12-0238 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
A
Application Number: _
12-00000238
Property Address:-
52725 HUMBOLDT BLVD
APN:
767-800-018-14 `-34968 -
Application description:
ADDITION - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
15433
T-i&t
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
EAST OF MADISON, LLC
PO BOX 1482
LA QUINTA, CA 92247
Contractor:
Applicant: Architect or Engineer: DBCA INC
P.O. BOX 1482
LA QUINTA, CA 92247
(760)393-5271
Lic. No.: 915336
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that licen under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business n Profe sion e, and my License is in full force and effect.
License Class: B Licens No.: 915336
�/ Date: • Contr
NER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I a111' empt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Pbsions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair a tructure, 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 _ 1 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 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 contractors) licensed
pursuant to the 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
4/12/12
WORKER'S COMPENSATION DECLARATION
1 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 TRAVELERS PROP Policy Number YEUB282D779711
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any mJWORKER
bec subject to the workers' compensation laws of California,
and agree that, ime ubje the workers' compensation provisions of Section
/ 377000 of the LabII fo hwith co ply with those provisions. .
Date:
#170 It A
WARNING: FAILURE TO SECURR OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CE TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). IN ADDIT OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR TE E T, 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 180days 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 ab inf ation is correct. I agree to comply with all
city and county ordinances and state laws relating to building s uctio , d hereby authorize representatives
of this county to a ter upon the above-mentioned property for p ction purpo s.
001.
Date: • tgnature (Applicant or A n
Application Number . . . . . 12-00000238
Structure Information
Construction Type .
. . . TYPE V, UNPROTECTED
Occupancy Type . .
. . . DWELLG/LODGING/CONG <=10
Other struct info . .
CODE EDITION 2010
-----------------------------------------------------------
2ND FLOOR SQUARE FOOTAGE
-------------
191.00
Permit . . .
BUILDING PERMIT
Additional-desc .
Permit Fee . . . .
171.00 Plan Check Fee
111.15
Issue Date . . .
Valuation . .
15433
Expiration Date
10/09/12
Qty Unit Charge
Per
Extension
BASE FEE
45.00
14.•00 9.0000
------------------------------------------------------------.-----------------
THOU 'BLDG -2,001-25,000
126.00
Permit . . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
21.69 PlanCheck Fee
5.42
Issue Date . . . .
Valuation
0
Expiration Date
10/09/12
Qty Unit Charge-
Per
Extension
BASE FEE
15.00
191.00 .0350
-----------------------------------------------------------------=----------
ELEC NEW RES -:1 OR 2 FAMILY
6.69
Permit . . . MECHANICAL
Additional desc .
Permit Fee
24.00 Plan Check Fee
6.00
Issue Date
Valuation . . . .
0
Expiration Date
10/09/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2.00 4.5000
EA MECH VENT INST/ DUCT ALT
9.00
----------------------------------------------------------------------------
Special Notes and Comments
ADDITION OF 191 SF OFFICE OPTION ON 2ND
FLOOR PER ENGINEERED DESIGN. 2007 CODES.
SUPPLEMENTAL TO PERMIT #11-638.
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
11.12
STRONG MOTION (SMI) - RES
1.54.
LQPERMIT
n
Application Number
. . .
12-00000238
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
216.69
.00
.00-
216.69
Plan Check Total
122.57
.00
.00
122.57
Other Fee Total
13.66
.00
00
13.66
Grand Total
352.92
00
.00
352.92
j
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Safety bikUng D
P.O. Box'1504,"78-495 Calle-Tampto
4-Quhtal CA 92253 -:(760) 777,701:2
Building PenWt Application and Tracking Sheet
Project Add!='wn
Owner's Nam'e, L
tKaVERA AND
Address: le's. A
.A.P Nu mber .7dvol-Alfe-018
Legal Description:
City. ST. zap -LA 00rVA CA' TZ24a
t-aqffione: (662v 7 U 7f R 9
Contractor. L AND
AM 41
J!rqe4 Desmiption:
City, ST. Zipl AA
Telephone
State Lic. 9: City Lir i1:
lid RILL,:. 1AiJ
CD
Ard, Bagr, So
Address.
p.. 'iG
ChN ST;Zip: LA. III2U 15:
State Vic, #:
omog
Construction Type- Occupancy:
prRied type e. "k Demo
Name of Contact Person:
Sq. FL: 9 4 Stories: ff Unitp:
&&uaw Value of Project: ad 0
Telephone # Of Contact Pewn:•zl 7701
APPLICANT: DO NOT WMM BELOW THIS LINE
#
submittal
Plan Sets
Wd
'ReNd eld
TRACENG PERMY FM.
