11-0747 (RER)`s _ r
P.O. BOX 1504
78=495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-00000747
Property Address: :53530 AVENIDA VALLEJO
APN: 774-123-001-24 -000000-
Application description:. REMODEL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 100000
Applicant: Architect or Engineer:.
LICENSED CONTRACTOR'S DECLARATION
^' VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/07/11
Owner:
HUNTLEY LOUISE B
60 HIGH OAK DR
- MEDFORD, OR 97504 /
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 1 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 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 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.).
(_) 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 ith a contractor(s) licensed
pursuant to the Contractors' -State License Law.).
( I am exempt under Sec. B.&P.C. for this reason CJ6f2 t`�S.p 1 �y Ly'2
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:
LQPERMIT
Contractor:�
Owner C
-----------_------------- ------------ ------ - - - - - -
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 numberare:
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
37YO of the Labor Codd IIS—ihh 11 forthwith comply with those provisions.
DC.� '1 .rAppli– ca�ntf•.
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 ofissuance 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.upon the above-mentioned property for;'.ppe n purposes.
1.: .
�e:.?1�Signature-(Applicant-or.Ag�=ntl:
Application Number
11-00000747
------ Structure Information
ADDITION+REMODEL/VB/RES-3/CLASS A
[ENG] -----
Other struct info . .
. . . CODE EDITION 2010
----------------------------------------------------------------------------
# BEDROOMS
2.,.00
Permit
BUILDING PERMIT
Additional desc .
Permit Fee . . .
639.50 Plan Check Fee
415.68
Issue Date
Valuation
100000
Expiration Date
4/04/12
Qty Unit Charge
Per
Extension
BASE FEE
414'.50
50.00 4.5000
--------------------------------------------------------------=--------------
THOU BLDG 50,001-100,000
-------------Permit
225.00
Permit
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee-.
66.49 Plan Check Fee
16.62
Issue Date
Valuation
0
Expiration Date
4/04/12
Qty- Unit.Charge
Per
Extension
BASE FEE
15.00
1471.Oo .0350
ELEC.NEW RES - 1' OR 2 FAMILY
51.49
Permit . . .
MECHANICAL
Additional desc .
Permit Fee
62.00 Plan Check Fee
15.50
Issue Date
Valuation . . . .
0
Expiration Date
4/04/12
Qty _Unit Charge
Per
Extension
BASE FEE
15.00
1.00 4.5000
-EA MECH-VENT INST/ DUCT ALT
4.50
1.00 16.5000
EA . MECH B/C >3-15HP/>100K-500KBTU
16.50
1.00 6.'5000
EA MECH AH <=10K CFM
6.50
3.00 6.5000
EA MECH VENT FAN
19.50
Permit . . .
PLUMBING:
Additional desc .
Permit Fee
103.50 Plan Check Fee
25.88
Issue Date
Valuation
0
Expiration Date
4/04/12
Qty Unit Charge.
Per
Extension
LQPERMIT
Application Number 11-00000747
Permit PLUMBING
Qty Unit Charge Per
Extension
BASE FEE
15.00
13.00 6.0000 EA PLB FIXTURE
.78.0.0
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
.1.00 3:0000 EA PLB WATER INST/ALT/REP
3.00
Special Notes and Comments
ADDITION + REMODEL/VB/RES-3/CLASS A -FR
[ENGINEERED] SQUARE FOOTAGE BREAKDOWN:
155SF ADDITION + 61SF STORAGE ROOM AND
150SF GARAGE CONVERSIONS TO RESIDENCE
WITH 162SF ADDITION TO GARAGE [TOTALS -
1,471SF RESIDENCE/523SF GARAGE/'156SF
PATIO] THIS. PERMIT DOES NOT INCLUDE
BLOCKWALLS OR DRIVEWAY APPROACH. MINOR.
ADJUSTMENT: 2011-636 FOR REDUCTION TO
SIDE -LOADED GARAGE SETBACK [13'-611] 2010
CALIFORNIA BUILDING CODES.
October.6, 2011 5:05:32 PM AORTEGA OK TO
ISSUE PER B.H.
-- - - - -- - ------------------------
Other Fees . . . . . ' BLDG-STDS ADMIN (SB1473)
--------------
4.00
ENERGY REVIEW FEE
41.57
STRONG MOTION (SMI) -_RES
10.00
Fee summary Charged Paid Credited
Due .
Permit Fee Total 871.49 .00 .00
871.49
Plan Check Total 473.68 .00 .00
473.68.
_
Other Fee Total 55.57 00 00.
