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07-3164 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Applicant: G07* 00003164 54310 AVENIDA JUAREZ 774-233-003-22 -000000- ADDITION - RESIDENTIAL COVE RESIDENTIAL 20077 Architect or I A 'r 40"- Tiht BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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: B C:8 C36 / ,% LicenseNo.: 343335 85.... Date: Contractor: - � i Contractor: / C 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).: (_) 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.). (_ 1 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.I. Lender's Name: Lender's Address: LQPERMIT Owner: JORDAN MARVIN L P O BOX 228 LA QUINTA, CA 92253 Contractor: ML CONSTRUCTION P O BOX 228 LA QUINTA, CA 92247 (760)564-4447 Lic. No.: 343335 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/04/08 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 Sectinn 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 3009759-2008 _ 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 forthwj;h comply with those provisions. Date: 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 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 is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspect purposes. J n v Date* Signature (Applicant or Agent): i"� ' Application Number: w, Property Address: ! APN: Application description: Property Zoning: Application valuation: Applicant: G07* 00003164 54310 AVENIDA JUAREZ 774-233-003-22 -000000- ADDITION - RESIDENTIAL COVE RESIDENTIAL 20077 Architect or I A 'r 40"- Tiht BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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: B C:8 C36 / ,% LicenseNo.: 343335 85.... Date: Contractor: - � i Contractor: / C 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).: (_) 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.). (_ 1 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.I. Lender's Name: Lender's Address: LQPERMIT Owner: JORDAN MARVIN L P O BOX 228 LA QUINTA, CA 92253 Contractor: ML CONSTRUCTION P O BOX 228 LA QUINTA, CA 92247 (760)564-4447 Lic. No.: 343335 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/04/08 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 Sectinn 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 3009759-2008 _ 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 forthwj;h comply with those provisions. Date: 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 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 is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspect purposes. J n v Date* Signature (Applicant or Agent): i"� ' LQPERMIT Application Number . . . . . 07-00003164 , ------ Structure Information ADDTN TO EXIST. RES. ----- Other struct info . : . . . CODE EDITION O1BMP04E05EN -- # BEDROOMS .00 FLOOD ZONE NO 6 1ST FLOOR SQUARE FOOTAGE 351.00 ------------------=------------------------------------------=----------- Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 216.00 Plan Check Fee140.40 Issue Date . . . . Valuation . . . . 20077 Expiration Date 7/02/08 Qty Unit Charge Per Extension BASE FEE 45.00 19.00 9.0000 ---------------------- ------------------------------------------------------ THOU BLDG 2,001-25,000 171.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 27.29 Plan Check Fee _ 6.82 Issue Date . . . . Valuation . . . . 0 Expiration Date 7/02/08 Qty Unit Charge Per Extension _ BASE FEE - 15.00 351.00 .0350 ---------------------------------------------------------------------------- ELEC NEW RES - 1 OR 2 FAMILY 12.29 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 19.50 Plan Check Fee 4.88 Issue Date . . . . Valuation . . . . 0 Expiration Date 7/02/08 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 --------------------------------------- EA MECH VENT INST/ DUCT ALT ------------------------------------- 4.50 Permit . . . PLUMBING Additional desc . . Permit Fee . . . . 27.00 Plan Check Fee 6.75 Issue Date . . . . Valuation . . . . 0 Expiration Date,. 7/02/08 Qty Unit Charge Per Extension LQPERMIT LQPERMIT Application Number . . . 07-00003164 Permit . . . . PLUMBING Qty Unit Charge Per Extension BASE FEE 15.00 2.00 6.0000 EA ; PLB ROOF DRAIN 12.00- ------------------- -----------------------------•---------------------------- Special Notes and Comments 351 SF. ENTRY & LIBRARY ADDITION TO EXISTING RESIDENCE. 2001 CBC,CMC,CPC, 2004 CEC, 2005 ENERGY CODES. -------------------------------------------------------= Other Fees ENERGY REVIEW ------------------- FEE 14.04 STRONG MOTION (SMI) - RES 2.00 Fee summary. Charged Paid Credited Due Permit Fee Total 289.79 .00 .00 289.79 Plan Check Total 158.85 .00 .00 158.85 Other Fee Total 16.04 .00 .00 16.04 Grand Total 464.68 .00 .00 464.68 c CERTIFICATE OF COMPLIANCE 4�o Desert Sands Unified School District 47950 Dune Palms Road Q BERMUDA DUNES O Date 117108 La Quinta, CA 92253 RANCHO MIRAGE C7 ",INDIAN WELLSPALM DESERT No. 29836 (760) 771-8515 1v 1 INDI NTA .yy a Owner Marvin Jordan APN # 774-233-003 Address 54310 Avenida Juarez Jurisdiction La Quinta City La Quinta Zip 92253 Permit # Tract # No. of Units 1 Type Residential Addition Lot # No. Street S.F. Unit 1 54310 Avenida Juarez 351 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Lot # No. Street S.F. At the present time, the Desert Sands Unified School District does not colied fees on garages/carports, covered patios/walkways, 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 Education Code Section 17620 and Goverment Code 65995 Et Seq. in the amount of $0.00 X 351 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 - Marvin Jordan Check No. Name on the check Telephone 564.6011 Funding Exempt r tt Y Dr. Sharon P. McGehee Superintendent 77` 0 Fee collected /exem y Sh McGa Payment Recd $9.00 ; Over/Udder 0' �N1 ry /% Signature C r4��" / x NOTICE: Pursuant to Government Code Section 166020(d)( is willSirve 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 Nwhicp 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 ent u orized to collect them on the Distrid('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID without embossed seal Embossed Original- Building Department Applicant Copy - Applicant/Receipt Copy - Accounting