Amount
structural CRICS.
RevIcw4 ready for corrections Plan check Deposit
Trust Cates.
Called CAMMel Person Pian Check . lWance
lanCh'
Tide 24 Calc&
ans14
Plans picked up Construction
PlGiading
Flood plata pian
Plans rcsub Milfted, Mechafikal
Mechanical "s " L
plan
2� Review, ready for cor JL I
- ol�wue
rManspicked6p
Subcostattor List
I'd I
Called Contact bin
Grant Deed
7 SM.L
H.O.A. Approval
Plans resubmitted 19t� 0111V) Grading
IN aous&:
3!4 W*jrj!, ready 2Lcnfic V11 + Developer Impact Fee
PlanalugApproval.
Called Contact Person ✓A.I.P.P.
Pub. VVka. Appr
Date/u
School Fen
Total Permit Fees
q123
Re C- "at 6:7 57� 'i `r -it S& � le- S
46/- 1AA�
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
DF.VF.I.OPF.R FF.FN PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMM/IND. AMOUNT:
DATE:
RECEIPT:
CHECK #:
INITIALS
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Madison Club, Date: July 17, 2012
Owner's Name: East of Madison, LLC Phone No. 602-920-7183
Project Address: 52-725 Humboldt Blvd. (Villa 14)
La Quinta, CA 92253
Project Description: Addition to new SFD under construction
APN: 767-880-018 Tract #: Lot #'s:
Type of Development: Residential Nx Commercial Industrial
Total Square Feet of Building Area: 191
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 half of the owner/developer.
Dated: July 17, 2012 Signature:
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJE 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
Note:
Number of Sq.Ft. 191 Pursuant to AB 181 any room additions or enclosures of 500
Amount per Sq.Ft. $3.20 sq. ft. or less are exempt from developer fees. Any mobile
homes being relocated within the same school district's
Amount Collected $611.20. jurisdiction are exempt from developer fees.
Building Permit Application Completed: Yes/No
By: Elsa F. Esqueda, Director of Facilities and Maintenance
Certificate issued by: Laurie Howard, Secretary Signature: 4g 4-&W 6'x-64
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 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.
NIV:clauydoes/devfees/ectl:ificate ofcompliance form updated 3-2007 11/2010
L" e
71-=780 San Jacintopr>Ste.. E2; Rancho Mirage;;.C'a:•9227,0, ph;
Letter of Transmittal
To: City of La Quinta Today's Date:
78-495 Calle Tampico City Due Date:
La Quinta, CA 92253 Project Address
Attn: Kay Plan Check #:
5-31-12
5-30-12
52-725 Humboldt Blvd
12-238
Submittal: ❑ 1St ❑ 4th
® 2nd ❑ 5th
❑ 3`d ❑ Other:
We are forwarding: ® By Messenger ❑ By Mail (Fed Ex or UPS) ❑ Your Pickup
Includes:
# Of
Descriptions:
Includes: # Of
Descriptions:
Copies:
Copies:
❑
Structural Plans
® 1
Revised Plans
❑
Structural Calculations
❑
Revised Struct. Calcs
®
1
Truss Calcs (stamped)
❑
Revised Truss w/Ltr.
❑
Soils Report Update
❑
Revised Soils Report
®
1
Structural P/C Comments
❑
Approved Structural Plans
®
1
Redlined Structural Plans
❑
Approved Structural Calcs
❑
Redlined Structural Calcs
❑
Approved Truss Calcs
❑
Redlined Truss Calcs
❑
Approved Soils Report
❑
Redlined Soils Reports
❑
,/
Other:
YZF E1VED
�
Comments:
Structural content is approvable
NAAV
Structural Plan Review Time =.75 Hrs.
This Material Sent for:
❑ Your Files ® Per Your Request
❑ Your Review ❑ Approval r
❑ Checking ❑ At the request of: ,
Other: ❑
By: John W. Thompson
Rancho Mirage Office: ® (760) 834-8860
Other: ❑