RER-14-781uia
3-495 CALLE TAMPICO D Q� VOICE (760) 777-7125
• FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/13/2014
Application Number: RER-14-781 Owner:
Property Address: 79975 RANCHO LA QUINTA DR KEN ROBERTSON
APN: 649740011 79975 RANCHO LA QUINTA DRIVE
Application Description: CONVERT CASITA TO GARAGE LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $0.00 D Q 0
Applicant: �• AUG 13 2014 Contractor:
RAWLINGS CUSTOM CONTRACTING' RAWLINGS CUSTOM CONTRACTING
P.O. BOX 3216 L P.O. BOX 3216
PALM SPRINGS, CA 92263 \ CITY OF LA QUINTA PALM SPRINGS, CA 92263
``/1 COMMUNITI' DEVELOPMENT DEPARTMENT
(760)322-8788
Llc. No.: 746930
[ l
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am license der pr • visions of Chapter
9 (commencing with Section 7000) of Division 3 oft u ess and rofes " ns Code,
and my License is in full force and effect.
Lice se�Cilass: Bim] License No.: 746930
Date: ° —�P -// Contrac 'F
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).:
(_) 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 contractor(s) 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
Lender's
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 isrl
workers' compensation insurance carrier and policy number are:
CarPolicy Number: �-
ertifythat in the performance of the wo o hich this permit is issued,
shall not employ any person in any manner so as eco a bject to the workers'
compensation laws of California, and agree th , if I )��e
h d b ome subject to the
workers' compensation provisions of Sectio 700La r e hall forthwith
comply with those provisions.
Late: 9 -1:2 -/ `i
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 Building Official 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 i rm ion is orrect.
I agree to comply with all city and county ordinances and stat ws re_ng
to uilding
construction, and hereby authorize representatives of this ci to en//pont a ov
mentioned property for inspection purposes.
fate: 9-/g-/ Z7) Signature (Applicant or Age
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT QTY
AMOUNT PAID
PAID DATE'
BSAS SB1473 FEE
101-0000-20306 0
$1.00 $1.00
8/13/14
PAID BY
METHOD RECEIPT # CHECK #
CLTD BY
RAWLINGS CUSTOM CONTRACTING
CHECK R689 7307
AOR
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $1.00
DESCRIPTION
ACCOUNT -
QTY
AMOUNT
PAID
PAID DATE
FIXTURES, FIRST 20
101-0000-42403
1
$23.83
$23.83
8/13/14
PAID BY
METHOD
RECEIPT # "`
CHECK #
CLTD BY
RAWLINGS CUSTOM CONTRACTING
CHECK
R689„
7307
AOR
Total Paid for ELECTRICAL: $23.83 $23.83
DESCRIPTION
ACCOUNT
QTY
AMOUNT PAID
PAID DATE
PLAN CHECK, ELECTRICAL
10160003428200
$23.83 $23.83
8/13/14
PAID BY
METHOD
RECEIPT # CHECK #
CLTD BY
RAWLINGS CUSTOM CONTRACTING
CHECK
R689 7307
AOR
Total Paid forPLAN CHECK, ELECTRICAL: $23.83 $23.83
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PLAN CHECK, REMODEL
10160003428200
$132.99
$132.99
8/13/14
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
RAWLINGS CUSTOM CONTRACTING
CHECK
R689
7307
AOR
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PLAN CHECK, REMODEL
10160003428200
$17.16
$17.16
8/13/14
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
RAWLINGS CUSTOM CONTRACTING
CHECK !
R689
7307
AOR
Total Paid forPLAN CHECK, REMODEL: $150.15 $150.15
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$21.45
$21.45
8/13/14
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
RAWLINGS CUSTOM CONTRACTING
CHECK
R689
7307
AOR
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
REMODEL, FIRST 100 SF
101-0000-42400
0,
$48.62
$48.62
8/13/14
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
RAWLINGS CUSTOM CONTRACTING
CHECK
R689
7307
AOR
Total Paid for REMODEL: $70.07 $70.07
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
$0.50
8/13/14
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
RAWLINGS CUSTOM CONTRACTING
CHECK
R689
7307
AOR
Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $0.50 $0.50
TOTALS:
Qin # (�
City of La Quinta
Building 8t Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: S �T•A �iZ .
