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BRES2015-045578-495 GALLE TAWPICO C 0 V � � VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 4/11/2016 Application Number: BRES2015-0455 Owner: Property Address: 78361 DEACON DR _/ %P ROBERT ANACKER APN: 770210025 Property Zoning: Application Valuation: $470,570.70 Applicant: KELLY DOMER PARTNERS INC DBA KELLY PACIF 1554 LINCOLN AVE SAN RAFAEL, CA 94901 D CITY OF LA QUINTA COMMUNITY DEVELOPMENT DEPARTMENT. 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 Professions Code, and my License is in full force and effect. License Class: B License No.: 346196 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 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.). (_ 11, 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: • ICONSTRUCTION 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 Contractor: - KELLY DOMER PARTNERS INC DBA KELLY PACIF 1554 LINCOLN AVE SAN RAFAEL, CA 94901 (415)464-0900 Llc. No.: 346196 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: _ 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 workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant 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 thi' 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 of this city to enter upon the above-mentioned property for inspection purposes. Date: Signature (Applicant or Agent): 4 D SCRtPTIO�N V M. NACCOUNT J' SOU. N D�A�3 E ART IN PUBLIC PLACES - RESIDENTIAL . 270-0000-43201 } 0 $676.42 .$0.00 RECEIPT #�CHECK:#CLTDBY'. Total'Paid for ART, IN PUBLIC•, PLACES'- All PP: $676:42 $0.60 D RIRTION`� ' Q. I 'f,��a, AC OUNTs F_ n QTY E AMOUN�x y ... PAID �PAID'>"DATE BSAS SB1473 FEE,V 101-0000-20306'1 ... 0 $19.00mw,.. PAID 4 METHOD ,ur,Yau. ,A + , RECEIPT# CHz K #'TD Y Total Paid for BUILDING STANDARDS. ADMINISTRATION BSA: $19.00 , $0.06 , �u.II,n`r"+*'A'YV C\M. tACCOUNT y .Q AMOUNT PAID x�F%„� �AIE DIF =CIVIC CENTER 252-0000=43206 r 0 $942.00 $0.00, BY i i : PAID�z $�.�-r': 7s''2.^�„Z'✓`a5's�K... w ,t METHOD E fir. &&&J `' REIPT# n.CHECK# rc , TDBY' Ix MM DESCRIPTION : MR ACPIMP COUNTS A(VIOUNT� PAI 2 PAID=DA "E DIF.-'COMMUNITY: CENTERS :254-0000-43200, . 0: $129.00 k' $0.00 �D46Y „� .METHOD 'zB.T"c�'-i %RECEIPT #e .{ r 3.. .�:-.r%5 CHECK# CITDBY.. •1 :'i'fY<' .F;`'.'K•:T'.'"'*"XT?.4,Y �'': '• 5 �.!+.�• Y.f.� DESCRIPTION r. ., WAi` COI1N .. ; . ES� XAu3Y'y�r Q� AMOUNT. ��i aY PA � � R""'.Q..�� OA" FIRE PROTECTION ' : 257-0000-43200- ;: 0 $433.00 $0.00. <PA D BY f n ice. MHOD Y� RECEIPT# tt s smcs # �LTUBY tES RI I Nom. a m. s ,.��.., � �ACCOUN� ..��QN�.b razar�xx .�.AMO�UNT_, wok SAID �� PA�ID�DT�E DIF`-LIBRARIES:: 253-0000-43200` ,. 0 $344.00 .1$0:00 RECEIPTS# CHECK#`'" CLTD BY y DESCRIPTION . _ ._ DIF - PARK MAINTENANCE -, COU,AMOl1NTO 256=0000-43.200; Q� 0 `R+x'-i'" , r >. $40.00 �.r' . r . PAID $0.00 3' �A10D R , _. � T RCET# r CHECK#RCLBY < DESCRIPTIIOOWN � ACCO NST 4 x AMOUNT.c,> sPAID PAID DATE 'DIF - PARKS/REG 251-0000-43200 0 ' . $2,048.00 MEN�.;.PIY�.. ,., M�H�'.--.' ,. RET# yHCK=� ' ; CLTD BY . j =DESCR POTION .'� ,� A O T� �4 �� 'ffliAMO U Tx PAID PAIDATE DIF -STREET MAINTENANCE:' : 255-0000:43200 " 0 .