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05-4235 (SFD)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4ht BUILDING & SAFETY DEPARTMENT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 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 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 70001 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.). 11 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 am exempt under. Sec. , B.&P.C. for this reason J Date: Owner: CONSTRU119ION 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: LQPERMIT DITION 2001/2005 Date: 3/22/06 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 4 4 . 00 Policy Number NO 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' co ensation provisions of Section /3700 of the Labor Cc e, shall forth ith comply with tho pr visions. Date: 7 • L / l I,2 Applicant: WARNING: FAILURE TO SECURE WORKERS' ENSATION 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 hereby authoriz esentatives of this county toenterupon the above-mentioned property ection poses. � ( Date: �NSignature (Applicant or Agent): BUILDING PERMIT Application Number: 05-00004235 Owner: Property Address: 79152 TOM FAZIO LN S PIPPIN JIM APN:' 766-042-004- - - Property Zoning: LOW DENSITY RESIDENTIAL Other struct info . . . . . C Application valuation: 440893 a D ontractor: Applicant: Architect or Engineer: Owner MAR 27 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 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 70001 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.). 11 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 am exempt under. Sec. , B.&P.C. for this reason J Date: Owner: CONSTRU119ION 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: LQPERMIT DITION 2001/2005 Date: 3/22/06 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 4 4 . 00 Policy Number NO 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' co ensation provisions of Section /3700 of the Labor Cc e, shall forth ith comply with tho pr visions. Date: 7 • L / l I,2 Applicant: WARNING: FAILURE TO SECURE WORKERS' ENSATION 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 hereby authoriz esentatives of this county toenterupon the above-mentioned property ection poses. � ( Date: �NSignature (Applicant or Agent): Application Number . . . . . 05-00004235 ' Permit BUILDING PERMIT Additional,desc . Permit Fee . . . 1833.00 Plan Check Fee 1191.45 Issue Date . . . . Valuation . . . . 440893 Expiration Date 9/18/06 Qty Unit Charge Per Extension ' BASE FEE 639.50 341.00 ---------------------------------------------------------------------------- 3.5000 THOU BLDG 100,001-500,000 1193.50 '� Permit ELEC-NEW RESIDENTIAL Additional desc.. Permit Fee . . . . 226.08 Plan Check Fee 56.52 Issue Date . . . . Valuation 0 Expiration Date 9/18/06 Qty Unit Charge Per Extension BASE FEE 15.00 5088.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 178.08 900.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 18.00 1.00 15.0000 -----------------------------------------------------------------------_----- EA ELEC TEMPORARY POWER POLE 15.00 'Permit GRADING PERMIT Additional desc . Permit Fee . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration.Date 9/18/06 Qty Unit Charge Per Extension ------------------------------------------------- BASE FEE -------------------------- 15.00 Permit . . . MECHANICAL 4� Additional desc . Permit Fee . . . . 119.50 Plan Check Fee 29.88 Issue Date . . . . Valuation . . . . 0 Expiration Date.. 9/18/06 �. Qty Unit Charge Per Extension. BASE FEE 15.00 4.00 9:0000 EA MECH FURNACE <=100K 36.00 4.00 9.0000 EA MECH B/C <=3HP/100K BTU 36.00 4.00 6.5000 EA MECH VENT FAN 26.00 1.00 ---------------------------------------------------------------------------- 6.5000 EA MECH EXHAUST HOOD 6.50 LQPERAIIT Application Number . . . . . 05-00004'235 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 207.00 Plan Check Fee 51.75 Issue Date . . . . Valuation 0 Expiration Date.. 9/18/06 ! Qty Unit Charge Per Extension BASE FEE 15.00 21.00 6.0000 EA PLB FIXTURE 126.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 ell 2.00 7.5000 EA PLB WATER HEATER/VENT 15.00 -1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 12.00 .7500 EA PLB GAS PIPE >=5 9.00 1.00 15.0000 EA PLB GAS METER 15.00 ---------------------------------------------------------------------------- Special Notes and Comments 5088 SQ. FT. SFD THIS PERMIT DOES NOT INCLUDE POOL & SPA BLOCK WALLS OR DRIVEWAY APPROACH.March 22, 2006 7:41:30 AM JJOHNSON ------=--------------------------------------------------------------------- Other Fees . . . . . ... . . ART IN PUBLIC PLACES -RES 602.23" DIF COMMUNITY CENTERS -RES 74.00 DIF CIVIC CENTER - RES 480.00 ENERGY REVIEW FEE 119.15 DIF FIRE PROTECTION -RES 140.00 GRADING PLAN CHECK FEE :00 DIF LIBRARIES - RES 355.00 DIF PARK MAINT FAC - RES 22.00 DIF PARKS/REC - RES 892.00 STRONG MOTION (SMI) - RES 44.:08 DIF STREET MAINT FAC -RES 67.00 DIF TRANSPORTATION - RES 1666.00 Fee -summary Charged ------ Paid Credited - --- ---------- ---------- ---------- Due ----------------- Permit Fee Total 2400.58 .00 .00 2400.58 Plan Check Total 1329.60 750.00 .00 579.60 Other.Fee Total 4461.46 .00 .00 4461.46 Grand Total 8191.64 750.00 .00 7441.64 LQPERMIT CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS -79 �SoL low.g.?.b c -e .5o,4 PERMIT NUMBER���. V% OWNER L6• 16; W -C BUILDER U `Z,,^eme(' This form' shall be posted on the jl_ob with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Trade: ssification.. ! Cla �1 : " •::r Contractor :..:. .....:... Company Name .:....:: .......:.State;:Gontr ona;License.:".::...... :..:. act : - Classification License Number Exp. Date (e.g. A, B, C 8) (xxxxxx) (xx/xx/x7x) ;.:...Workers:Com ensationansurance:.>:> :.: P Carrier Name Policy Number Exp: Date (e.g. State Fund, CalComp) (Format Varies) (xx/xx/xx) Crty:Business:License License Number Exp. Date Ixxxx) (xx/xx/xx) EARTHWORKIC 121 �deJo ee�: y3g83`{ y( al -0 t 5i.+eeve CONCRETE (C 8) ��c1vJe�� �.nu2 I O� b t 31 0 vl� 0 313110 FRAMING (G5) �cace�. �e>i�` G��nS1fi� Z 3`10 �� - 103 ��OZ Cn�l� o'�cw .� ��ta ?� g i l S 102 3131 �o? dl� STRUCT STEEL IC 51i t` g�l� e 1 CSI 7� $2Z ' ZI2e167 Sty. 1175 y qT0 X131106 MASONRY (C 29) I -SID PLUMBING (C 36) .> Clnnr�S Sect: W' SSOC. nn /, IJ &36 a J / v5L 10-3-04S��%`i Cr/ �f I O �i �� -p LATH; PLASTER (C=35) C/N� '1 q i { y ' P.O. BOX 1504 BuildVAg ..— ii t 78-495 CALLE TAMPICO Address i"'1 1 �Y7�.t.'�fst% In I QUINTA, CALIFORNIA 92253 Mailing Address — Contractor Address City Zip JTel. & Classif. I Lic. # Designer r)CAVb rim 4B LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that he 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 Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or im- provement is sold within one year of completion, the owner -builder will have the burden of proving that he 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) O 1 am exempt under Sec. B. & P.C. for this reason Date WORKER'S COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less). 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 Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT If, after making this Certificate of Exemption you should become subject to the Workers' Compensation Provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 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 city to enter the above-mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip APPLICATION ONLY BUILDING: TYPE CONST. OCC. GRP. A.P. Number l l/l i Legal Description Project Description_ �= G WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE Sq. Ft. C . Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Front Setback from Center Line Rear Setback from Rear Prop. Line Ky Side Setback from Property Line FINAL DATE INSPECTOR Estimated Valuation Date Permit PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const.d Mech. Electrical Plumbing S.M.I. Grading Driveway Enc.OEp U,, A Infrastructure TOTAL REMARKS WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE Date 3/24/06 No. . 28288 Owner Jim Pippin Address City Zip Tract # Type Single Family Residence CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # Study Area No. of Units u-:Dso� 0 Q BERMUDA DU Es r C/] RANCHO MIRAGE N-) INDIAN WELLS a^ PALM DESERT LA QUINTA d%.INDIO J+ 766-042-004 La Quinta 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 79152 Tom Fazio Ln 5088 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments CC for $13,341.44 + $40.00 cash = amount due At the present time, the Desert Sands Unified School District does not collect 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: 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 $2.63 X 5,088 S.F. or $13,381.44 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/Bank of America - Chris Pippin Check No. 2022091721 Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exemp :daron M Gilvrey Payment Recd $0.00 7� = $13, 381.44 4Ovedtj� 'den• � Signature NOTICE: Pursuant to Government Code Section 66020(Z1), wi 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 thw ich the building or installation permit for this project is issued, or from the date on which those amounts are paid to the Districts) or to another puauthorized 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