04-5773 (AR)/Lam Q'
z
�i BUILDING & SAFETY DEPARTMENT
P.00�. Box 1504
(760).777-7012
OF , 7804��9�r CALLE TAMPICO FAX (760) 777-7011
LA�QdJINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
nX BUILDING PERMIT
of P1.
Dip'(.
pplication Number . . . . 04-00005773 Date 8/06/04
Property Address . . . . . . 51865 AVENIDA CORTEZ
APN: 773-152-025-7 -000000-
Application description ADDITION - RESIDENTIAL
Property Zoning . . . . . . . COVE RESIDENTIAL
Application valuation . . . . 32432
Owner Contractor
GOODMAN JAY OWNER
P 0 BOX 25
51865 AVENIDA CORTEZ
LA QUINTA CA 9.2253
------ Structure Information 567 SQ. FT. FAMILYROOM ADDITION -----
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 567.00
-------------------------------------------------------'---------------------
Permit . . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 304.00 Plan Check Fee 197.60
Issue Date Valuation . . . . 32432
Qty Unit Charge Per Extension
BASE FEE 252.00
8.00 6.5000 THOU BLDG 25,001-50,000. 52.00
----------------------------------------------------------------------------
Permit . . . . . . ELECT - ADD/ALT/REM
Additional desc
Permit Fee 34.85 Plan Check Fee 8.71
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
567.00 0350 ELEC NEW RES - 1 OR 2 FAMILY 19.85
----------------------------------------------------------------------------
Permit GRADING PERMIT
Additional desc
Permit Fee 15..00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
P.O. BOX 1504�� VOICE (760) 777-412
T-Ildf
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: / "J 77 _�> Date:
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
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 License is in full force and effect.
License Class License No.
Date Contractor
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).):
( j 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.).
(__) 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 amexemptunder Sec. , B .C. for this reason
Datey 2 — O y Owner /
WORKERS' COMPENSATION DECLARATION
.1 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:
Cartier Policy Number
_ 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 pro 'ions.
Date I J Y Applicant Lc/
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.).
Lender's 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 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 pernit
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 hereby authorize representatives of this count ter upon the above-mentioned property for inspection purposes.
Date D —� Signature (Applicant or Agent):
Page
2
Application Number
04-00005773
Date
8/06/04
Qty Unit Charge
Per
Extension
BASE FEE
15.00
--------------------------7-------------------------------------------------
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
----------------------------------------------------------------------------
Special Notes and Comments
567 sq. ft. addition
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . ENERGY
REVIEW FEE
19.76
STRONG
MOTION (SMI)
- RES
3.24
Fee summary Charged
---------------------------
Paid Credited
------------------------------
Due
Permit Fee Total
377.85
.00
.0*0
377.85
Plan Check Total
212.31
.00
.00
212.31
Other Fee Total
23.00
.00
.00
23.00
Grand Total
613.16
.00
.00
613.16
'
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District~eERMUDA
47950 Dune Palms Road
SO
Date
8/9/04
La Quinta f CA 92253
RANCHO MIRAGE
� INDIAN WELLSDESERT
No.
26288
(760) 771-8515
�% PALM
LA QUINTA �y
QINDIO L�
B
Owner
Jay Goodman
APN #
773-152-025-7
Address
51865 Avenida Cortez
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
567 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments Residenital addition of 567
sq. to existing home.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
50D 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 567 S.F. or $1,270.08 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 cc/Washington Mutal Bk/Delia Goodman Check No. 588236320
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green
Signature
Payment Recd
$1,270.08
0.00
Over/Under.
NOTICE: Pursuant to G,6veftnment 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 identiFhe ove 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 p Districts) or to another public entity authorized to collect them on the Districtfs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original- Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of variuus trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760)777-7012
FAX:
t
OWNER'S SIGNATURE/DATE
PROPERTY ADDRESS
V� a
PERMIT NUMBER(s)
stet �A City of .La Quinta
Building at Safety. Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
X .Project Address: 5 I gG J �Owncr's Name: e' G. ood, e-!\
A.Y. Number Address: =bio c� 6•2 c 0c i C 2—
Legal
Legal Description: City, ST, Zip•�-
X Contrictor.
FIclephone:'
.
j( :Address: Xprojest Description:
�C City, ST, Zip , b 7 C . J
Telephone: i_ r
. a .Y:..
X Stats Lic. # : city Lic. #
Arch., Engr., Designer SSC Uc /Q.
Address:
City. ST, Zip:-
Telephone: - -_�
ep .�. Construction Type: Occupancy:
State Lic. #:. Project type (circle one):. NewAdd'n Alter Repair Dano
;.,.:�. .
X Name of Contact Person:') e LI t� (�;00dl A ltd XSq. Ft.: # Stories: # Units:
ie Telephone # of Contact Person: 1%7- S 0 5- Nunated Value of Project:.
APPLICANT: DO NOT WRITE BELOW THIS UNE
'{'otat Permit
#-7
Submittal
Req'd
Rec'd
TRACKING PERMIT FEES
cz
Pian Sets
Plan Check submitted
.7dlof Item Awoual
Structural Cites.
Reviewed, ready r correction
Plan Check Deposit
7i
Truss Cala.
Called Contact Person
Plan Check Balance
Energy Cala.
Plans Picked up
/(p Construction
Flood plain plan
Plans resubmitted
`, Meedsaical
Grading plan
2" Review, ready for correctio issue
$ Electrical
Subcontactor Lst
Called Contact Person. S
Plumbing
Grant Deed •
Plans picked up
SAII.1.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
s'' Review, ready for eorrectioaslissue
Developer impact Fee
Plannin Appeoval
Called 6ontactlerson
'{'otat Permit