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10-0041 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Appljcation.Number: 10-Q00b0041 Property Address: 52525 AVENIDA VALLEJO APN: 773-292-012-1 -000000- Application description: ADDITION - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 20000 Applicant: OIC BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or. Engineer: 4:o*V4R44S-S Gaet�en/� ----------------- 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 Professionals Code, and my License is in full force and effect. Ljsense lass• B Lice a No.: 769229 Dater 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).: 1 _ I 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.). (_) 1, 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 ' pursuanttothe Contractors' State License Law.). ( 1 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 Name: _ Lender's Address: LQPERDIIT Owner: ALBERS WILLIAM & AMY 49855 RANCHO SAN FELIPE LA QUINTA, CA 92253 (760)774-8787 Contractor: ALBERS CONSTRUCTION PO BOX 238 LA QUINTA, CA 92253 (760)771-9954 Lic. No.: 769229 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/08/10 � a MAR 0,8 2010 ]1] Ck-NC . CITY OF LA QUINTA FINAtICE DEPT. 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 workerscompensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 0004885-2009 _ 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 //*L!� 37000 /o the Labor e, I shall fort ith om I 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 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 o thiss co �yn"t to enter upon the above-mentioned prope or inspectiop/`�pgr/o Date: ✓ o '" ,Signature (Applicant or Agent): ` ✓�/"i..—• Application Number 10-00000041 ------ Structure Information 1318 EXIST SFD ----- Construction Type TYPE V, UNPROTECTED Occupancy Type. DWELLG/LODGING/CONG <=10 Other struct,info . . . . . CODE EDITION 2007/08 ENERGY # BEDROOMS 1.00 FLOOD ZONE NO GARAGE SQ FTG .00 PATIO SQ FTG .00 1ST FLOOR SQUARE FOOTAGE 260.00 -------------------------------------------------------------------- 2ND FLOOR SQUARE FOOTAGE .00 -------- Permit . . . BUILDING PERMIT Additional desc 260 BEDROOM & BATH ADDITION Permit Fee 207.00 Plan'Check Fee 134.55 Issue Date . . . . Valuation . . . . 20000 Expiration Date 9/04/10 Qty Unit Charge Per Extension BASE FEE 45.00 18.00 9.0000 ----------------------------------------------------------------------------- THOU BLDG 2,001-25,000 162.00 Permit . . ELECT - ADD/ALT/REM . Additional desc . Permit Fee . . . . 30.10 Plan Check Fee.. 7.53 Issue Date Valuation . . . . 0 Expiration Date 9/04/10 Qty Unit Charge Per Extension BASE FEE '15.00 260.00 .0350 ELEC NEW RES - 1.OR 2 FAMILY 9.10 8.00 .7500 ----------------------------------------------------------------------------- PER ELEC DEVICE/FIXTURE 1ST 20 6.00 Permit . . . MECHANICAL Additional.desc . Permit Fee . . . 24.00 Plan Check Fee 6:00 Issue Date . . . . Valuation 0 Expiration Date 9/04/10 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 4.5000 ---------------------------------------------------------------------------- EA MECH VENT INST/ DUCT ALT 9.00 Permit PLUMBING LQPERMIT LQPERMIT Application Number . . . . 10-00000041 Permit . . PLUMBING Additional desc . Permit Fee 69.00 Plan Check -Fee -. 17.25' Issue Date . . . . Valuation 0 Expiration Date 9/04/10 Qty Unit Charge Per Extension. BASE FEE. 15.00 7.00 6.0000 EA PLB FIXTURE 42.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 3.00 3.000.0 EA PLB FIXTURE DRAIN/VENT REP/ALT 9.00 ---------------------------------------------------------------------------- Special Notes and Comments 260 SF BEDROOM & BATH ADDITION TO EXISTING SFD. 2007 CODE 2008 ENERGY: REFERENCE CODE CASE # 087.868. ---------------------------------------------------------------------------- Other Fees .. . . . . . BLDG STDS ADMIN (.SB1473) 1.00 ENERGY REVIEW FEE 13.46 STRONG MOTION (SMI) - RES 2.00 Fee summary Charged Paid Credited Due Permit Fee.Total 330.10 .00 .00 330.10 Plan Check Total 165.33 .00 .00 165.33 Other Fee Total 16.46 .00 .00 16.46 Grand Total 511.89 .00 .00 511..89 LQPERMIT Bin # . .. - `p Permit # io'I Project Address: � •. � , � city Cr of La Q Uinta Building 8t Safety Df fslon P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Owner's Name: al LL�� A. P. Number: . � p 2- 0(2 Address: 52ef2—GLl Legal Description: Contractor: e Oa"?'(b Ttaw� City, ST, Zip.• 6ANVe CA 22 V3 : :.. Telephone.3-A Address: 2'3 8 Project Desciption: City. ST, Zip: Telephone: '7) 1 Q q .7 Li State Lic. # : l i 1 (sa 2Zcj City Lic. #; Arch., Engr., Designer GUS W Address: a City., ST, Zip AA 11'Q'26'0 Telephone p ©t d. .::.. <. Construction Type: Occsspancy: State Lic. #: proj� type (circle one): New Add' Alter Repair Demo Name of Contact Person:Sq. Ft : O #Stories: #Units: Telephone # of Contact Person:o Estlrriated�Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rec'd TRACKING , PERMIT FEES Plan Sets Plan Check submitted io' Item Amount 2 Stroctanl Coles Reviewed, ready for omctioo l �j Plan Check Deposit Truss Calcs. Called Contact P n Plan Check Balance. Title 21 Cal mPlans picked up Construction Flood plain plan Plans resubmitted (p Mechanical Grading plan k 11 2'! Review, ready for correctio ue 3 8 Electrical Subcootactor List Called Contact Person 3 Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. . Pub. Wks. Appr Date of permit issue School Feu • Total Permit Fees ,r7 z�z� /✓.8 RFL CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road Date 3/8/10 La Quinta, CA 92253 No. 30626 (760) 771-8515 Owner . M/M William & Amy Albers APN # Address 52-525 Avenida Vallejo Jurisdiction La Quinta City La Quinta Zip Permit # Tract # No. of Units 1 Type Residential Addition. 4C-���F�Sc�o BERMUDA DUNES CO) RANCHO MIRAGE INDIAN WELLS d PALM DESERT t}1 LA QUINTA �y QINDIO y� Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 52525 Avenida Vallejo 260 Unit 6 Unit 2 Unit 7 ' Unit 3 Un1t'8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on-garages/carports, covered patiostwalkways, 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: 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 260 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 - Amy Albers Check No. Name on the check Telephone 760-771-9262 Funding Exempt By Dr. Sharon P. McGehee Superintendent Fee collected /exempt d by S n McGilvrey Payment Recd 6.00 `77:�Over/Untied v Signature N �y NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 9D -day approval period in which you may protest the fees o r 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. i NOTICE: This Document NOT VALID without embossed seal Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting