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04-3591 (AR)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO ' FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number 04-00003591 Date 4/28/04 Property Address . . . . . 54211 SHOAL CREEK APN: 775-041-007- - - Application description . . . ADDITION - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation 8453 Owner ------------------------ JOHNSON, PEGGY Contractor ------------------------ EDWARD- CONSTRUCTION, BOB 79920 FIESTA DR LA QUINTA CA 92253 Qty Unit Charge Per 7.00 BASE FEE 9.0000 THOU BLDG 2,001-25,000' ju,� 1 Euu��ens°i� A 45.Q0 . 10 WCC: PREF INS WC: WKN1090403 01/01/05 CSLB: 684857 03/31/06 CCC: B ------ Structure Information 92 SQ. FT GOLF CART, 50 SQ. FT. PATIO ----- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . GAR, CARPORT, SHED, AG Flood Zone . . . . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 CBC FLOOD ZONE NO GARAGE SQ FTG 92.00 PATIO SQ FTG 50.00 ---------------------------------------------------------------------------- Permit . . . . . .. ELECT - ADD/ALT/REM Additional desc Permit Fee . . . 27.34 Plan Check Fee 6.84 ..Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 92.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 1.84 14.00 .7500'PER ELEC DEVICE/FIXTURE 1ST 20 10.50 ----'------------------------------------------------------------------------ Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee . . 108.00 Issue Date . . . . Plan Check_Fee :� 70„�20 Valuation ,453 � '. 3 Qty Unit Charge Per 7.00 BASE FEE 9.0000 THOU BLDG 2,001-25,000' ju,� 1 Euu��ens°i� A 45.Q0 . 10 .i P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT I Air Application Number: Applicant: Applicant's Mailing Address: Date: � �`c Arch=10fteer:gin Architect o LEn gjnes d (_ n Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under enalty 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 Lice s is in full force and effect. g/ 7� �7 License f Class n Lic nse No.�— Data �P (- "4 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 1, as owner of the property, am exclusively contracting with licensed confractors 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. have/and nd 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 i �rk compensation insurance came an�d p�,1 rc umbar ar Carrier Policy Number l.�/1r�y\y1� 6 4 06 I certify that, in the performance f 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 Calif i , and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall 11f 4 frt/hwith comply with thos pr i�sn's. .Date Ll ` �O Applicant - WARNING: licantWARNING: 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 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 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 c ellation. I certify that I have read this application and state that the abo ICE tion is correct. I agree to comply with all city and county ordinances and state laws relating to building construct* n, Thereby authorize representatives of this co ty t e er up n the abo tinned property for inspection purposes. Date Signature (Applicant or Agent): i R Page 2 Application Number . . . . . 04-00003591 Date 4/28/04 ---------------------------------------------------------------------------- Special Notes and Comments 92 SQ.FT. GOLF CART AND 50.SQ. FT. PATIO ADDITION. ---------------------------------------------------------------------------- Other Fees . . . . . . ART IN PUBLIC PLACES -RES. .00 ENERGY REVIEW FEE 7.02 STRONG MOTION (SMI) - RES .84 Fee summary Permit Fee Total Plan Check Total Other Fee Total Grand Total Charged Paid 135.34 .00 77.04 .00 7.86 .00 220.24 .00 Credited Due .00 135.34 .00 77.04 .00 7.86 .00 220.24 CERTIFICATE OF COMPLIANCE Desert Sands Unified School District �o�c'�o 47950 Dune Palms Road ¢ eERMUOA DUNES r Date 6/18/04 La Quinta CA 92253 RANCHO MIRAGE (� 7 � INDIAN WELLS No. 26068 (760) 771-8515 �,� PALM U;NT� y QINDIO y7� a Owner Peggy Johnson APN # 775-041-007 Address - 25876 Kellogg St Jurisdiction La Quinta City Loma Linda Zip 92354 Permit # Tract # Study Area Type Residential Addition No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 54211 Shoal Creek Unit 2 Unit 3 Unit 4 Unit 5 Comments 92 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 At the present time, the Desert Sands Unified School District does not collect 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 92 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 - Bob Edwards Check No. Name on the check Telephone By Dr. Doris Wilson Superintendent Fee collected 0 Funding Exempt Payment Recd $0.00 Over/Under NOTICE: Pursuant to Government Code Section 66020(d)(1), this I serve o 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 whicloMbuilding 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