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