$116.00* .....$0.00. . PAIDBY x,� v METHOD�RECEIPTct .,dwJiw'rvCSS'if.3tC :S,'. , n5:4.+ .i'�.?x '��`siro`WNC„h. � `i� CHECK #. .''.:". +..'.C9,i CLTD BY r k� DESCRIPTION b . s4 -. 5'•��y' ' v ACCOUNT wsa�E. �.;� �s�}s.�`, R. x •s�v'� IJNT h.rsc�,.r.-� ,�`y:sa PAID' ,. PAID ATE sz•w DIF, TRANSPORTATION 250-0000-43200 0 < "$2,842.00 $0:00 , " PAID'eBY ,`METHODIN aRC1zPT# CHE-C# „R CT`BY Total'Paid forMIF'- SINGLE FAMILY DWELLING: $6;894.00 $0.00 U�ESC�RIPTION yACCOUNT ate„ QTY�AIVIOUNT PAUAIDOATE � ,.� RESIDENTIAL, , EA ADDITION I;000SF 101-0000-42403. 0 $86.31 $0.00. ,. PAIDBY �� METHODSjMN RECE FTS#��, , y �CWECK# CLTD BY �DESC PIT ONS ,��_ .> �� ACCOUNT , AMOUNT " � � PAID r PAC PDATE .-.',RESIDENTIAL, EA ADDITION 1,000SF PC •, • , 101-0000-42600,• '. 0 • $M.S6 ' . `$0.00 ��, ffiPAI BY 3� 1d3. :wi? i,�u^a ti METHODS EIPT # .� E �z`.� .....;.. CHEyCK# - CL V13Y _.. �DESCR PTIONu 3 ACCOUNTS � "4 s�X O UNT PAID _FPAID :.. TE RESIDENTIAL;?FIRST 1,000SF 101-0000-42403 ' .� 0 $145.03. : � PAID BY �,'� . a -11 "��z�� . � � r� � NINE.O - sem• � RECEIRT�#� 5 :; n CIECK# *B'% > CLTDxBY � ' . •�Y` {- •. :,''� �ih''"�'i>"i5Y'. "x� 5 PTQN:QTYME C i�Y • _ Si�6F�f - l 4. ; .. ,T� AMOUNT PAID MZo -�&`i' ii •_ :RESIDENTIAL,FIRST 1,60 SF;PC. 0 $47.86 : `$0.00 MO.. f . �A�00 BnM�ETHOD�,RECEIPFT;�# ., x CHE K #LTDBYk Total Paid for"ELECTRICAL-= NEW CONSTRUCTION: $314.76 $0.00. ' `i.. DESCRIPTION ,�,'�` ii�,."'i.`Vi`rt�v r?`•i ACCOUNT YY. �`'i�" �rQTYX "b�'W.�,."{Yry�-/�`' . rY AMOUNTOr 'S'�C'�w",� PAIDrDATE k,%�F�� .'� . RESIDENTIAL PRECISE GRADING- CUSTOM. HOME LOT >7KSF , 101-000042408 - 0 . $36.26 $0.00 PAID�BY „F , ° rPR :��. 3 METHODy ,.... � � a �� RECE PT # � `%g, CHECK # CLTD B - �DESCRIPTIOIV QAC O NT "�3 T'w MOUNT ,rY. _.-.� PAID : ,mak. 1 TE PA DSD RESIDENTIAL PRECISE GRADING CUSTOM .,HOME LOT>.7KSF PC.. ,,101-0000426000 •'$181.29.' $0.00 PAID BY ��HOD x - " RECEI # ACTH CK # CLTD BY z Total Paid for GRADING: '$21.7.55 $0:00 g DESCRIPTION s,x..,. ..... a v ,x �ACUNT'ti��QTY� AMO T'A PAIDPAID arc pA ' r CONDENSER/COMPRESSOR 101;0000=42402: J.' :0.- $145.04• $0:00.. €x=�„rt :�PAIU�BY �� v METHOD:IBM RECEIPT # CHECKS#” CLOT g�Y , . ; DESCRIPTION ��y BMWACCO N QTY AMOl1NT' s ti 3_ �.. PAID �E :•,•CONDENSER/COMPRESSOR PC -:.101-0000 42600 0 $96.68 $0.00 07 PAID BYMETHS..., z r x : RECEIPTS# ?x ..�HEK# CLTDBI(. �5y,�`v'k'�, .:�,'` h DESCRIPTION..,, _.�..�..a� QTY �S.+i�/,, e't3� F AM Eq , ,. PAID AIDvDA � ,EXHAUST HOOD -101-0000-424020 $12.09 $0.00` AID>BY w METHOD }RECEIPT # CHECK#= CCTD BYE DESCRIPTION , , _ _,.,.� ACCOUNT QTY AM NT $4.83 ,PARD F $0.00 PAS A ` EXHAUST HOOD PC,101-0000-42600 ' 0 NOW IDBY METO >RECEIT# �=a�PK# TD`BY' . %DESCRIPTION f.QT}}Y� AMOUNT , pPA10PAMOATE ,'. FURNACE'" 101-0000-42402 0 $145:04. $0:00 " PAID BY v ¢ METHOD <RECEIFTa# >� WINES CHECK # 'iOt3' CLTD .'�.,6`.T✓S'.nR.& DESCRIPTION:.�A000UNT ,y �T�Y A. MOUNT � 1.PAID PAIDDATE ' FURNACE PC � 101-0000, 42600: f 0 $96.68: $0:00 PAID`BYI� *ksti:rN.uy, mrc*xt^;tdCe.a ��METHOD T, RECEIPT# CHE#' CLTDB DESCRIPTION � :.�.�, ACCOUNT 3,� N z ,AMORT . P: '184 � SM A VENT FAN 101-0000-42402 ! 