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04-7946 (AR)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 9225.3 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number0�4-00_OOW946 Date -12/23/04 Property.Address . . .. . 57895 STONE CREEK TR E APN: 762-240-999-65 -30834.- Application descriptionADDITION - RESIDENTIAL Property Zoning . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 5148 Owner Contractor ---------------------------------- MADISON ESTATES --------------------------------- SOUTH POINT CONSTRUCTION INC 437 S HIGHWAY 101 NO 220 44420 VIA DEL SOL SALANA BEACH, CA 92075 LA QUINTA, CA 92253 (760)345-5521 WCC: STATE FUND WC: 1795243 08/21/05 CSLB:` 447883 08/31/06 CCC: B p LQ 0 JAN 0 3 2G25 CITY OF LA QUINTA FINANCE DEPT. P.O. BOX 1504 • VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Ozi- 7 q 14 &I Date: Applicant: Architect or Engineer: Applicant's Mailing Address: Afchitect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of p ' ry that I am licensed under provisions o h8 ter 9 (rim nncing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full f r and effect. (7/ p /License Class dense No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury this exempt from the Contractors' 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 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 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 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 did not build or improve for the purpose of sale.). U 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.). U I am exempt under Sec. , BA P.C. for this reason Date WORKERS' 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. J�I�aeve will rt}ar'ntain wo ers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is /JJY pensation in a carrier and p li y rib �fe: arrier olicv Number _ �� �'/G- �3 _ I c rtify 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. ate Z 2 fP D Applicant WARNIN : FAIL RE TO SECURE W RK S' 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 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 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 cr 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 in<er is correct. t agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize re sentatives of this county topon the above- tioned property for inspection purposes. e Z 1 Signature (Applicant or Agent): ---------------------------------------------------------------------------- (�Application Number 04-00007946 ----------------------------=----------------------------------------------- ------ Structure Information 90 SQ.T. ADDITION UNDER EXISTING ROOF. ----- Construction Type . . . . . TYPE V - NON RATED Occupancy Type .. . . . . DWELLG/LODGING/LONG <=10 Flood Zone . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 CBC.. FLOOD ZONE NO ---------------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 90.00 Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee 81.00 Plan Check Fee 52.65 Issue Date . . . . Valuation . . . . 5148 Qty Unit Charge Per Extension BASE FEE 45.00 4.00 9.0000 ----------------------------------------- THOU BLDG 2,001-25,000 ------------------------------------ 36.00 Permit . . . . . . ELECT - ADD/ALT/REM Additional desc Permit Fee 18.15 ..Plan Check Fee-. 4.54 Issue Date. Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00. ,;90.00. .0350 -------------------------- ELEC NEW RES - 1 OR 2 FAMILY -------------------------------------- 3.15 ------------ Permit . . . . . MECHANICAL Additional desc Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per. Extension BASE FEE 15.00 1.00 9.0000 ---------------------------------------------------------------------------- EA MECH APPL REP/ALT/ADD 9.00 Permit . . . PLUMBING Additional desc . . Permit Fee . . . . 18.00 Plan Check Fee 4.50 Issue Date . . . . Valuation . . . . 0. d. Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 Special Notes and Comments add. 90 sq: ft.to living room. and relocate post in kitchen area. 12/22/04 10:58:22 AM jjohnson ------------------------------------------------------------=--------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 5.27 STRONG MOTION (SMI) - RES .51 Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 141.15 .00 .00 141.15 ---------------------------------------=-------------------------- - - - - ----- -- 'Application Number . . . . . 04-00007946 -------------------------=--------------------------------------------------- Plan Check Total 67.69 00 .00 67.69 Other Fee Total 5.78 .00 .00 5.78 Grand Total 214.62 .00 .00 214.62 Coachella Valley Unified School District 83-733 Avenue 55, Thermal, CA 92274 (760) 398-5909 — Fax (760) 398-1224 This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT LEVEL ONE AMOUNT: LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMMAND. AMOUNT: DATF: RFCFIPT• CFIFCK N- INITIAL.` CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name:. MADISQN�L!LG Date: December 28, 2004 Owner's Name: MADISON LLC Phone No. (760) Project Address: ' 58-895 STONE CREEK TRAIL Project Description: 1 LIVING ROOM ADDITION APN: 762-240-999 Tract #: Type of Development: Residential XX Total Square Feet of Building Area: Lot #'s: Commercial Industrial 90 So. 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 tosign on behalf of the owner/developer. Dated: 12/28/04 Signature: 4 1. SCHOOL DISTRICT'S REQUIREMENTS FOR THE ,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. 90 Amount per Sq.Ft. $ 2.68 Amount Collected $ 241.20 Building Permit Application Completed: Yes/No By: Carey M. Carlson, Asst. Supt., Business Services Certificate issued by: Leticia C. Torres, Facilities Clerk Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requirektbdf 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. 11,14':ctmydocs/dcvfcisrccrtitic Iii i+i'Uompliancc fnrol iablcsf(:)1!Sf-:.dD.: 1/16/03 T TANDrS- �.;� INSPECTION INC. •.:� �f PO BOX 13766 , Nti PALM DESERT, CA 92255' SPECIAL INSPECTION DAILY REPORT OFPAGER 760..776.FICE/FAX 776.3 39717 ' 339 I TYPE OF INSPECTION PERFORMED i.) G�-��1� SAMPLE INFORMATION DATE — �;[- _.0 PHYSICAL ADDRESS 7 — PERMIT NUMBER (moi �wAjIZbjtxlz s OLI -.3 `T ,JOB NAME oc-4 r �`F7�� �OtF STRUCTURE`t ARCHITECT \ E EES GENERALCONTRACTOR SUB CO�NTRACTOR t, I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. CC: 411SPECTORS SIGNATURE INSPECTORS CERTIFICATION AGENCY AND NUMBER SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER SAMPLED AIR TEMP TEMP SAMPLE SLUMP TIME IN MIXER ` ti� G� �Sb�-6�F•{o `c�� �i�W �� o � � �• LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. CC: 411SPECTORS SIGNATURE INSPECTORS CERTIFICATION AGENCY AND NUMBER