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04-3350 (AR)�10 j R 1:2 M4 ! BUILDING & SAFETY DEPARTMENT .�PO--.Box-1-50'4-��, (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA,'CA.L,1fORNIA 92253 INSPECTION REQUESTS\(760)�7.7t7-7153 BUILDING PERMIT Application Number . . . `'04-00003350 �._ Date Property Address . . . . . . 54269 AVENIDA VELASCO APN: 774-251-027-4 -000000- Application description ADDITION - RESIDENTIAL Application valuation . . . . 73226 . Owner Contractor ------------------------ SANDY KING ------------------------ A-1 MAINTENANCE 54-269 AVENIDA VELASCO P.O. BOX 3795 LA QUINTA CA 92253 BIG BEAR LAKE CA 92315 (323) 893-3866 (909) 70-9694 WCC: NONE WC: EXEMPT 05./27/04 CSLB: 797255 07/31/05 CCC: B ------ Structure Information ADDITION/ GARAGE/ RE -MODEL ----- Construction Type TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/LONG <=10 Flood Zone . . . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 # BEDROOMS 1.00 FLOOD ZONE NO GARAGE SQ FTG 576.00 FIRST FLOOR SQ FTG =------------------------------------ 1252.00 ---------------------------- Permit . . . . . . BUILDING PERMIT =---------- Additional desc Permit Fee . . . . 522.50 Plan Check Fee 339.63 Issue Date . . . . Valuation . . . 73226 Qty Unit Charge Per Extension BASE FEE 414.50 24.00 4.5000 THOU BLDG 50,001-100,000 108.00 ---------------------------------------------------------------------------- Permit . . . . . MECHANICAL Additional desc . Permit Fee . . . . 30.50 Plan Check Fee 5.38 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 1.00 6.5000 ---------------------------------------------------------------------------- EA MECH EXHAUST HOOD 6.50 P.O. BOX 1504s �f 44� VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 TINSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: S4A/D4,/ �Ci�{t9 Applicant's Mailing Address* _5 Y, •269 ,OVO ✓,erZ.JSeo .CA tQJINTA 60- Z2.2 5-3 Date: 4-4'04/ Architect or Engineer: NB Al Architect or Engineer's Address: /✓owal' 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 (coing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class dpi License No. J Date G 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).): 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. , B.& P.C. for this reason Date WORKERS' 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: Cartier Policy Number 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 rthwi comply with those provisions. Date Applicant 7�4 WARNIN : 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 kt0/k(L_ Lender's 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 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 hereby authorize representatives of this county to enter u oWthe bove-mentioned property for inspection purposes. Date /0(1 Signature (Applicant or Agent): ✓ Fee summary Charged Permit Fee Total 655.72 Plan Check Total 365.14 Other Fee Total 41.28 Grand Total 1062.14 Paid Credited .00 Page 2 Application Number . . . . . 04-00003350 Date 4/08/04 Permit . . . . ELECT - ADD/ALT/REM .00 Additional desc Permit Fee . . . . 48.72 Plan Check Fee 10.38 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 576.00. ..0200 ELEC GARAGE OR NON-RESIDENTIAL 11.52 20.00 .7500 PER ELEC DEVICE/FIXTURE 18T 20 15.00 16.00 .4500 EA ELEC'DEVICE/FIXTURE'>20 7.20 ---------------------------------------------------------------------------- Permit PLUMBING Additional desc . Permit Fee . . . . 39.00 Plan Check Fee . 9.75 Issue Date . . Valuation . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 6.0000 EA PLB FIXTURE 24.00 - Permit . . . . GRADING PERMIT Additional desc Permit Fee . . . . 