55.57
Grand.Total: 1400.74 .00 .00
1400.74
Ti4P.O. BOX 1504 W
78-495'CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 11-00000747 Owner:
Property Address: 53530 AVENIDA VALLEJO HUNTLEY LOUISE B
APN: 774-123-001-24 -000000- 60 HIGH OAK DR
Application description: REMODEL'- RESIDENTIAL MEDFORD, OR 97504
-- Property Zoning: COVE RESIDENTIAL _
Application valuation: 100000
_ Contractor:
Applicant: _ Architect or Engineer:. Owner
7
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/07/11
--------=-------------------=----------------------------==---=--=---------------
- - - - - - -
LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm under penalty of perjury that I am licensed under. provisions of Chapter 9 (commencing with _
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._
License.Class: -
I have and will maintain a certificate of consent to self•inswe for workers' compensation, as provided
License No.:
for by Sktion 3700 of the Labor Code, for the performance of the work for which this permit is
Date: Contractor: -
issued.
I have and will maintainworkers' compensation insurance, as required by Section 3700 of the Labor
OWNER -BUILDER DECLARATION
Code, for the performance of the work for which this permit is issued. My workers' compensation
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
insurance carrier and policy number are:
Carrier Policy Number
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
_ I certify that, in the performanceof the work for which this permit is issued, I shall not employ any
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
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
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
37 0 of the Labor Cade, I shall torthwlth comply with those provisions. '
that he she o exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031:5
li
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001.
1.
1—) I, as owner of the
�' leant:
at 14
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
-0
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the `
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
- conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects hh,a contractorls) licensed
- 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
( I am exempt under Sec. B.&P.C. for this reason Lal of $Y$ �
- whose benefit work is performed under or pursuant 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
,v OWaer.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
-
CONSTRUCTION LENDING AGENCY
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
'
I hereby affirm under penalty of perjury that there is construction lending agency for the performance of the
permit to cancellation.
I certify that 1 have read this application and state that the above information is correct. I agree to comply with all
work for which this permit Is Issued (Sec. 3097, Civ. C.).-
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
Nam¢: �
of this county to enter upon the above•meritioned property for i pen purposes.
Lender's Address: �
MIPLender's
-�!/7j��i+—SignaSutat{Applica�t,p�,�Ag�nt): _� A.a�....�
.��-v��.-�- '
LQPERMIT
Application Number .
. . . 11-00000747
-=---- Structure Information ADDITION+REMODEL/VB/RES-3/CLASS A
[ENGJ -----
Other struct info
. . CODE EDITION 2010
------------------------------------7---------------------------------------
# BEDROOMS
2.00
Permit . . . BUILDING PERMIT
Additional desc
Permit Fee . . .�.
639.50 Plan'Check Fee
415.68
Issue Date . . . .
Valuation
100000
Expiration Date
4/04/12
_. Qty Unit Charge
Per
Extension
BASE FEE
414.50
50:00 4.5000
----------------------------------------------------------------------------
THOU BLDG 50,001-100,000
225.00
Permit . . . ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee . . . .
66.49 Plan Check Fee ..
16.62,
Issue Date . . .
Valuation . .
0
Expiration Date
4/04/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1471.00 .0350
ELEC NEW RES - 1 OR 2 FAMILY
51.49
Permit . . . MECHANICAL
Additional desc
_
Permit Fee . . . .
62.00 Plan Check Fee
15.50
Issue Date . . .
Valuation . . . .
0
Expiration Date
4/04/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 - 4.5000
EA MECH VENT INST/ DUCT ALT
4.50
1.00 16.5000
EA MECH B/C >3'-15HP/>100K-500KBTU
16.50
1.00 6.5000
EA MECH AH <=10K CFM
6.50
3.00 6.5000
-------------------------------------------------
EA MECH VENT FAN
19.50
. . PLUMBING
Additional desc .
Permit Fee
103.50 Plan Check Fee
25.88
Issue Date
Valuation . . . .
0
Expiration Date
4/04/12
Qty Unit Charge
Per
Extension
LQPERMIT -
Application Number 11-00000747
Permit . . . . . . PLUMBING
Qty unit Charge. Per
Extension
BASE FEE
15.00
13.00 6.0000 EA PLB FIXTURE
78.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
1.00 3.0000 EA PLB WATER INST/ALT/REP
3.00
-----------------------------------------------=----------------------------
Special Notes - and Comments
•
ADDITION + REMODEL/VB/RES-3/CLASS A -FR
[ENGINEERED] SQUARE FOOTAGE BREAKDOWN:
155SF ADDITION + 61SF STORAGE ROOM AND
150SF GARAGE CONVERSIONS TO RESIDENCE
WITH 162SF ADDITION TO GARAGE [TOTALS-
1,471SF RESIDENCE/523SF GARAGE/156SF
PATIO] THIS PERMIT DOES -NOT INCLUDE
BLOCKWALLS OR DRIVEWAY APPROACH. MINOR
ADJUSTMENT: 2011-636 FOR REDUCTION TO -
SIDE -LOADED GARAGE SETBACK [13'-611] 2010
CALIFORNIA BUILDING CODES.