Owner's Name: tc3K IQGbSKJ%M
A. P. Number: Z $70 -011-+
Address: -14191S R69MQ LA
Legal Description:
City, ST, Zip: LA 40014TA
Contractor::`:':'
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Telephone:
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Address:
Project Description:
City, ST, Zip:
SI . -.Tb AA Go
Telephone: An
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State Lie. # : 14L, jg
City Lie.
Arch., Engr., Designer: JONSMAN
Address: '7: 50 VL ME012 VM- 10-7
City, ST, Zip:.JwApigr
L14 'r
Tele hone:.
P 17 8 <?€;:<.:;:>:.:::.;>::•s :>::>;:l:>s .;<::>•s:::
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State Lic. #: C�`•»':?:>:<:>:: # :>:ys:
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Construction Type: Occupancy:
Project type (circle one): New Add, n Ite Repair Demo
Name of Contact Person:
Sq. Ft.: ��.
# Stories:
# Units:
Telephone # of Contact Person: 8
Estimated Value of Project: Ott Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'.d
TRACKING
PERMIT FEES.
Plan Sets
Plan Check submitted
Item Amount
Structural Cates.
Revicwed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for corrections/issue
O
Electrical
Subcontactor List
Called Contact Person
PIumbi
Grant Deed
Plans picked up
S.
H.O.A. Approval
Plans resubmitted
Gradi
IN HOUSE:
'"' Review, ready for correctionstissue
Develoier IF
Planning Approval
Called Contact Person
A.I.P.P. u
Pub. Wks. Appr
Date of permit issue
. 1
School Fees
Total Permi s
v v �vi7 -
' — CITY OF .LA QUINTA
COMMUNITY DEVELOP
C MENT
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Date 8/13/14 La Quinta, CA 92253
No. 32244 (760) 771-8515
.Owner
Ken Robertson
Address
79975 Rancho La Quinta Dr
City
La Quinta Zip .
Tract #
Type
Garage Addition
BERMUDA DUNES
Cn RANCHO MIRAGE
INDIAN WELLS
PALM DESERT y
LAQUINTA „jam
QINDIO y�
0
APN # 602-370-011-4
Jurisdiction La Quinta
Permit #
No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 79975 Rancho La Quinta Dr 114 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments Convert Casita to Golf Cart Garage
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Convert Residential to Garage
EXEMPT
This certifies that school facility fees imposed pursuant•to
in the amount of $0.00 X 114 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 - Patrick Rawlings Check No.
Bank Name/Recipient of Certificate Telephone 760-275-8568
Funding Exempt
By Dr. Gary Rutherford
Superintendent
t
Fee collected /exem d bySh rop4cailvrey Payment Recd
Ua;,FrlUnder
r
Signature
NOTICE: Pursuant to Government Code Section 66n2, 0)(1), thisVill serve to notify you that the 90 -day approval period in which you may protest the fees
or 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 without embossed seal
Embossed Original Building Department Applicant Copy - Applicant/Receipt Copy - Accounting
Cw
Tihf 4 4 Q. am r10
COMMUNITY DEVELOPMENT DEPARTMENT
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
(760) 777-7012 FAX (760) 777-7011
CERTIFICATION OF BUILDING AREA
STREET ADDRESS OF JOB: 79-975 RANCO LA QUINTA DR.
APN: 602-370-011-4
DESCRIPTION OF WORK: CONVERT CASITA TO GOLF CART GARAGE
SQUARE FOOTAGE: 114 SQ. FT.
OWNER'S NAME: KEN ROBERTSON
For questions regarding this letter, please call:
City of La Quinta Permit Center
(760) 777-7012
Coachella Valley Unified .School District
83-733 Avenue 55
P O Box 847
Thermal, CA 92274
(760) 398-5909.T.
T.
0 ° � � � � � P�
[DATE
LDING & SAFE I `l DE
APR�VED
Desert Sands Unified School District FOR CON, CION
47-950 Dune Palms Road
La Quinta, CA 92253 ` �o�l B
(760) 771-8515
Please note: This letter verifies conditioned square footage. Please can
your School District to verify school fees; requirement for cashier's check
or money order and hours of operation.