08-1833 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
•
Application Number: ! 08-00001833
Property Address: '80645 LA DOCENA TR
APN: 777-040-004- -
Application description: ADDITION - RESIDENTIAL
Property Zoning: VERY LOW DENSITY RES
Application valuation: 1292
Tiht 4 4a Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
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 CI s: B�/ License No.: 769229
/ -Date: ' 6 �Contracmr. l
f` -
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 (5500).:
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 _ 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 contractorls) 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
Date: 12/10/08
Owner: U G
THOMAS & DIANE RI S
80-645 LA DOCENA.
LA QUINTA, CA 92 53
c FC11?0
Contractor:
ALBERS CONSTRUCTION CO, INC.
78060 CALLE ESTADO, SUITE #11
LA QUINTA, CA 92253
(760)771-9954
Lic. No.: 769229
-----------------------------------------------
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 0004'885-2008
_ 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
3►,7700 of the Labor Code,I shall forthwith comply with those provisions.
Date:l/a Applicant:/m,(„� '
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 Ouinta, 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
ofthis cou y t enter upon the above-mentioned grope Zr inspecti pur
Date: Signature (Applicant or Agentl:
Application Number . . . . 08-00001833
------ Structure Information 16SF ADDITION/VB/RES-3 [ENGINEERED]
-----
Other struct info . . . . . CODE EDITION 2007CODES
FLOOD ZONE NO
1ST FLOOR SQUARE FOOTAGE .
----------------------------------------------------------------------------
16.00
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 31.00 Plan Check Fee
20.15
Issue Date . . . . - Valuation . . . .
1292
Expiration Date 6/08/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
8.00 2.0000 HND BLDG 501-2,000
----------------------------------------------------------------------------
16.00
Permit . . . ELECT•- ADD/ALT/REM
Additional desc . .
Permit Fee . . . . 15.56 Plan Check Fee
3.89
Issue Date . . . . Valuation . . . .
0
Expiration Date . . 6/08/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
16.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY
--------------------------------------------------------------- -------------
.56
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 24.00 Plan Check Fee
6.00
Issue Date . . . . Valuation
0
Expiration Date 6/08/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 6.0000 EA PLB FIXTURE
6.00
1.00 3.0000 EA• PLB WATER INST/ALT/REP
3.00
----------------------------------------------.-------------------------.-----
Special Notes and Comments
.
16SF ADDITION/VB/RES-3/A-FR [ENGINEERED]
RESIDENCE IS UNDERCONSTRUCTION WITH
REMODEL/ADDITION PERMIT NUMBER: 08-965.
THIS PERMIT DOES NOT INCULDE REVISIONS
TO THE ALREADY PERMITTED CONSTRUCTION.
2007 CALIFORNIA BUILDING CODES.
December 10, 2008 4:28:27 PM AORTEGA
LQPERM[T
Application Number
08-00001833
-----------=----------------------------------------------------------------
Other Fees . . .
. . . . . .
ENERGY REVIEW
FEE
2.02
STRONG MOTION
(SMI) - RES
.50
Fee summary
-----------------
Charged
----------
Paid
--------------------
Credited
----------
Due
Permit Fee Total
70.56
.00
.00
70.56
Plan Check Total
30.04
.00
.00
30.04
Other Fee Total
2.52
.00
.00
2.52
Grand Total
103.12
.00
.00
103.12
LQPERMrf '
Bin #
2
City of La Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico �p
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: Ncem-
Owner's Name: S
A. P. Number: "1
Address:
Legal Description:
City, ST, Zip:
Contractor: y,
/`�vk-AS
Telephone:
Address: -Po
Project Description:
City, ST, Zip: Q✓(K CA—
r
Telephone:
State Lic. # : `� ZZ City Lic. #:
Arch. ngr., Designer: 0a+9
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:3 �l ` J S
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: -7 Lk - 1;5 i
Estimated Value of Project: i 'L% -' (ev);
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERNM FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
nA
Energy Cales.
Plans picked up
Construction
t?
Flood plain plan.
Plans resubmitted
Mechanical
Grading plan
2'" Review, ready for correctio slissue /
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted ( lob
Grading
IN HOUSE:-
''' Review, ready for correctio s/ ssue 121
15
Developer Impact Fee
Planning Approval
Called Contact PersonA.I.P,P.
Pub. Wks. Appr
Date of permit issue
/
School Fees
Total Permit Fees
6�
APPROc.46 G� liqpnv�laso.�
^^ i
C �tkc,.Nlla Valley Unified School District
8r-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:
COMM/IND. AMOUNT:
DATE:
RECEIPT:
CHECK #:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: [Thomas & Diane Richards.— P610 Estates Date: December 11, 2008
Owner's Name: Thomas & Diane Richards Phone No.
Project Address: 80-645 La Docena Trail, LaQuinta, CA 92253
Project Description: Room Addition
APN: 777-040-004 Tract #: Lot #'s:
Type of Development: Residential XX Commercial Industrial
Total Square Feet of Building Area: 16
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: December 11, 2008 Signature:
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 Approval Prior to 1/1/87 Requirement
Note: Pursuant to AB -181, any room additions of 500 square
Number of Sq.Ft. 16 sq. ft. feet or less on existing dwelling units are exempt from
Amount per Sq.Ft. $ 0.00 developer fees. Pursuant to AB -181, any mobile liome being
Amount Collected $ 0.00relocated or replaced within our school district is exem Y
from developer fees.
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Support Services
Certificate issued by: Laurie Howard, Secretary III Signature: C J
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/mydocs/devices/certificate of compliance form tablesTO USE.doc 1/16/03 T