0 $96.72 $0.00 �PAIDBY ��u� dMETHOD a.... RECEIPT # CHECK #: CLTDB �`stlt;iiMr'�4,1"4'S � DE�SCRI TIrON., �' � ACCOUNT d Q 1f . wx ,X'kW/j? Y�F ; AMOUNT ; 0„� .F z7,�� ANNAID cAID E VENT FAN PC- 101-000042600 0 $38.64 5 MM�,��E� .F,tjf .��fi 5... .v✓+��:�r`Tz+ki�,]s�YL .+h`�i'3�:�"..l i” C "' 2,,F'iF µ� W6 Total "Paid for MECHANICAL: $635.72: $0.00 '. DESCRIPTION :.. ��, W� �.� . ACCOUNT �� QTY AMOUNTrPAID • r x- " �a��' CAID?DAT MULTI SPECIES RESIDENTIAL`0 8 UNITS' -:'.-,101-0000-20330 2015 UPDATE �. 0 $1,301:00 $0.00 '��iPAIU BY.�`# METHOD ;,: PT # . REC ,,Y • ,»c-`�.. ,e 3 CHECKn# ��`rk�•�v,;Y2.^., e CCTD1BY o:7M6 �': ,Total Paid for:MULTI=SP.ECIES.RESIDENTIAL; . $1,301:00 $0.00 �. � I:PTION . C ACOUN QTN ASM UNT; r PAID _ a U'DATE � NEW CONSTRUCTIONVERMIT 101-0000,42400 , ., 0. $733.33 $0.00 ��PM.ABYMEHOD ,. REQ T.11m .'HK #s GLTD BY `. �. Total :Paid `for NEW CONSTRUCTION PERMIT: $733.33 $0.00 NEW CONSTRUCTIONPLAN CHECK '> 101-000042600. Y gDESCRIPTIQTNOUN,T: : 0 ' ' $1;000:00;1 x rPy PAADT�E .$1,000.00 -12/18/15' s... PAID BYE N�HOD '., . RECEIPT#AN x K @ UE CLTD BY� KELLY PACIFIC CONSTRUCTION`'. CHECK; , R11621 15522 MFA' +ate DESCRIPTION _�� ACCO�UNT > . �. QTY AMOUNT a PAIDPA�DDATEt .:�,,�. r NEW CONSTRUCTION PLANCHECK 101-0000-42600 0 .'. $570.68 $0.00 �rPA D�BY 14113 E�,F rHAN 'S"'. LT,00 Total:Paid for NEW:C'ONSTRU,CTION PLAN CHECK:: :$1,570.68 $1,000.00• a ec DESCRIPTION' 42?,%A, ACCOUNT a ti QTY`• . AMOUNT� k6, ` PAID z W� `..°'�... PAID=DATES5`„ �, ,.VSs" BACKFLOW DEVICE 101-0000-42401`'` 0 $12.09' :$0.00 PAID"BY y Off. f CHE�C,K# s'DESCRIPTION�� . r: d `.M 32 ,�i+Fk`"''4''+!`.a $`tx� ACCOUNT .v. �: k :.• :G. QTY' _` AMOUNTS . tea c�x a�.r 0 _ ads PAID- f�'�i'i�... r� `#;,� PAIDFDATE' MI de:� BACKFLOW DEVICEP.0 101-0000-42600 0 , . $4.83 *A�� PAIUMBY �� METHOD � � RECEIP..T # `. }� CHECKS#� CL<TDSBY ,:� TN� ,.,�A'".�:,�"'�R�'� A'.. fQTY AOUNT M .'xii'.Si F�SK `s AA ..: BUILDING 'SEWER.",. 101=0000-42401 `' 0 $12.09 $0.00 PAIUtBYx; r . . R✓3A'`.s^5 .k�.�., METHOD /. RECEIPT # -, F.fiK4a'L`i5`,�ak�t�',5#'�Ak�n CHECK #' 9CLTD BYE' DESCRIPTION ..� ��ACCOUNT Q47Y-AMOUNTe _ PAID �PAI�DATE $UILDING SEWER:PC 301-0000-426060 $12.09 .. $0.00 PAI"D,I4 ; LS?.�."'�.'a�x.� L ��:C $d r �A MET O ., R SY",2".zetbC.''.''�}s.c,4 „RECEIPT # y d?3.'.&..:.•'�'.✓#.v..x �C ECK!# ' a'.> .0 CLIT"Y . ..;M AC OUNT u.� Q�AMOUNT TpA E "'FIXTURE/TRAP '101-0000-42401 0 $265.98 $0.00 PAIDBY�f1A .,�� Hipp x� .. :� ,...,. "WR RECEIPPT�� . CHECK #� CLTD BY.. , , ` DESCRIPTION_ , ,r„ .;.,- a. �� ACCO UNT�#AMO h ,n UN P ID �ADA�; :'`:FIXTURE/.TRAPPC 101-0000=42600 0 +. $265'.98, $0.00 DOWN PAID BYE VME HOD RE EIPT# A ^ CHECKf# CLTD BY _ . .. ACCOUNT °. WIN �. . , O�UNT� W,PAID � PAIDDAT�E - GAS: SYSTEM; -S+ OUTLETS,.:. `"101-0000-42401 ` ' 0:. $36.26 ' $0.00 ' �� w 1=1111 s �CA tIT • �MN.i MORROWPAffiDAT��RIM Y t GAS SYSTEM; 54 -.OUTLETS PC 101-000042600_ ` 0 $24.17 ` a10ON �D gmq q YOr �.4.-< � � M OD RECEIPT # CHECK # CLTD BY' - . R" DESC PT O MIN COUNT QTY AMO TPAID` PAI PATE ROOF DRAIN' .' 101-0000-42401 0 $12.09 $0.00 x" PAID Y ' METHOD REGEI T'# CHECK #Tp gY 5 x`L DESGRIPT,ION�K y � al m �:'�53'✓is.".'