October 6,'2011 5:05:32 PM AORTEGA OK TO
ISSUE -PER B.H.
-------------------_------------------------------------------
Other Fees . . . BLDG STDS ADMIN (SB1473)
--------------
4.00
ENERGY REVIEW.FEE
41.57
STRONG MOTION (SMI) - RES
10.00
Fee summary Charged Paid Credited
Due
-------- ---------- ---------- ---------- ----------
Permit Fee Total 871.49 00 00
871.49
Plan Check Total 473.68 00 00
473.68
Other Fee Total 55.57 .00 :00
55.57
Grand Total 1400.74 .00 .00.
1400.74
LQPERMIT -.
Bin # `
City of La Quinta
Building 8t Safety Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA -92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
Project Address: O A us-.uift
Owner's Name: go R fJ 1JC\AR Wd vi�ST
A. P. Number: - d Z _
Address: U fl
Legal Description:
, vF
Contractor: �t3D L`�- C�i'�
City, ST, Zip:
: l% :v:;'i.?:: r' tY;; A•: i 1;;::;v::::;'{i: vi'
Telephone: _541 Qj _'Z �8 :ri:nr<€><:'•.<:��r:::%:^:,::
Address:JC -- 6 �'c9 ���
Project Description:
City, ST, Zip: IlkLQ-210' _ TZ 2 S 3
tJ W
Telephone--zi
•:: .:.. .
toW -`•,&)
State Lic. # : Kg4 02 Lp
City Lic. #:
Arch., Engr., Designer: .�__
\ ��
Address: ST5
S,
City., ST, Zip: Q .<3 z.S
Telephone: '74p 5&
Construction Type: !�S Occupancy:
State Lic. #:
Project nPa circle one): New Add'n Alter Repair Demo
Name of Contact Person:Sq.
Ft.: S's
# Stories:
#Units:
Telephone # of Contact Person: S 1- S35 -" ZZ1 3
Estimated Value of Project: pp O o
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted %/8 l
Item Amount .
Structural Calcs.
z
Reviewed, ready for corrections 1 'A (
Plan Check Deposit t�
Truss Calcs.
Called Contact Person IWUU
Plan Check Balance.
Title 24 Calcs.
Plans picked up'
Construction •�
Flood plain plan
Plans resubmitted Ali
Mechanical '(s
Grading plan
2°" Review, ready rrections ' ue'J.JjIkt
Electrical
Subcontactor List
Called Contact Person $
Plumbing ZS
Grant Deed
Plans picked up $01 t
S.M.I.
H.O.A. Approval
Plans resubmitted 9
Grading r—
IN HOUSE:-
'"' Review, ready f orrec issue 9
Developer Impact Fee
Planning Approval
Called Contact Person9 L'
A.I.P.P. ►--�
Pub. Wks. Appr
Bele�Lpaswliiscuq P�(,� g
:��
School Fees
L S40
ss X kFtftto
I
Total Permit Fees 3q
.718 --�� "� ?/22-/11 .
too Oft-.
iliql;tt - s4*t, --!P
CERTIFICATE OF COMPLIANCE J�1Ft
Desert Sands Unified School District o
47950 Dune Palms Road ¢BERMUDA DUNES 0
N RANCHO MIRAGE d
Date 10/7/11 La Quinta, CA 92253 INDIAN WELLS
�i PALM DESERT ,y
No. 31119 L INTyA
- IND %
Owner Huntley Louise B/McLaren APN # 774-123-001
Address 53530 Avenida Vallejo Jurisdiction La Quinta -
City La Quinta Zip Permit #
Tract # No. of Units 1
Type Residential Addition
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 11' 53530 'Avenida Vallejo 366 Unit 6
Unit 2 Unit 7
Unit 3 Unit ,
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
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 366 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 - George Lambert Check No.
Name on the check Telephone 541-535-2213
By Dr. Sharon P. McGehee
Superintendent
Fee collected /exempd by
Signature •
Funding Exempt
/fe Payment Recd
Y
/f ;Over/Under
=r,r,
r
NOTICE: Pursuant to Government Code Section 66020(d)(1), t is'A serve to nofrfy 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 n ich 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 without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting