xX! Commercial Industrial
Total Square Feet of Building Area: 80
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: June 28, 2012 Signature:
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
17620 65995
Number of Sq.Ft. 80
Amount per Sq.Ft. $0.00
Amount Collected $0.00
Project Agreement Existing Not Subject to Fee
Approval Prior to 1/1/87 Requirement
Building Permit Application Completed: Yes/No
By: Elsa F. Esqueda, Director of Facilities and Maintenance
Note:
Pursuant to AB 181 any room additions or enclosures of 500
sq. ft. or less are exempt from developer fees. Any mobile
homes being relocated within the same school district's
jurisdiction are exempt from developer fees.
Certificate issued by: Laurie Howard, Secretary Signature:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
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.
MV:c/n N-docsldevfees/certificate of compliance form Updated 3-2007 11/2010
JUN/2V2012/THU 09;27 AM The Monarch Group FAX No.760 776 5111 P.001/002
The Management Trust
MONARCH GROUP DIVISION
June 28, 2012
GLEN & ZENIA DZIADYK
RE: Architectural Submittal for 80-396 CAMARILLO WAY
Account#636971
Dear Homeowner.
The Architectural Review Committee for MOUNTAIN VIEV1l HOA has reviewed and APPROVED your architectural
submittal for the installation of extention of existing den as well as a new closet and bath per, the plans submitted.)
have also Included the Notice of Completion form to be filled out when the job is complete.
With the following condit[onm
if there Is any changing to the exterior materials or color to addvlse us through an additional Architectural
Applleation.
All construction must commence within 120 days of this appro4W letter. If construction has not been commenced
within the 120 days, such approval shall be deemed withdrawn.
ARC approval of plans shall not constitute a representation, warranty, or guarantee that such plans and specifications
comply with englneering design practices or zoning and building ordinances, or other govemmental agency regulations
or restrictions. The ARC shall not be responsible for reviewing, nor shall its approval of any plans or design, be
deemed approved from the standpoint of structural safety or conformance with building or other codes. By approving
such plans and specifications, neither the ARC, the Members thereof, the Association, any Member thereof, their Board
of Directors, any Members thereof, or the Declarant assumes any liability or responsibility therefore or for any defect in
the construction or improvement.f om such plans or specifications. As provided in the CC&R's neither the -ARC, the
Association, the Board of Directors or the Association or any Members thereof, not the Declarant or Developer shall be
liable to any Member, Owner, Occupant, or other person or entity for any damage, loss or prejudice s uffered or
claimed on account of (1) the approval or disapproval of any plans, drawings, or specifications, whether or not
defective, or (2) the construction or performenoe of any worn whether or not pursuant to the approved plans, drawings,
or specifications.
Your patience and coopenAon with the architectural review process is appreciated. If you have any questions, please
contact the association at (760) 776-5100, Extension 333.
Sincerely,
On behalf of the MOUNTAIN VIEW HOA Architectural Review Committee
Heather Yslas I Assistant Manager
Jamie Hansen
The MenagementTrust - Monarch Group Division
Enclosures (1)
cc: Board of.Direcbrs
Unit File
39763 Berkey Drtw, Surte A.. Palm Desert, CA 92211
CONNEMMPEOPLVOTHeMONM PH. 60.776.5100 mx:760.776.6111
www.manegemennrusteom
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