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04-5956 (AR)K 1504 ,ALLE TAMPICO TA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . . . X04=Q0-0-0-5-9-5=6� Date 9/01/04 Property Address 4877"5 VA ENIDA FERNANDO APN: 658-300-001- - - Application description ADDITION - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL , Application valuation 200490 Owner Contractor NOVOTNY GERALD R BIGHORN BUILDERS, INC. P 0 BOX 859 P.O. BOX 13793 ZEPHYR COVE NV 89448 PALM DESERT CA 92260 (760) 341-3191 WCC: STATE FUND WC: 1545949 01/01/05 CSLB: '37.6108 12/31/05 CCC: B ------ Structure Information 60.0 SQ FT. ADDITION AND REMODEL ----- Construction Type . . . . . TYPE V - NON RATED Occupancy Type DWELILG/LODGING/CONG <=10 Flood Zone NON -AO FLOOD ZONE Other struct info CODE EDITION 2001 CBC # BEDROOMS 1.00 FLOOD ZONE NO GARAGE.SQ FTG 25.00 FIRST FLOOR SQ FTG' 600.00 --------------=------------------------------------------------------------- Permit . . . . . BUILDING PERMIT Additional desc Permit Fee 993.00 Plan Check Fee 645.45 Issue Date Valuation . . . . 200490 Qty Unit.Charge Per Extension BASE FEE 639.50 101.00 3.5000 THOU BLDG 100,001-5001000 353.50 -------------------------------------------- Permit . . . . . . -------------------------------- MECHANICAL Additional desc Permit Fee . . . . 46.00 Plan Check Fee 11.50 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00. 9.0000 EA MECH FURNACE <=100K 9.00 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 64- 5q 5 ('0I Date: Applicant: Architect or Engineer: Applicant's Mailing Address: /. ON Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS 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 Lice in full force and effect. Q cense Class ,01� e No. / OWNER-StNLOER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U 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 or 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 sate.). U 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 properly who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason Date ' Owner WORKERS' 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. Lhave 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 r su d M wo com a sation in nce carrier a d n= Carrier 4t� ; Vwl C11 --Policy Number _ I certify that, in the performance of the work for which this permit is issued, I sffall 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 me subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those proyja - , il-\ �oj WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAW , AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO HE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN .SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 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 Ouinta, 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 ' I ree 10 ply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to r upon the abov entio property for inspection purposes. Date -S&g--n-ature (Applicant or Agent): Page 2 Application Number . . . . . 04-00005956 Date 9/01/04 Qty Unit Charge Per Extension 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 2.00 6.5000 EA MECH VENT FAN 13.00 ---------------- Permit . . ---------- . . . . -------------------------------------- ELECT - ADD/ALT/REM ------------ Additional desc Permit Fee . . . . 69.50 Plan'Check Fee 17.38 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 600.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 21.00 25.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL .50 20:00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 15.00 40.00 .4500 EA ELEC DEVICE/FIXTURE >20 18.00 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc Permit Fee . . . . 85.50' Plan Check Fee 21.38 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 9.00 6.0000 EA PLB FIXTURE 54.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 2.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 6.00 ---------------------------------------------------------------------------- Special Notes and Comments 600 sq. ft. addition and int. remodel. THIS PERMIT DOES NOT INCLUDE POOL & SPA BLOCK WALLS OR DRIVEWAY APPROACH. ---------------------------------------------------------------------------- Other Fees . . . . . . . . ENERGY REVIEW FEE 64.55 STRONG MOTION (SMI) - RES 20.04 Fee summary Charged ---------- Paid Credited Due ------------------ Permit Fee Total ------------------------------ 1194.00 .00 .00 1194.00 Plan Check Total 695.71 .00 .00 695.71 Other Fee Total 84.59 .00 .00 84.59 Application Number . . . . . 