. 'FX�9 F�...ia.'Fl ROOF DRAIN PC :. ACCOUNT FmR �! ,a3bx�-i'...9°d�'.. :' ,101-0000-42600. ala - . 0 $12.09 .`!;;mss. $0.00 AID�DATEf `4a",•'r"�.`:SC�. A D BY' E HOOD RE IPT .: G CK # WINE v DE CRIPTION �� MR, COUNT,41\INIOUNT IWE PAID� 10 MAP WATER HEATER/VENT .'; 101-0000 42401' 0 $24.18 $0.00 EH RRM- 2CHWIDE CK# f CLTD BY J y DESCRIPTION f ACCOUNT �� Q� ,�OUNT �'�� ie'1�'iyxY'r �` s^�PAID PAID . WATER HEATER/.VENTPC 101-0000-42600 0 $14.50 $0:00: t Y'Y{ -f�'hy ��L w '�i ."t. „-?. �� SS'�.33.GY*�C' Xyl "�. �"r cY x ,m 1.X: �� w`i'� 'i'�.Nw"a .a �` S+ 4• � 'Y� .4 ry"Y ,y'�%� � ' " DESCR N�� 0" rW. N F,Z - � nACCOUNT � N� ,�s• � : � x .�,� MOUNT �� : z� „� .. PAID , �;,�� ;. �PA��OATE .,WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09' $0.00 " PAIDBY y >' ON RECEIPT # CHECK# CLTD BY OESCRIP�TION �� ACCOl1N�T ON W. MOUNT` y PAID ��PAID DgTE ' WATER SYSTEMINST/ALT/REP PC ,_. 101-0000-42600 'i 0 $12.09 $0.00. '" . PAID' ECLT RKCEIPT, #' ,@Rs�K7C v�s C#. ..WON 'Total Paid for PLUMBING FEES: $720.53 .: $0.00 fLa` � DESCRIPTIO � . n• AC000NT � e . AIVI QA$�fgfi,% PAID 0101ATE SMI 'RESIDENTIAL 101-0000-20308 0. - ,$61.17 $0:00 s PAID BY6 ° �METHOD� REC IPT #'CHECK 'F'`'�.z''?.�Et:.`�u+?r # SSt' �, �w`k^•#'+i'-,.,.+r' CLT,D BY &;u'e.0 = .., Total_ Paid for STRONG MOTION INSTRUMENTATION SMI: $61.17 $0.00 kDESCRIPTION �� •�' ��ACCOUNTQTY� 5� wANiOUNT `.. *>w. r a 1yPAID DATE SINGLE: FAMILY. DETACHED; .224-0000-20320 0 •_ $1,837.44. $0:00 ��AID�BY�t, �� ? METHOD RECIPT�# CHECK # �CLTDBY Total.Paid for TUMF RESIDENTIAL: $1,837.44 $0.00 Description: ANACKER/TRADITIONS/5,345 SF DWELLING/VB/RES-3/CLASS A-FR/13D Type: BUILDING, RESIDENTIAL Subtype: DWELLING - SINGLE Status: APPROVED -CONDITIONS Applied: 12/18/2015 MFA FAMILY DETACHED Approved: 3/4/2016 BHA Parcel No: 770210025 Site Address: 78361 DEACON DR LA QUINTA,CA 92253 Subdivision: TR 28611 Block: Lot: 11 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $470,570.70 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 1/25/2016 Details: 5,345 SF DWELLING - LOT 11 [VB/RES-3/CLASS A-FR/13D] THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS OR DRIVEWAY APPROACH. 2013 CALIFORNIA BUILDING CODES. ADDITIONAL SITES Printed: Monday, April 11, 2016 3:20:09 PM 1 of 7 SYSTEMS CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES NOTE MARY FASANO 1/25/2016 1/25/2016 BROUGHT IN PM10 PLAN CHECK COMMENTS FROM CONSULTANT RAMSES SEVILLA 1/6/2016 1/6/2016 STRUC READY FOR CORRECTIONS 1/5/16 RECEIVED PLAN CHECK COMMENTS FROM CONSULTANT RAMSES SEVILLA 3/2/2016 3/2/2016 RECEIVED PLAN CHECK COMPLETE/READY FOR PICK STEPHANIE KHATAMI 1/20/2016 1/20/2016 GENE KELLY UP PLAN CHECK SENT TO MARY FASANO 12/18/2015 12/18/2015 OUTSIDE PC PLAN CHECK SENT TO RAMSES SEVILLA •2/19/2016 2/19/2016 OUTSIDE PC Printed: Monday, April 11, 2016 3:20:09 PM 1 of 7 SYSTEMS PLAN CHECK SUBMITTAL MARY FASANO 12/18/2015 12/18/2015 RECEIVED PLAN CHECK SUBMITTAL RAMSES SEVILLA 2/19/2016 2/19/2016 RECEIVED NOTIFIRD JIM DEFORD PLANS ARE APPROVABLE WITH TELEPHONE CALL BURT HANADA 3/4/2016 3/4/2016 ADMINISTRATIVE ITEMS REQUIRED PRIOR TO PERMIT ISSUANCE. LEFT MESSAGE