2004-4702 (SFD)78-495 CALLETAMPICO D�MMN�iI/
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: BUILDING, RESIDENTIAL/DWELLING -SINGLE FAMILY DETACHED
Application Number: SFD-04-4702
Property Address: 79675 TOM FAZIO LN N
APN: 766032020
Application Description:
Property Zoning:
Application Valuation: $0.00 ( l
Applicant:
i
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions 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 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 orher 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.).
(_) I am exempt under Sec. . B.&P.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.).
Lender's
Lender's
1 VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/20/2017
Owner:
HILL ROBERT M
79620 TOM FAZIO LANE NORTH
, 92250
Contractor:
SUN VISTA DEVELOPMENT CORPORAT
P.O. BOX 1144
, 92253
(760)771-4722
LIC. No.:
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: _ 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 provisions.
Date:
Applicant:
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 Building Official 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 city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
Application Number: SFD-04-4702
Property Address: 79675 TOM FAZIO LN N
APN: 766032020
Application Description:
Property Zoning:
Application Valuation: $0.00
Date: 10/20/2017
Owner:
HILL ROBERT M
79620 TOM FAZIO LANE NORTH
, 92250
Applicant: Contractor:
SUN VISTA DEVELOPMENT CORPORAT
P.O. BOX 1144
92253
(760)771-4722
Llc. No.:
----------------------------------;----------------------------------------------------------;
Detail:
FINANCIAL INFCIRMATICIN
DESCRIPTION
ACCOUNT QTY AMOUNT
ART IN PUBLIC PLACES -RES
27000003650500 $789.29
Total Paid for ART IN PUBLIC PLACES -RES: $789.29
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DIF CIVIC CENTER - RES
25200003650000
$366.00
Total Paid for DIF CIVIC CENTER - RES:. $366.00
DESCRIPTION
ACCOUNT
QTY
1
AMOUNT
DIF COMMUNITY CENTERS -RES
25400003650000
1 $97.00
Total Paid for DIF COMMUNITY CENTERS -RES: $97.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DIF FIRE PROTECTION -RES
25700003650000
$97.00
Total Paid for DIF FIRE PROTECTION -RES: $97.00
DESCRIPTION
ACCOUNT
QTY'
AMOUNT
DIF LIBRARIES - RES
25300003650000
$225.00
Total Paid for DIF LIBRARIES - RES: $225.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DIF PARK MAINT FAC - RES
25600003650000
$5.00
Total Paid for DIF PARK MAINT FAC - RES: $5.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DIF PARKS/REC - RES
25100003650000
$502.00
Total Paid for DIF PARKS/REC - RES: $502.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DIF STREET MAINT FAC -RES
25500003650000
$15.00
Total Paid for DIF STREET MAINT FAC -RES: $15.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DIF TRANSPORTATION - RES
25000003650000
$1,098.00
Total Paid for DIF TRANSPORTATION - RES: $1,098.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
ENERGY REVIEW FEE
10160003220600
$135.69
Total Paid for ENERGY REVIEW FEE: $135.69
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT FEES
0
$2,087.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT FEES
0
$254.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT FEES
0
$15.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT FEES
0
$175.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT FEES
0
$289.50
Total Paid for PERMIT FEES: $2,822.34
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PLAN CHECK FEES
0
$356.88
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PLAN CHECK FEES
0
$63.71
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PLAN CHECK FEES
0
$43.88
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PLAN CHECK FEES
0
$72.38
Total Paid for PLAN CHECK FEES: $536.85
DESCRIPTION
ACCOUNT
CITY
AMOUNT
STRONG MOTION (SMI) - RES
10100002030800
$51.57
Total Paid for STRONG MOTION (SMI) - RES: $51.57
•
Coachella Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
Project Name: Robert Hill
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMM/IND. AMOUNT:
DATF.,
RFr.F.IPT,
CFTF.CK Nl
INITIAIN,
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Date: June 8, 2004
Owner's Name: Robert Hill Phone No. (760) 771-4722
Project Address: 79t Tom Fazio Lane, La Quinta
Project Description: If SPD
APN: 766-032-020 Tract #: Lot #'s:
Type of Development: Residential XX Commercial Industrial
Total Square Feet of Building Area: 5972 Sq. Ft.
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer.
Dated: 06/08/04
Signature:
SCHOOL DISTRICT'S REQUIREMENTS FOR THE AB VE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Number of Sq.Ft. 5972
Amount per Sq.Ft. $ 2.68
Amount Collected $ 16,004.96
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Business Services
Certificate issued by: Leticia C. Torres, Facilities Clerk Signat)de:
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these
Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to
advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other
requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this
time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of
Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up
to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject
of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
i-1V:clmvdocsi'dcvfc.eslCertiticrite of oornplianoc form tablesTO USF.doc 1/16/03 T
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9
Certifidate of Occupancyp
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GOF9�7 Building & Safety Department
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This Certificate is issued pursuant to the requirements of Section 109. of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
R
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BUILDING ADDRESS: 79-67570M FAZIO LANE NORTH
i
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-4702
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
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Owner of Building: ROBERT HILL Address: 79620 TOM FAZIO LANE N.
City, ST, ZIP: LA QUINTA, CA 92253
{
By: GARY HARTMAN
'
Date: JANUARY 11, 2006
Building Official
POST IN A CONSPICUOUS PLACE i
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