04-00005956 Grand Total 1974.30 .00 R Page 3 Date 9/01/04 00 1974.30 Bin # City of La Quinta oar Building 8E Safety Division �p7 Q;�i' P.O. Box 1504, 78-495 Calle Tampico Permit # -J La Quinta, CA 92253 - (760) 777-7012 0 i{0 3 -359 Building Permit Application and Tracking Sheet Jf Project Address: yj %%57j/eN jCjgZ fwNq N bo O,---ner's Namc: 91nS e l-& 0 v4 0 A. P. Number: Address: 1/1775 vewir)q FG/IV,i,t ld O/ Legal Description: ] City. ST. zip:14) 4 124 �Z Contractor. ' FTeI hone •`= <_Z_ � �^ J( Address: p �j d k 7 ?f S Project Description: )C City, ST, Zip: ,eSe sol' ejf, w� ` 1 X Telephon 7 f 1+ %X State Lic. # : O $ City Lic. #: a A (f \ �— Arch., Engr., Designer. X20 a Me S0 A.) //\\%'% I U (a Address:#S--A& Q 'D i•t w vo a'f IV C. Ai City, ST. Zip: 1( elf. T Z2G d v67 Telephone: 70) 548- Q y.rw Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alta Repair Demo A Name of Contact Person: a S h A r P Sq. Ft.: �ZSM N # Stories: # Units: X Telephone # of Contact Person: (, stimatcd Value of Project: 000 ' 11 APPUCANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Ree'd TRACKING PERMIT FEES N�• lan &ts /1,v Plan Check submitted ? Item Amount Reiewedready foStructural res :s r c0111A, s. p 1 Plan Check Deposit Truss Cak& Called Contact Person Plan Check Balance Energy Cala Plans picked up / Construction Flood plain plan Plans resubmitted • b� Ntechaaical Grading pian Y' Review, ready fo correction issue Electrical Subcoatattor List Called Contact Person Plumbing Grant Deed Plans picked up u . 7I�� S.M.I. H.O.A. Approval Plans resubmitted �� Grading IN HOUSE:- '''a cviI. ready for Rorrectio issue V lg Developer Impacl Fee Planning Approval Called Contact Pcrsoo ' A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 3 �5hr v� +0 1 (� At Z �2 1k� �(s PFC- U0 \P/L !4 cc �r✓ �4�� " FOR- c oR- V �� / v�� @ R �azsTu 4-,t> 8roAz p(le— z-&-d� /lf Date 9/1/04 No. 26396 Owner Mr. & Mrs. Gerald Novotny Address 48775 Avenida Fernando City La Quinta Zip 92253 Tract # Type Residential Addition CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # Study Area No. of Units Q BERMUDA DUNES r rn RANCHO MIRAGE d INDIAN WELLS J PALM DESERT ,y LA QUINTA -: QINDIO O 658-300-001 La Quinta 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 48775 Avenida Fernando 600 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments 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 fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.24 X 600 S.F. or $1,344.00 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 Cash -Rod Sharp Check No. N/A Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Vanessa Robles Payment Recd $0.00 $1,344.00 Over/Under Signature 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 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 1) ument NOT VALID if Duplicated Embossed Original - Building Depaplicant Copy - Applicant/Receipt Copy - Accounting S ^4 TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 SPECIAL INSPECTION DAILY REPORT OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OF INSPECTION PERFORMED SAMPLE INFORMATION DATE fiEL.-� lzv,Lj>Ixf r 5.. lo®S PHYSICAL ADDRESS PERMIT NUMBER 4B,'775 AAA i t>mANc>a —LA QJAlnrr4 _.044 —,595(p ,108 NAME� � ` ro�� �{ TYPE OF STRUCTURE J F ARCHITECT ENGINEER GENERAL CONTRACTOR SUB CONTRACTOR/ E?4 15%f5ys-►% #v- (:3 o 2 DESCRIPTION OF WORK INSPECTED 0iSSE7P--" - -f'L ' Q LOO.rai G-- e S 4 1` v-siT o �1CI S 111J �9' S' R A Q 'QZ.flT� � V\^ ` s, l.�l✓ L�t (cam i� b LJO-A<s,. I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. CC: INSPECTORS SIGNATURE } -lPc-c t U 131-1 !S - INSPECTORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION ME SUPPLIER TICKET NUMBER MIX NUMBER SAMPLED AIR TEMP STEMPE SLUMP TIME IN MIXER LOCATION WELDING INFORMATION PROCESS C 4, Lo NR Z3 -L_ WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER '120V6--EYL lk- c osr{pk, E?4 15%f5ys-►% #v- (:3 o 2 I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. CC: INSPECTORS SIGNATURE } -lPc-c t U 131-1 !S - INSPECTORS CERTIFICATION AGENCY AND NUMBER