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04-5298 (RPL).r ° u�ctcv BUILDING & SAFETY DEPARTMENT c mw P.O., Box 1504 - (760).777-.7012 F'I19 78-495 CALLE TAMPICO . FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 : INSPECTION REQUESTS .(760) 777-7153 BUILDING PERMIT Application Number 04--00'0052,98�__fD Date 7/02/04 Property Address . . . 57595 SOUTH VALLEY -LN 'APN: 762-250-0097 Application description description POOL - RE:SIDENTIAL Property Zoning.. LOW DENSITY'RESIDENTIAL .Application valuation 36000 Owner Contractor GEYER DOUGLAS L DEVI.NE SWIMMING POOL DESIGN 78.512 , NAPLES DR. .8:0844. BOULDER DRIVE LA' QU.INTA. CA 92253 INDIO.. CA 92201 (760) '.989-.0.354. .:WCC::..- STATE - FUND WC : 1641733.....: 07./01/05 :..CSLB:... 7.86814 _ 11/30/04 CCC: ``. C53 Permit BLDG POOL PERMIT Additional desc Permit Fee 32.3.50 Plan Check Fee 2.10..28. Issue Date Valuation 36000 Qty. Unit Charge Per Extension BASE FEE 252-.00. 11.00 6.5000 THOU BLDG '25,001-50,00.0 71.5.0 --.-.---------------------------------------------------------------- ...-Permit. MECH POOL_ --------- Additional desc Permit Fee 24.00 Plan Check Fee.. 6.00 Issue Date Valuation 0 Qty .Unit Charge Per Ext ension . BASE FEE 15.D0 1..00 -9.0000 EA MECH FURNACE `<=100K 9.-00 -- - - - - - - -.= -- - - - - - - ---=------------------- - - - - -- - -- -- - - - - -- - Permit . . . . . ELEC POOL PERMIT -RES 0 Additional desc Permit Fee . . . 45.00 Pla C k FAX 11.25 Issue Date Va a 'on O. 0 Qty Unit Charge Per. O �� Extension BASE FEE G ���� 15.00 1.00 30.0000 EA . ELEC PRIVATE. SWI I P OL 30.00 _ _.4 P.O. Box 1504 VOICE(760) 777-'7012 78-495 CALLS TAMetco FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: Applicant: I Architect or Engineer: , Applicant's Mailing Address: O-L►ja�. Architect or Lic. No.: BUILDING PERMIT DECLARATIONS 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 Die Business and,Professionals Code. and myS�.in full force and effect. G� �I t7' License Clas3—License No. 0 Date e7 —2 - OA4 Contractor OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that 1 am exempt from the Contractors' State License Law for the fotlowtng reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to constrict, alter. impfoye, demolish, or repair any stricture. 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 stricture 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 old not build or improve for the purpose of sale.). .0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business arid 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 Owner. WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: . _ I have and will maintain a certificate of consent to selfinsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the.perfommance " of the work for which this permit is issued. 1 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 is uad. My ,wD kers' compensation insurancecarrier 7d policy number are: Canter � Ott "'t d. Policy Number _ Lo q / Z 2 _ I certify that, In the perfommance of the work for which this permit is issued, I shalt 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 7 .2-03 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. CONSTRUCTION LENDING AGENCY 1 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 Lenders 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 Quinta, its officers, agents -and employees for any act or omission related to 0)e 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. 1 certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to buQding construction, and hereby authorize -representatives of this county to enter u Ore above�tmention ropeRy for inspection purposes. l ' \ Date . �_ -6 Signature (Applicant or Agent): v� ��— Page 2 Application Number 04-00005298 Date 7/02/C4 Permit PLUMBING Additional desc Permit Fee87.00 Plan Check Fee 21.75 Issue Date . . . . Valuation .0 Qty Unit Charge Per. Extension BASE FEE 15.00 2.00 6.0000 EA PLB FIXTURE 12.00 10.00 3.0000 EA PLB WATER INST/ALT/REP 30.00 10.00 3.0000 EA PLB ----------------------------------------------------------------------------- GAS PIPE 1-4 OUTLETS 30.00 Special Notes and Comments POOL/SPA. ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED Fee summary Charged Paid Credited Due Permit Fee Total 479.50 .00 .00 479.50 Plan Check Total 249.28 .00 .00 249.28 Grand Total 728.78 .00. .00 728.78 fi C,oad�lla Valley Unified School District 83-733 Avenue 55, Thermal, CA 92274 (760) 398-5909 Fax (760) 398-1224 Project Name: Owner's Name: Douglas Geyer Project Address: r57=595 South-` Project Description: 1 SFD APN: 762-250-009 Type of Development: This Box For District Use Only DEVELOPER FEES PAID AREA: " AMOUNT LEVELONEAMOUNT: LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMMAND. AMOUNT: DATF.- RRCF.IPT- CHF.r.K H- INITIALS, 'CERTIFICATE OF COMPLIANCE (California Education Code 17620) V Lane. La Ouinta.-_.----1 Date: May 4, 2004 Phone No. (760) 345-1409 Tract #: Lot #'s: Residential XX Commercial i Industrial Total Square Feet of Building Area: 3982 Sq. Ft. Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement lmder • penalty of perjury and further represents that he/she is authorized to sign q ehalf of the owner/developer. ' Dated: 05/04/04 Signature: SCHOOL DISTRICT'S REQUIREMENTS FOR THE AB('] ACCORDANCE WITH ONE OF THE FOLLOWING: (CIR( .OJECT HAVE BEEN OR WILL BE SATISFIED IN 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. 3982 Amount per Sq -Ft- $ 2.68 Amount Collected $ 10,671.76 Building.Permit Application Completed: Yes/No By: Carey M. Carlson, Asst. Supt., Business Services Certificate issued by: Leticia C. Torres, Facilities Clerk Signature: NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notic2 to the project appellant, at the time of payment of school fees, mitigation payment or other exactions (f°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 verve 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 CertiEcate 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. •1V:c'm}•docs,'devfc.e.s.'Certillcate ofu)mplianoe f Inn table+s O USE:.doc 1/16/03 T Building & Safety Department .M c OF ' -'78-495 Calle Tampico PO Box 1504 La Quinta, CA 92253 - , (760) 777-7012 voice — (760) 7777-7011 fax - CERTIFICATION OF BUILDING AREA STREET ADDRESS OF JOB: 57-595 SOUTH VALLEY LANE APN:' 762-250-009 DESCRIPTION OF WORK: SINGLE FAMILY DWELLING SQUARE FOOTAGE: 3982 S.F. OWNER'S NAME: DOUGLAS GEYER. Coachella Valley Unified School District 83-733.Avenue 55 P O Box 847 Thermal, CA 92274 (760) 398 5909 SCHOOL. FACILITY FEES COLLECTION HOURS: 8.00 A.M. - 4.00 P.M. Monday Friday PLEASE NOTE: FEES MUST BE PAID IN CHECK OR CASHIERS CHECK. NO CASH. For questions regarding this letter, please call: Ed Randall, Counter Technician (760) 777-7012 March' 2, 2004 To whom it may concern, .The plans for Mr. & Mrs. Geyer 57-595 South Valley Lane, Lot #9 have been approved by The Lions HOA. Sim c ly, ert Cross President Lions Gate HOA 760-777-8477