15.00 Plan Check Fee'. .00. Issue Date 4/08/04 Valuation 0 Expiration Date 10/05/04 Qty Unit,Charge Per Extension BASE FEE 15.00 ---------------------- Special Notes and ----------------------------------------------------- Comments 504 S.F. GARAGE CONVERSION TO LIVABLE / 748 S. F. ROOM ADD I T I ON / 5 7 6' S. F. - DETACHED GARAGE / KITCHEN RE -MODEL -------=-------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 33.96 STRONG MOTION (SMI) - RES 7.32 Fee summary Charged Permit Fee Total 655.72 Plan Check Total 365.14 Other Fee Total 41.28 Grand Total 1062.14 Paid Credited .00 .00 .00 .00 .00 .00 :00 .00 Due 655.72 365.14 41.28 1062.14 CERTIFICATE OF COMPLIANCE ,Desert Sands Unified School District zo ,�°o '; "• ;' . ` 47950 Dune Palms Road ¢ BERMUDA DUNES r' Date - 4/12/04 - La QUinta � CA 92253- 00) RANCHO MIRAGE CJ -` ,�. .. + � � INDIAN WELLS - '1 760 771-8516 PALM DESERT No. 25784 . ) ' `%N10 , LA DIO - • � t �� UINTA I� s s Q. O y y' Owner Sandy King r APN # 774-251-027 Address 45269 Avenida Velasco t Jurisdiction La'Quinta + City La Quinta Zip 92253 Permit_ # Tract # F Study Area r Type Residential Addition No. of Units 1 - Lot # No. Street S.F. • Lot # No. Street S.F. Unit 1 54269 Avenida Velasco. •1252 Unit 6 , Unit 2 E Unit 7 b Unit 3 Unit 8 y } Unit 4 �s �' _ Unit 9 Unit'i ' Unit 10 , Comments ' k ' • 't At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkway's, 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: EXEMPTION NOT APPLICABLE ' r r This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. r in the amount of $2.24 X 1,252, S.F. 'or $2,804.48 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/First Mo6ntain'Bank Frank'Howes ti , Check No:. 112918, - Name on the check �Telephone'760/777-4648 - t Funding Residential } By,., Dr. Doris Wilson ; Superintendent Fee collected /exempted by Sharon MCGilvre.y , Payment Recd • J$0.60 , $2,804.48 OveriUnder ' y - Signature C ; .71* NOTICE: Pursuant to Government Code Section d 66020 , this will serve to notify fy 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 TAN Dr.S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 SPECIAL INSPECTION DAILY REPORT OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OF INSPECTION PERFORMED �PoX DESCRIPTION.- DATE . TICKET NUMBER MIX NUMBER AIR TEMP SAMPLE SLUMP TIME IN MIXER SAMPLED TEMP . �y 2 PHYSICAL ADDRESS Sq -?-(o9 L PERMIT NUMBER , 0 4 -N ; r JOB NAME TYPE OF STRUCTURE K,n S ARCHITECT ENGINEER R GENECONTRACTOeRA�, SUBCONTR �j /� (� RAACTOR I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, u UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I HAVE FOUND THIS INSPECTORSRE WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS 8 APPLICABLE BUILDING LAWS.cl / tr" -• 1�k "Sn7l I c) 4 CC: INSPECTORS CERTIFlCA K)N AGENCY AND NUMBER i DESCRIPTION.- SUPPLIER TICKET NUMBER MIX NUMBER AIR TEMP SAMPLE SLUMP TIME IN MIXER SAMPLED TEMP . LOCATION ont • �. WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER 41 , V:��,�► I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, u UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I HAVE FOUND THIS INSPECTORSRE WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS 8 APPLICABLE BUILDING LAWS.cl / tr" -• 1�k "Sn7l I c) 4 CC: INSPECTORS CERTIFlCA K)N AGENCY AND NUMBER i SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER AIR TEMP SAMPLE SLUMP TIME IN MIXER SAMPLED TEMP . LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER 41 I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, u UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I HAVE FOUND THIS INSPECTORSRE WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS 8 APPLICABLE BUILDING LAWS.cl / tr" -• 1�k "Sn7l I c) 4 CC: INSPECTORS CERTIFlCA K)N AGENCY AND NUMBER i