FOR JIM KELLY (415-722-9388) THAT PLAN TELEPHONE CALL JAKE FUSON .1/20/2016 1/20/2016 REVIEW WAS COMPLETE, REVISIONS WERE REQUIRED, AND PLANS WERE READY TO BE PICKED UP. CONDITIONS CONDITION DATE' CONTACT DATE DATE STATUS< REMARKS NOTES TYPE ADDED REQUIRED SATISFIED GRANT DEED READY TO ISSUE BURT HANADA 3/4/2016 4/11/2016 COMPLETE SCHOOL FEE PAYMENT CHECKLIST HOA APPROVAL CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE JAX EMAIL APPLICANT KELLY DOMER PARTNERS INC DBA 1554 LINCOLN AVE SAN RAFAEL CA 94901 (415)464-0900 KELLY PACIF CONTRACTOR KELLY DOMER PARTNERS INC DBA 1554 LINCOLN AVE SAN RAFAEL CA 94901 (415)464-0900 KELLY PACIF OWNER ROBERT ANACKER 40 OAK KNOLL DR SAN ANSELMO CA 0 (415)464-0900 Printed: Monday, April 11, 2016 3:20:09 PM 2 of 7 w sys rrms Printed: Monday, April 11, 2016 3:20:09 PM 3 of 7 CRWIYSTEMS* C; DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT.# CHECK # METHOD PAID BY. - BY BY , BSAS SB1473 FEE 101-0000-20306 0 $19.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $19.00 $0.00 BSA: DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $0.00 DIF - COMMUNITY 254-0000-43200 0 $129.00 $0.00 CENTERS DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 $0.00 DIF - LIBRARIES 253-0000-43200 0 $344.00 $0.00 DIF - PARK 256-0000-43200 0 $40.00 $0.00 MAINTENANCE DIF - PARKS/REC 251-0000-43200 0 $2,048:00 $0.00 DIF - STREET 255-0000-43200 0. $116.00 $0.00 MAINTENANCE DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 $0.00 Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $0.00 RESIDENTIAL, EA 101-0000-42403 0 $86.31 $0.00 ADDITION 1,000SF RESIDENTIAL, EA 101-0000-42600 0 $35.56 $0.00 ADDITION 1,000SF, PC RESIDENTIAL, FIRST 101-0000-42403 0 $145.03 $0.00 1,000SF RESIDENTIAL, FIRST 101-0000-42600 0 $47.86 $0.00 1,000SF, PC Total Paid for ELECTRICAL - NEW CONSTRUCTION: $314.76 $0.00 RESIDENTIAL PRECISE GRADING - CUSTOM 101-0000-42408 0 $36.26 $0.00 HOME LOT >7KSF Printed: Monday, April 11, 2016 3:20:09 PM 3 of 7 CRWIYSTEMS* Printed: Monday, April 11, 2016 3:20:09 PM 4 of 7 •-9?SYSTEh1S CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY RESIDENTIAL PRECISE GRADING - CUSTOM. 101-0000-42600 0 $181.29 $0.00 HOME LOT>7KSF PC Total Paid for GRADING: $217.55 $0.00 CONDENSER/COMPRES 101-0000-42402 0 $145.04 $0.00 SOR CONDENSER/COMPRES 101-0000-42600 0 $96.68 $0.00 SOR PC EXHAUST HOOD 101-0000-42402 0 $12.09 $0.00 EXHAUST HOOD PC 101-0000-42600 0 $4.83 $0.00 FURNACE 101-0000-42402 0 $145.04 $0.00 FURNACE PC 101-0000-42600 0' $96.68 $0.00 .. VENT FAN 101-0000-42402 0 $96.72 $0.00 VENT FAN PC 101-0000-42600 ' 0 $38.64 $0.00 Total Paid for MECHANICAL: $635.72 $0.00 MULTI -SPECIES RESIDENTIAL 0-8 UNITS 101-0000-20310 0 $1,301.00 $0.00 -2015 UPDATE Total Paid for MULTI -SPECIES RESIDENTIAL: $1,301.00 $0.00 NEW CONSTRUCTION 101-0000-42400 0 $733.33 $0.00 PERMIT Total Paid for NEW CONSTRUCTION PERMIT: $733.33 $0.00 NEW CONSTRUCTION 101-0000-42600 0 $1,000.00 $1,000.00 12/18/15 R11621 15522 CHECK KELLY PACIFIC MFA PLAN CHECK CONSTRUCTION NEW CONSTRUCTION 101-0000-42600 0 $570.68 $0.00 PLAN CHECK Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,570.68 $1,000.00 Printed: Monday, April 11, 2016 3:20:09 PM 4 of 7 •-9?SYSTEh1S Printed: Monday, April 11, 2016 3:20:09 PM 5 of 7 SYSTEMS CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY BACKFLOW DEVICE 101-0000-42401 0 "$12.09 $0.00 BACKFLOW DEVICE PC 101-0000-42600 0 $4.83 $0.00 BUILDING SEWER 101-0000-42401 0 $12.09 $0.00 BUILDING SEWER PC 101-0000-42600 0 $12.09 $0.00 FIXTURE/TRAP 101-0000-42401 0 $265.98 $0.00 FIXTURE/TRAP PC 101-0000-42600 0 $265.98 $0.00 GAS SYSTEM, 5+ 101-0000-42401 0 $36.26 $0.00 OUTLETS GAS SYSTEM, S+ 101-0000-42600 0 $24.17 $0.00 OUTLETS PC ROOF DRAIN 101-0000-42401 0 $12.09 $0.00 ROOF DRAIN PC 101-0000-42600 _ 0 $12.09 $0.00 WATER HEATER/VENT 101-0000-42401 0 $24.18 $0.00 WATER HEATER/VENT 101-0000-42600 0 $14.50 $0.00 PC WATER SYSTEM 101-0000-42401 0 $12.09 $0.00 INST/ALT/REP WATER SYSTEM 101-0000-42600 0 $12.09 $0.00 INST/ALT/REP PC Total.Paid for PLUMBING FEES: $720.53 $0.00 SMI -RESIDENTIAL 101-0000-20308 0 $61.17 $0.00 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $61.17 $0.00 SINGLE FAMILY 224-0000-203200 $1,837.44 $0.00 DETACHED Total Paid for TUMF - RESIDENTIAL: $1,837.44 $0.00 TOTALS:.0 $1,000.00 Printed: Monday, April 11, 2016 3:20:09 PM 5 of 7 SYSTEMS INSPECTIONS PARENT PROJECTS REVIEWS RETURNED STATUS REMARKS REVIEW TYPE REVIEWER SENT DATE DUE DATE NOTES DATE IST BLDG NS (3 WK) JAKE FUSON 12/18/2015 1/19/2016 1/19/2016 REVISIONS REQUIRED SEE 1ST REVIEW - CORRECTION LIST. 1ST BLDG STR (3 KURT CULVER 12/18/2015 1/17/2016 1/4/2016 REVISIONS REQUIRED 0 WK) (ESGIL) FEE SHEET.pdf 1ST REVIEW BRES2015-0455 - 1ST DOC 1/4/2016 WQMP EXEMPTION FORM NEEDS TO BE IST PW GREEN AMY YU 1/25/2016 2/1/2016 1/26/2016 READY FOR APPROVAL COMPLETELY FILLED OUT SHEET - CONDITION 2ND REVIEW BRES2015-0455 - 2ND DOC 3/3/2016 AJ ORTEGA STRUCTURAL REVIEW STRUCTURAL WQMP EXEMPTION FORM COMPLETE 2ND BLDG NS (2 BURT 2/19/2016 3/4/2016 3/4/2016 APPROVED- CALL JIM DEFORD 949-922-3251 WHEN WK) HANADA (APPROVED) (APPROVED).pdf CONDITIONS COMPLETE. 2ND BLDG STR (2 KURT CULVER 2/19/2016 3/4/2016 3/1/2016 READY FOR APPROVAL DOC TRUSS 1ST WK) CERTIFICATION FORM WEST.pdf 1 BOND INFORMATION ATTACHMENTS ' '. .......... - � ....... ... Attarhment7ypa ...... ..�CRE�AiTED� � . "''' ' .. OV NEIN. ........ . �� [��iC��P��ON PATHNAME SUBDIR ETRAKIT ENABLED 1ST REVIEW BRES2015-0455 -1ST DOC 1/4/2016 AJ ORTEGA STRUCTURAL FEE SHEET REVIEW STRUCTURAL 0 (ESGIL) FEE SHEET.pdf 1ST REVIEW BRES2015-0455 - 1ST DOC 1/4/2016 AJ ORTEGA STRUCTURAL REVIEW STRUCTURAL 0 CORRECTIONS (ESGIL) CORRECTIONS.pdf 2ND REVIEW BRES2015-0455 - 2ND DOC 3/3/2016 AJ ORTEGA STRUCTURAL REVIEW STRUCTURAL 0 TRANSMITTAL TRANSMITTAL (APPROVED) (APPROVED).pdf SCHOOL FEE AREA 78361 DEACON DR. DOC 3/4/2016 BURT HANADA CERTIFICATION FORM WEST.pdf 1 Printed: Monday, April 11, 2016 3:20:09 PM 6 of 7 SYSTCti1S Printed: Monday, April 11, 2016 3:20:09 PM 7 of 7 SYSTEMS ATTACHMENTS Attachment Type . CREATED, OWNER DESCRIPTION PATHNAME v SUBDIR ETRAKIT ENABLED BRES2015-0455- IST 1ST REVIEW - REVIEW - DOC 1/20/2016 JAKE FUSON NONSTRUCTURAL 1 NONSTRUCTURAL CORRECTIONS CORRECTIONS.pdf DEBRIS MANAGEMENT DOC 2/4/2016 STEPHANIE KHATAMI DEBRIS MANAGEMENT PLAN 2-4-16 BRES2015- 0 PLAN 2-4-16 0455.pdf DOC 2/4/2016 STEPHANIE KHATAMI PM10 APPROVAL PM10 APPROVAL.pdf 0 Printed: Monday, April 11, 2016 3:20:09 PM 7 of 7 SYSTEMS �C45�� S2�u • P.O. BOX 1504 Building 78-495 CALLE TAMPICO Address LA QUINTA, CALIFORNIA 92253 Owner �tt�" "�✓ a// .c. Mailing Address I City Zip Tel. 9z z r� yes(=77_,7 94r State Lic. City & Classif.