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08-0965 (AR)�Y. P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T-iht BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 08-00000965. Property Address: 80645 LA DOCENA TR APN: 777-040-004- - - Application description: ADDITION - RESIDENTIAL Property Zoning: VERY LOW DENSITY RES Application valuation: 700000 Applicant: Architect or Engineer: Lic. No.: --------------- ----------------- 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 the Business and Professionals Code, and my License is in full force and effect. License Class: B p I n License No.: 769229 Dat 2 ba 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, 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 contractor(s) licensed pursuant to the Contractors' State License Law.). 1 1 I am exempt under Sec. , BAP.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: TOM & DIANE RICHARDS VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/08/08 Contractor: L� U ALBERS CONSTRUCTION CO, 78060 CALLE ESTADO., SUI( 11±�� LA QUINTA, CA 92253 U 12 (760)771-9954 Lic.. No.: 769229 CITY OF LA QUINTA ----------------------------------------------- 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 number are: Carrier STATE FUND Policy Number 0004885-2007 _ 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 (� 1 3700 of the Labor Code, I shall fo�rthw�ith comply with those provisions. � AL ]'I , Date: O 1 Applicant: %96C/CQpLJ%9&C470Q 40 i�`��►. 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 of this c_o my to enter upon the above-mentioned property for inspection Apurpo s. Date: iz Vp Signature (Applicant or Agent) (///�A(L,'(////t//'SL' - _ j Application Number . . . . . 08-00000965 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 2639.50 Plan Check Fee 1715.68 Issue•Date . . . . Valuation . . . . 700000 Expiration Date 2/04/09 Qty Unit Charge Per Extension BASE FEE 2039.50 200.00 ---------------------------------------------------------------------------- 3.0000 THOU BLDG 500,001-1,000,000 600.00 .Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 59.44 Plan Check Fee 14.86 Issue Date . . . . Valuation' 0 Expiration Date 2/04/09 Qty Unit Charge Per Extension BASE FEE 15.00 1252.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 43.82 31.00 --------------------- .0200 ------------------------------------------------------ ELEC GARAGE OR NON-RESIDENTIAL .62 Permit . . . MECHANICAL Additional desc . Permit Fee 50.00 Plan Check Fee 12.50 Issue Date . . . . Valuation . . . . 0 Expiration Date 2/04/09 Qty Unit Charge Per _Extension BASE FEE 15.00 1.00 9.0000 EA MECH APPL REP/ALT/ADD 9.00 3.00 6.5000 EA MECH VENT FAN 19.50 1.00 ----------------------------------------------------------------------------- 6.5000 EA MECH EXHAUST HOOD 6.50 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 138.75 Plan Check Fee 34.69 Issue'Date . . . . Valuation . . . . 0 Expiration Date 2/04/09 Qty Unit Charge Per Extension BASE FEE 15.00 18.00 6.0000 EA PLB FIXTURE 108.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 LQPERA11T Application Number . . . . . 08-00000965 Permit . . . . . . PLUMBING Qty' Unit Charge Per Extension 7.00 .7500 EA PLB GAS PIPE >=5 5.25 ---------------------------------------------------------------------------- Special Notes and Comments 1252 SQ. FT. ADDITION WITH 1094 SQ. FT. PATIO AND INTERIOR REMODEL. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 171.57 STRONG MOTION (SMI) - RES 70.00 Fee summary Charged --------------------------- Paid -------------------- Credited ---------- Due Permit Fee Total 2887.69 .00 .00 2887.69 Plan Check Total 1777.73 .00 .00 1777.73 Other Fee Total 241.57 .00 .00 241.57 Grand Total 4906.99 .00 .00 4906.99 LQPERNIIT / P.O. BOX 1504 Building �vp �] "y 78-495 CALLE TAMPICO Addrezlda LA QUINTA, CALIFORNIA 92253 Mailing Address ' Cit Zip Tel. r & Classif. Lic. # Arch., Engr., Designer �/)�f/ . - /5), 0 APPLICATION ONLY BUILDING: TYPE CONST. OCC. GRP. / A.P. Number 7/� —B-4 0 -oil e Legal Description / Project Description .2Z �eZ& �- f L�e��•,�7 Address Tel. �%reOl 77 47 -46"W City Zip State D'o2- LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that he 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 ($500). O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or im- provement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law) ❑ 1 am exempt under Sec. � B. & P.C. for this reason Date WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Com* atlon Ins�]4ulaGc !)a certified copy tr�of. ($ec. 00, La or Code.) Pol' y No. Try _�____ company 7Zt {t G/ apy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less). 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 Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 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 city to enter the above-mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT No. Dw. New ❑ Add Alter ❑ Repair ❑ Demolition ❑ "R T OV Estimated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: YELLOW = APPLICANT PINK = FINANCE (.,' Co&eheIla Valley Unified School District X33-733 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: DATE: RECEIPT: CHECK #: INITIALS: CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: R_ichards_(Polo Estates) Owner's Name: Tom Richards Project Address: 80-645 La Docena Trail LaQuinta, CA 92253 Project Description: SFD-Addition APN: 777-040-004 Tract #: Type of Development: Residential XX Commercial Total Square Feet of Building Area: 1,252 Date: August 8, 2008 Phone No. Lot #'s: Industrial 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 behalf of the owner/developer. Dated: tI"-► Ot Signature: W& l *********************************************************************** SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE 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 ApprovalPrior to 1/1/87 Requirement Note Number of Sq.Ft. 1,252 Amount per Sq.Ft. $2.97 Amount Collected $3,718.44 Building Permit Application Completed: Yes/No By: Carey M. Carlson, Asst. Supt., Support Services Certificate issued by: Laurie Howard, Secretary Signature: 4 v w a4A� 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. 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. MV:c/nrydocs/devfees/certilicale of compliance form updated 3-2007 3/9/07