09-0884 (AR)4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/24/09
Application Number: 09-00000884 Owner:
Property Address: 54740 SECRETARIAT DR FRY PAUL
APN: 767-320-999-235 -32879 - 54-740 SECRETARIAT DRIVE
Application description: ADDITION - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (
Application valuation: 6500 O
Contractor:
Applicant: Architect or Engineer: Owner O
<?;
------------------
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 Class: License No.:
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 Cade: 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 Icommencing with Section 70001 of Division 3 of the Business and Professions Code) or
that h or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001.:
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 contractin 'th licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The C racto ' State License Law does not apply to an owner of
property who builds or improves thereon, an ho co acts for the projects with a contractors) licensed
pursuant to the Contractors' State License w.). i
(_) I am exempt under Sec. , B.&P.C. f this r ,e /��/
Date:
Owner:
I 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:
LQPERMIT
---------------------------------- - - ---- - - - - —
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 ar _
Carrier Po' Nu er
I certify that, in the performance of a work f which this permit is issued, I shall not employ any
person in any manner so as to come su ct to the wprkers' compensation laws of California,
nd- ree that, if I should bec a subj he om ensation provisions of Section
7 e Labor Code, I sh I fo it sions.
Date: pplicant:
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 applicagove
null and void if work is not commenced
within 180 days from date of issuance of cessation of work for 180 days will subject
permit to cancellation.
certify that I have read this application and state that tmation is 'rr t. I agree to comply with all
city and cou y or pnarices and state laws relating to bu' a er, y�a ze representatives
of this(7�Jyn o on the above-mentioned grope
Date: / i,mnure (Applicant or Agent):
LQPERA11T
Application Number . . . . . 09-00000884
------ "Structure Information 63SF SAUNA ROOM ADDITION
[CONVENTIONAL] -----
Other struct info . . . . . CODE EDITION
2007CODES
FLOOD ZONE.
NO
1ST FLOOR SQUARE FOOTAGE 63.00
Permit BUILDING PERMIT
Additional desc .
Permit Fee 90.00 Plan Check
Fee 55.50
Issue Date Valuation
. . . . 6500
Expiration Date 2/20/10
Qty Unit Charge Per
Extension
BASE FEE
45.00
• -5.00- 9.0000 THOU BLDG 2,001-25,000
----------------------------------------------------------------------------
45..00
Permit ELECT - ADD/ALT/REM,
Additional desc .
Permit Fee . . . 17.21 Plan Check
Fee 4.30•
Issue Date . . . Valuation
. . . . 0
Expiration Date 2/20/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
•63.00 .0350 ELEC NEW RES - 1 OR 2
----------------------------------------------------------------------------
FAMILY 2.21
Permit . . . PLUMBING
Additional desc".
Permit Fee . . . . 30.00 Plan Check
Fee 7.50
Issue Date . . . . Valuation
. . . . 0
Expiration Date 2/20/10
Qty Unit Charge Per
Extension
BASE FEE
15.00-
2.00" 6.0000 EA PLB FIXTURE
12.00
1.00 3.0000 EA PLB WATER INST/ALT/REP
3.00
----------------------------------------------------------------------------
Special Notes and Comments
63SF SAUNA ROOM ADDITION/VB/RES-3/CL-A
[CONVENTIONAL] THIS PERMIT DOES NOT ADD
ADDITIONAL CONDITIONED SQUARE FOOTAGE.
2007 CALIFORNIA BUILDING CODES.
August 24, 2009 11:56:33 AM AORTEGA
--------------------------- ------------------------------------------------
Other Fees . . . . . . . . . ENERGY REVIEW FEE
5.85
`V _
Application Number
. . . . .
09-00000884
----------------------------------------------------------------------------
Other. Fees
STRONG MOTION
(SMI) - RES
.65 ,
Fee summary
Charged
Paid
--------------------
Credited
----------
Due
-----------------
Permit Fee Total
----------
137.21
.00
.00
137.21
Plan Check Total
70.30
.00
.00
70.30
Other Fee Total
6.50
.00
.00
6.50
Grand Total
214.01
.00
.00
214.01
LQPERn4IT
i
City of La Quina
Building 8i Safety Division
Permit #
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: — Q -Owner' N
�. me:
A. P. Number:
Address: ` / e C2. � -
�S� _ M�O
Legal Description:
City, ST, Zip:
Contractor. b
1
Tele h
pone: ` �"� ' � �' $ :,i�<'`• •,�v..�lrs .
Address:
Project Description:
City, ST, Zip:
?� Vlti Ove puz -
Telephone:
'c 1#`S'4/C
State Lic. # :
City Lie. C
Arch., Engr., Designer:
Au 4rL g
.
A
Address:00,
City, ST, Zip:
Telephone:
y�
Construction Type: Occupancy:
State Lic. #:
's r•`f�`•
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Perso
- � (o S �
Estimated Value of Proje
APPLICANT: DO NOT
WRITE. BELOW THIS LINE
#
Submittal
Req'd
Rec'.d
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Plan Check Deposit
Structural Caics.
Reviewed, ready for corrections
Truss Calcs,
Called Contact Person
Plan Check Balance .
