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04-3320 (AR)Ti4f 4 4wc a P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 MI -1 ¢- 777-7011 INSP IONAQU S -U 777-7153 MAY ;13.2004 Application Number . LFI�NANCE�OEPMat�e .. . . 04�000.0332_0,Property �FRNANDO 5/07/04 Address . . . . . . 4` 92.00AVENID E APN: 658 -280 -017 -150 -000000 - Application description . . . ADDITION - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 100000 Owner Contractor ------------------------ PRICE LEW C ------------------------ CLARK JR GEN CONTR, JACK 548 PINEWAY CIRCLE 51220 AVENIDA CARRANZA BLOOMFIELD HILLS MI 48302 LA QUINTA CA 92253 (760) 564-3511 WCC: EXEMPT WC: EXEMPT 03/04/05 CSLB: 506667 03/31/05 CCC: B ------ Structure Information REM / ADD 170 SQ. FT. ----- Construction Type TYPE V - NON RATED Occupancy Type . . . . :.. DWELLG/LODGING/LONG <=10 Flood Zone :.. NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 CBC FLOOD ZONE NO FIRST FLOOR SQ FTG 170.00 -----------------------7---------7------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 639.50 Plan Check Fee 415.68 Issue Date . . Valuation . . . . 100000 Qty Unit Charge Per Extension BASE FEE 414.50 50.00 4.5000 THOU. BLDG 50,001-100,000 225.00 ----------------------------------------------------------------------------- Permit .. . . . . . ELECT - ADD/ALT/REM Additional desc Permit Fee . . . . 44.95 Plan Check Fee 11.24 Issue Date Valuation . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 170.00 .0350. ELEC NEW RES - 1 OR 2 FAMILY 5.95 20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 15.00 20.00 .4500 EA ELEC.DEVICE/FIXTURE >20 9.00 P.O. Box 1504�� VOICE (760) 777-7012 Twit 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: o/4— 33 ,�, o Date: 5 d Applicant: I Architect or Engineer: Applicant's Mailing Address: tol fLAV Architect or Engineer's Address: Av,. Vb ka, "J(` be` 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 iLise is in full force and effect. Sjy 6b6q cense Class ,cense No. 'Date 5 1 63-04 Contractor 30(JLC[0-11L )vl- OWNER-BUILDER 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 for a 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 sale.). U 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.). U I am exempt under Sec. , BA P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 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 ante carrier and policy number are: farrier — / PoliNumber 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 IS lj-t A nt 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. 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.). Lenders Name Lenders 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 orr 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, indemnity 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 arid 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 repr ntatives of this county to enter upon the above-mentioned property for inspection purposes. ate � � 63 r O �l Signature (Applicant or Agent): -f/ 0, `L ��A"D L `T%-� . Al ' Page 2 Application Number 04700003320 Date 5/07/04 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL Additional desc Permit Fee . . . 24.00 Plan Check.Fee 6.00 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH APPL REP/ALT/ADD 9.00 ---------------------------------------------------------------------------- Permit . . . . PLUMBING Additional desc Permit Fee 42.00 Plan Check Fee 10.50 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00. 3.00 6.0000 EA PLB FIXTURE 18.00 1.00 6.0000 EA PLB ROOF DRAIN 6.00 1.00 _3.0000 EA PLB WATER INST/ALT/REP 3.00 ------------------- Special Notes and ------------------------------------------------- Comments REMODEL AND 170 SQ. FT. ADDITION TOTAL CONSTRUCTION PRICE $100.000 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 41.57 STRONG MOTION (SMI) - RES 10.00 Fee summary Charged Permit Fee Total 750.45 Plan Check Total 443.42 Other Fee Total 51.57 Grand Total , 1245.44 A Paid Credited Due ---------- ---------- ---------- .00 .00 750.45 .00' .00 443.42 .00 .00 51.57 .00 .00 1245.44 City of La Quinta 7A- Building at Safety Division 7Perrmn-itP.