05-5113 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00005113
Property Address:
49000 AVENIDA EL NIDO
APN:
658-300-017- - -
"'� Application description:
ADDITION - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
11853
c&ty/ 4 4 Q"
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: B Li se No.: 74,6760
r
Date: I� 3 Q 6Contractor:
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).:
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 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—) I am exempt under Sec. , BAP.C. for this reason
Date:
Owner:
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:
LQPER,I4IT
Owner:
BYFORD ROSWITHA
49000 AVENIDA EL NIDO
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/12/06
Contractor:
B & M CONSTRUCTION �f
P.O. BOX 1977 "nit
I 1
LA QUINTA, CA 92247 r 2Q06
(760)578-0406 C OFIA I
Lic. No.: 746760 HAAIIe� Q�I�NTe
-----------------------------------------------
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 STATE FUND Policy Number 1542480
_ 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 th workers' compensation provisions of Section
y 3,7'10/0 of the Labor Code, hall forthwith co with those pr
Date: v Vv Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPEN ATION 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 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 I by authorize representatives
of this county to enter upon the above-mentioned property fhspection pur901-Is
s.
r
Date://7 31676 Signature (Applicant or Agent):
Application Number . . . . . 05-00005113
Permit . . . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
135.00 Plan Check
Fee
87.75
Issue Date . . . .
Valuation
. . . .
11853
Expiration. Date
7/11/06
Qty Unit Charge
Per
Extension
BASE FEE
45.00
10.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
90.00
Permit . . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee
24.45 Plan Check
Fee
6.11
Issue Date
Valuation
. . . .
0
Expiration Date
7/11/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
270.00 .0350
-----------------------------------------------------------
ELEC NEW RES - 1 OR 2 FAMILY
-----------------
9.45
Permit . .. .
MECHANICAL
Additional desc .
Permit Fee . . . .
30.50 Plan Check
Fee
7.63
Issue Date . . . .
Valuation
. . . .
0
Expiration Date
7/11/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.00'00
EA . MECH APPL REP/ALT/ADD
9.00
1.00 6.5000
--------------------------------=------------------------------------------=
EA MECH VENT FAN
6.50
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
30.00 Plan Check
Fee
7.50
Issue Date.
Valuation
. . . .
0
Expiration Date
7/11/06
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
bath, closet and sitting
room addition
LQPEILVIIT
Application Number . . . . .
05-00005113
----------------------------------
Special Notes and Comments
----------------
------------
--------------
under existing patio.January
12, 2006
9:07:02 AM j3ohnson
----------------------------- ----------------------------------------------
Other Fees . . . . . . . . .
ENERGY REVIEW
FEE
8.78
STRONG MOTION
(SMI) - RES
1.18
Fee summary Charged
---------------------------
Paid Credited
------------------------------
Due
Permit Fee Total 219.95
.00
.00
219.95
Plan Check Total 108.99
00
.00
108.99
Other Fee Total 9.96
.00
.00
9.96
Grand Total 338.90
.00
.00
338.90
LQPERMIT
4
X21 � 1 �s 6Z L ` iJ D PN Vf
City of La Quinta
Building 9 Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: qqo oo Avfn,ud,- E( Nt ct z?
Owner's Name: �j� 0.1nd �D 5t✓! y/�ia O/
A. P. Number:
Address: L(gDD0 Avg, 4 G/ lvll it
Legal Description:
ST, Zip: (p, (PL, 11f, Ir, 9aas3
jCity,
Contractor: j3 q- �� CO %
Telephone:
; £ • ,_ .
Address: '7 `7
Project Description:
City, ST, Zip:1-0. s�.�: ,. �' o� ct — 9.:) a C/
r (�
Telephone: Cj 7 ez51 — 0�,( 0 b
r.
D
State Lic. # : (0 7 r a .
City Lic. #:�,
r7
Arch., Engr., Designer: Mayk 8.' UQ'ea1 e��t�
Address: 11 Li a % 7 Mo KV`J�rV 4v e- �/-
01 A/e��S S " 7-- A'VT
/�
City, ST, Zip: PQ rl u-� D e= rv., 7� l �� T �r� a 6 _6
Telephone: 3 Lf 6 - 3 / S'
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
2
Name of Contact Person: (> S e
Sq. Ft.: �0.
# Stories: j
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
LLI
,d
Item Amount
Structural Cates.
Reviewed, readyor corrections
(Z
flan Check Deposit
Truss Calcs.
Called Contact
Plan Check Balance
nergy Cales.
Plans picked up
l?'.�
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading.plan
2"d Review, ready r correction issue
121��
Electrical
Subcontactor List
Called Contact Pe
'7
Plumbing
Grant Deed
Plans picked up
No6
S.M.I.
H.O.A. Approval
Plans resubmitted
i ��
Grading
IN HOUSE:-
'`" Review, ready for correcti Pissue
'
Developer Impact Fee
Planning Approval
Called Contact Person
i I
•
A-1-P.P.
Pub. Wks. Appr
Date of permit issue
r
School Fees
Total Permit Fees
X21 � 1 �s 6Z L ` iJ D PN Vf
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential- additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. 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
in the amount of $0.00 X 270 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 Brian Sprueill Check No. 0.00
Name on the check Telephone
ceding Residential.
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by ESpe Lara Payment Recd
Over/Under
Signature
FT
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 o
r 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
0