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10-0540 (RER)- I ;; P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 ApplicationNUm— ber: 10200000540 Property Address: 81440 CARBONERAS APN:. 764-490-016- - - Application description: REMODEL'- RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 46000 Td�v 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Enginegr: ��JtR4�=�� l`�kARE� � ��L9�✓L�1�L. Bs42Ank 6NDe 91757 Owner: LEBEDOVICH, STEPHEN & DARLENE Contractor: TD DESERT DEVELOPMENT LP P O BOX 1716 LA QUINTA, CA 92247 (760)771-1941 Lic. No.: 762987 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/09/10 ----------------- ------------------------------------------------------------------------------- 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 Profession d my License is in full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: B License No.: 762987 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is , �/ a issued. ✓ Dater / Contractor _ 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 O14L1__,S11,IUDER 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 CA REST MUTUAL Policy Number CRO1094517 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work 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 to become subject 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 Ishould ,P subject to orkers' c ensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 00 of the Labor Cod (I shall fo hwit omply with those pr isions. 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).: Date. Applicant: (_) 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 WORKERS' C P ION 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 HUNDR D THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). 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.). (_ 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 contractor(s) licensed pursuant to the Contractors' State License Law.). 1 _ 1 I am exempt under Sec. B.&P.C. for this reason Date: Owner: is r CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the perf v an a�of lie / work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT 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 r� of La Qui ma, its officers, agents and employees for any act or omission related to the work being .` performed under or following issuance of this permit. �NAny 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. �certif that I have read this application and state that the above informsect.I agree to comply with all nd county ordinances and state laws relating to buildin cons ionand hereauthorize representatives /coouln y t enter upon upon the above-mentioned erty for i ection purposes. Date v �� 'tel Signature (Applicant or Age Application Number . . . . . 10-00000540 ------ Structure Information 272 SF GUEST SUITE ----- Construction Type . . . . . TYPE V, UNPROTECTED Occupancy Type . . . . . DWELLG/LODGING/CONG <=10 Other struct info . . . . . CODE EDITION 2007/08 ENERGY ------------------------- # BEDROOMS -------------------------------------------------- 1.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 388.50 Plan Check Fee 252.53 Issue Date . . . . Valuation . . . . 46000 Expiration Date .. 2/05/11 Qty Unit Charge Per Extension BASE FEE 252.00 21.00 6.5000 ----------------------------------------------------------------------------- THOU BLDG 25,001-50,000 136.50 Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 31.80 Plan Check Fee 7.95 Issue Date . . . . Valuation . . . . 0 Expiration Date 2/05/11 Qty Unit Charge Per Extension BASE FEE 15.00 20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 15.00 4.00 .4500 --------------------------------------- EA ELEC DEVICE/FIXTURE >20 ------------------------------------- 1.80 Permit MECHANICAL Additional desc . Permit Fee 30.50' Plan Check Fee 7.63 Issue Date . . . Valuation . . . . 0 Expiration Date 2/05/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 1.00 6.5000 ---------------------------------------------------------------------------- EA MECH AH <=10K CFM 6.50 Permit . . . PLUMBING Additional desc Permit Fee . . . . 42.00 Plan Check Fee 10.50 Issue Date . . . . Valuation 0 Expiration Date . . 2/05/11 LQPERAIIT Application Number . . . . . 10-00000540 Permit . . . . . . PLUMBING Qty Unit,Charge Per Extension BASE FEE 15.00 4.00 6.0000 EA PLB FIXTURE 24.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 ---------------------------------------------------------------------------- Special Notes and Comments GARAGE CONVERSION TO GUEST SUITE - 272 SQ. FT. R-3 OCC. TYPE V -B CONSTR. 2007. CODES 2008 ENERGY. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN ,(SB1473) 2.00 ENERGY REVIEW FEE 25.25 STRONG MOTION (SMI) - RES 4.60 Fee summary Charged Permit Fee Total 492.80 Plan Check Total 278.61 Other Fee Total 31.85 Grand Total 803.26 LQPERMIT Paid Credited Due .00 .00 492.80 .00 .00 278.61 .00 .00 31.85 .00 .00 803.26 Bin # ^ % Ijej1' City of La Qumta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # �-j Project Address: G J u It Cj � ary'�� �� L�. /�� Owner's Name: r�� ��} ,•, i! I%- �r�,� C;� A. P. Number: Address: V Legal Description:i 1, S 16 e ( — I L.e, � 31 City, ST, Zip:(_ Contractor: 1 r S ' % jivc�fJ i Telephone: ' Address: '� y I � ( (� Project Description: City, ST, Zip: (_ L� r HiQ 7 L ` % / L e Tele hone.7% 0 7 7 7 ',:,��k\:;�?J l4�^Je}tiiS:vi:.'•i'S:Li2C:Si State Lic. # :7&2 j 8 -7 City Lic. Arch., Engr., Designer:- — Address: City, ST, Zip: Tele hone:Construction >:s >•;:...,,:....:,. ,;.: ,;:. Type: Occupancy: State Lic. #::�w Project type (circle one): New Add'nAl er Repair Demo ,/r Name of Contact Person: C� �� r , 11 Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: (, 7,, 7 7 Estimated Value of Project: IW6 cam•<-. — APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Rec'd TRACKING I PERMIT FEES Plan Sets Pian Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections i 17 -plan Check Deposit Truss Calcs. C Iled Contact Person ! Y( 4visInI 1/7 Plan Check Balance. Title 24 Caics. Pians picked up 'Tlo- Construction Flood plain plan Plans resubmitted / Mechanical Grading plan 2" Review, ready for correction issue $ Electrical Subcontactor List Called Contact Person YK S Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''° Review, ready for correctionstiissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees W� 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: Date: August 11, 2010 Owner's Name: T.D. Desert Development, LP Phone No. 760 777-1001 Project Address: 81-440 Carboneras, La Quinta, CA Project Description: Garage Conversion to Guest Suite (Room Addition) APN: 764-490-016 Tract #: Type of Development: Residential ii Total Square Feet of Building Area: Commercial 272 Lot #'s: Industrial 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: 0,01(L I t ro 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 17620 Gov. Code Project Agreement Existing Not Subject to Fee 65995 Approval Prior to 1/1/87 Requirement Note:' Number of Sq.Ft. Amount per Sq.Ft. Amount Collected 272 $2.97 $807.84 Building Permit Application Completed: Yes/No By: Jamie T. Brown, Asst. Supt., Business Services Certificate issued by: Marcela Valdez, Construction Analyst Signature: Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) �writt9h 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-im osition 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. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. 9V:::'rt�dex sh? ,fees-.ellili.itti i i conrpii:tne.: form updated? -2007 3/9/07