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 6-"1-33 26 Building Permit Application and Tracking Sheet X Project Address: 9, IM -00 Ave 1—(/IyDu i r Owner's Name: �Lvq �✓i`L � A. P. Number. Address: '0Q60 Ave- '( P40 Leeal Description: n/� ( Ciry. ST, Zip: Le, Q1k i ✓i:ia X Contractor. --�&I JL ;Telephone: 'iC7 � J( Address: 4—, 01'na V a4'L -7-4L Xproject Description: Re- V,11044ex-L a.,-4 JC City, ST, Zip:. Le, 61 Li vL-�2- . 1�1/1A 5`� �-✓ �� &u, d ljv,4-Q 014141— ec , Telephone: Gj�� �j711 _z4•,�- ` �:f- State Lic. # : 0 to Arch., Engr., Designer. City Lic. #: 176 64 F7- RejD 06 Address: �a D City, ST, Zip: 8 DOS o Telephone: " �:� ri `u Construction Type: �% ^ --'0c ncy: -3 State Lic. #: Project type (circle one): New Add'n PAIj Repair Demo X Name of Contact Person: �Sq. Ft 170 # Stories: # Units: X Telephone # of Contact Person: rEstimatcd Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets . Plan Check submitted Item Amount Structural Cala. Reviewed, ready for corrections. <° y Plan Check Deposit Truss Cala. Called Contact Person Plan Check Balance Energy Calm Plans picked up Construe tion Flood ,plain pian Plans resubmitted �J 2.y Mechanical Grading pian Y' Review, ready for correc onslssne Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3" Review. ready for corrcctionslissue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue ! . .1 1 School Fc Total Permit Fees &gyp Z D dl' Y/Zd�o y 7/Z6 s�Rve� RFL y/22 St tvct- .�pac 6L- C'I�ecl� i -v be eio.to i rl-IlouS ti Date 5/12/04 No. 25895 Owner Lew C. Price Address 49200 Avenida Fernando CERTIFICATE OF COMPLIANCE . ,�AFIEDS' Desert Sands Unified School District �4�,cS�Rly�o 47950 Dune Palms Road ¢ BERMUDA DUNES r La Quinta CA 92253 � -RANCHO MIRAGE (� f � INDIAN WELLS (760) 771-8515 �� P LA QUINTAT INDIOy 0 APN # 668-280-017 Jurisdiction La Quinta .City La Quinta Zip 92253 Permit # Tract # Study Area Type Residential Addition No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 49200 Avenida Femando Unit 2 Unit 3 Unit 4 Unit 5 Comments 170 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 At the present time, the Desert Sands Unified School District does not coiled 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: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 170 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 - Jack Clark check No. Name on the check Telephone Funding Exempt By Dr. Doris Wilson Superintendent Fee collected /exempted by haron McGilvrey' Payment Recd Over/Under . Signature C 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 Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting EMEMOMM JCM Inspections 39725 Garand Lane Suite F Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS EPDXY INSPECTION REPORT JP-roject Name: Project No: Tc.s.. �` SQ\\A e nt 2. k la (2- OVA- Sa Date S- %-a Projecct Address: City: (� 4 1-0100 ! rq vC!_ L a\1' \ Title 24 AWS UBC File# E]D1.1 App# ❑ D 1.4 ❑ Other Other: /Client: Sub -Contractor: General Contractor: Architect: Structural En ineer: �>` �( CA�� W . 1 Sk�u� a ��,Ck -,-1-n c F_� Anchor Bolts ^��— Rebar Epoxy Type: J'� Tr. So I ' a Epoxy Shelf Life: 0 C-" 0 s— Hole Cleaning Method(s): kAlp \,J n C`Q 0,\ . o ., o r\cCe Weather: , n Unresolved IteAs' ®'None See Below Description of Work Inspected: O n .1 L4 pA,,, A,,,.,n�� I 1���A4 ..1c, e) � M r ry rr 11 ✓II 11 \ ' / Vi ��t1c�e G - •.� a�,T;nn �D oU irrt a ) l 0 ; J n \tl OXO Cir n l 0 Pr 'IQ Ar Q i Work complies with written approval from Structural Engineer and ICBG 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 issued at project completion.1112 Inspector: Jack. Millin ICBG Certlfic\atioli No: 0842216-49 ContractorsReprese tam ve: Copy 1 JCM Inspection "'.`"` Copy 2 Project Superintendent Copy 3 Governing ge%� ncy Page I of I