��''�6 �9 G Lic. # Arch., n Designer Address Tel. 7 7.0. fey /.� - .0 176 `i.�� r)-� ,,-v �1p12z.t C`# _ 7Z� LICENS VNTR OR'SDECLARATION I hereby affir I am li d s of Chapter 9 (commencing with Section 7000) of Division the B In s a ode, and my license is in full force and effect. t' sl XDATE i7from BUILDER DECLARATION I hereby affrm that I am the Contractor's License Law for the following reason: (Sec. 7031.5, Business and Prode: Anycity or county which requires a permit to consWct, atter, improve,demolish, orreany sWcture, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contrac- tor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that he 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 Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such 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 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner' WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less). I certify that in the performance of th ork for i h s tis issued, I shall not employ any person m any manner so as to be a sub' rk mpensation Laws of California. Date Owner NOTICE TO APPLICANT. er making this Certific or Exemption you should become subject to the Workers' mpensation provision he Labor Code, you must forthwith comply with such provisi s or this permit shall be ed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 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 of this city to enter the above-mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT APPLICATION ONLY BUILDING: TYPE CONST.C. GRP. A.P. Number /G /� Z 5— Legal Legal Description Project Description Sq. Ft. y?No. No. Dw. Add Alter❑ Repair❑ Demolition IEstimated Valuation / `/S� 0 0 V ' I PERMIT I I AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL CONTACT INFORMATION NAME: �7�,� t- /6 T PHONE: ZONE: BY: Minimum Setback Distances: Front S rackfrom Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Validated by: — Validation: YELLOW = APPLICANT Date Permit PINK = FINANCE Date: 4/11/2016 No.: 16-00182-1 Owner: Robert Anacker Address: City: Type: Single Family Residential Lot # Street No. 78361 Comments: CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Qunita, CA 92253 (760)771-8515 Street Name Deacon Drive West Email: Jurisdiction: La Quinta Tract #: Sq. Feet APN 5345 770-210-025 J��>QIEp S c 2y % o RERMUDA r ` N MIRAGE C F . INOIM WELLS - y ii ..PALM DESERT '4' COACMELLA ' .a lA OiINTA. 7� y Permit No. 