Title 24 Caics.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
EL
2`4 Review, ready for corrcctions/issue
Electrical
Plumbing
Subcontactor List
Called Contact Person
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review,.ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
i
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
LEVELONEAMOUNT: '
LEVELTWOAMOUNT:
MITIGATION AMOUNT:
COMMAND;AMOUNT:
DATE:
RECEIPT:
CHECK#: .' ,.
MITIALS: ..
-
t
CERTIFICATE OF COMPLIANCE
• (California Education Code 17620) I
Project Name: Griffin�Rartch Date: August 28, 2009
Owner's Name: Paul Fry Phone No.
Project Address: 54-740 Secretariat Drive, La Quinta
Project Description: Sauna Room Addition
APN: 767-780-012 - Tract #:
Type of Development: Residential XX Commercial
Total Square Feet of Building Area: 63
Lot #'s:
M
Industrial
Certification of Applicant/Owners: The person signing certifies thatthe,0qve information is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized to sign n befialf of the owner/developer.
Dated: August 28, 2009 Signature: Zl
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. 63 sq. ft.
Amount per Sq.Ft. $ 0.00
Amount Collected $ 0.00
Building Permit Application Completed: Yes/No
Project ' ` Agreement Existing Not Subject to Fee
Approval Prior to 1/1/87 Requirement
Note: Pursuant to AB -181, any room additions of 500 square
feet or less on existing dwelling units are exempt from
developer fees. 'Pursuant to AB -181, any mobile home bei g.
relocated or replaced within our school district is exempt
from developer fees.
By: Jamie T. Brown, Asst. Supt., Business Services
Certificate issued by: Laurie Howard, Secretary IH 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/mydoes'devfees/certificate ofcompliance lbrm tablesf0 USE.doc 1V, 1/16/03 T
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE . ,
Disclosures & Forms for Owner -Builders Applying for Construction Permits
d,1 MRT'ANTt NOTICE TO PROPERTY OWNER
Dear Property Owner
An. application—for--a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at
We are.providing you with an Owner -Builder Acknowledgment and Information Verification. Form to make you aware of your
responsibilities and possible risk you may incur by having this permit, issued in your name as the
Owner -Builder. We will not issue a building permit until you -have read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.'
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
I understand a frequent practice of unlicensed persons is td have the property owner obtain an "Owner -Builder"
4u' ding permit that erroneously implies that the property owner's providing his or her own labor and material personally. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
'on mvinoDrAY.
understand building permits are not required to be signed by property owners unless they are responsible for the
p/rr ,and are not hiring a licensed Contractor to assume this responsibility.
14#I understand as an "Owner -Builder" I am the responsible party of record. on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
0
K41 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
pe ontracts.
understand if I employ or otherwise engage any persons- other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
Z
st federal law.
4. understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and' contribute to unemployment
c.*kK.
ompensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
res cannot .legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
eorcial
erstand as an Owner -Builder if I.sell the property for which this permit is issued, I may be held liable for any
personal.injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
wor or materials.
understand I may obtain more information regarding my obligations as an "employee, from the Internal Revenue
Se ice, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321- B (2752) or www.csib.ca.gov for more information about licensed contractors.
ele,ally
am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
and financially responsible for proposed construction activity at the following address:
agree that, as the party legally and financially responsible for this proposed construction activity,.I will abide by all
�aws and requirements that govern Owner -Builders as well as employers.
agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information 1
e rovided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a- license, the Contractors' State License Board may be unable to assistyou with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also
important for you to. understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property; you may be held liable for damages. if you obtain a permit as Owner -Builder and wish to hire Contractors,
You will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing; the. permit ote. A copy of the property owner's deiver's:licensei form notarization, or
other verification acceptable to the agency 1W. ed to be presented when the permit is issued to verify the property
owner's signature. ol)
Signature of property owner Date: /
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand. is my personal responsibility, I hereby authorize
the following person(s) to act asmy agents) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature..
Property Owner's Signature: Date:
JCM Inspections .
39725 Garand Lane Suite F
Palm Desert, CA 92211
INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 I N S P E C11 O N S
EPDXY INSPECTION REPORT Date: 9.3-,0
Project Name: n Q Projekt No: p
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Project Address: City,
!do '��->Ca C, WA40 CC-'
Client:S�u+b- ont\ractor
C JI�J«o� �s1 ?]tti` �011.•'�rt C--. .
General Contractor: Architect: Structural Engineer:
Anchor Bolts FZkRebar
Epoxy Type:
Epoxy Shelf Life: >J nl I
Hole CleaningMethod(s): n.11,., rr,. �c<ac�.,�� •,�_C,--r V�v\,A
IBC
Title 24
Other:
Unresolved Items:
None.
See Below .
Description of Work Inspected: Dnx\ n VA -)nu -- C C} l le nro A P, CApis 3i Sheer a
Af�nX"C) Vnt� 0 [_,VD Irtlh
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Work complies with written approval from Structural Engineer and ICC Evaluation Report #�
I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved
plans, specifications _applicable building laws. Final report at project completion:
Inspector: Jack C. Millin ICC ICe— ificatio, , n No: 0842216-49
Contractors Representative:
Copy 1 JCM Inspections— Copy 2 Project Superintendent i Copy 3 Governing Agency Page of