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: EXEMPTION NOT APPLICABLE This certifies that school facility fess imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the. amount of $3.36 X 5345 S.F. or $17,959.20 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in the proposed project may now be issued. Fees Paid By: CC/US Bank - Jim Kelly Check No.: 5214502802 Bank Name/Recipient of Certificate Telephone: Funding: Residential By Dr. Gary Rutherford Superintendent Fee Collected/ Exempted by: Sh r McGI vrey Amount Due ~17 9 $ 59.20 Original Payment(s) Recd: $0.00 New Payment Rec?d:. $17;959.20 Over/,Linder: `$0.00_ l NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest die, 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 to Building Department: THIS DOCUMENT VALID ONLY IF IMPRINTED WITH EMBOSSED SEAL. Plan Submittal Job Site Building Permit Number. BRES 2015-0455 Project Description: SFR Exempt: O (Materials may contain hazardous wastes and are not subject to recycling provisions) Construction Debris Management Plan Owner's Name Number, Street, or PO Box City, State, Postal Code Owners Phone Number Owners E -Mail Address Project Managers Projed Managers Phone N Project Managers E -mall Ai Builder / Corrin Number, Street or PO City, State, Postal C 1/26/2016 78361 Deacon Drive W. Steve Rubin Mark Powell 760-409-4848 rmr powel! at'�kelNoaGflacom Kelly Pacific Const 1554 Uncoln Ave San Rafael Ca. 94901 Projed Square Footage 5,300 sq. ft. City Approval By &ae&-, Data of City Approval RECEIVED FEB 0 4 2016 CITY OF LA QUINTA COMMUNITY DEVELOPMENT Materials To Be Discarded: Product Tons Trash 20.00 Not recyclable Product Tons Asphalt Brick/Block 0.00 Recyclable 0.00 Recyclable Masonry (broken) 0.00 Recyclable Cardboard 0.00 Recyclable Plaster Scrap Metal 5.50 Recyclable 0.00 Recyclable Commingled Concrete 0.00 Recyclable Tile (floor) 0.25 Recyclable Drywall 18.00 Recyclable 2.25 Recyclable Tile (roof) 050 Recyclable Donated / Reuse' 0.00 Recyclable Wood Landscape DebrisPARecyclable Recyclable *Describe Items tals: Rec cle Trash 35.0 r 20.0 Projected Diversion: 63.84% 1 understand it is the property owners responsibility to submit copies of weight tickets or receipts to the District Environmental Coordinator as these hauls occur. I hereby certify that completion, Implementation and adherence of the Debris Management Plan (DMP) for the above named project shall guarantee that at least 50% of the jobsite waste is diverted from landfilling. The remaining material will be recycled or reused. I will divert, for recycling or re -use, remaining materials generated from the first day of the project through the completion of the project in accordance with this plan. This DMP is Issued In the name of the property owner(s) and shall remain their property throughout the construction and/or demolition project A contractor serving as agent of the owner may obtain a DMP for the owner. However, the DMP is suit Issued in the name of the property owner(s) and the owner retains legal responsibility for ensuring that the provisions of the DMP are adhered to. The property owner(s) and general contractor shall be kept informed of the diversion progress through bimonthly reports. N seri hauling, all refuse material from this jed site m be taken to an a vad re Pero cycle► or transfer %/d99�i% o LC 0-7 Zo Owner / Developer / Project Maneger / pedntendant Da