13-1390 (AR)'
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00001390
Property Address:
78550 AVENIDA LA FONDA
APN:
770-142-012-196 -000000-
Application description:
ADDITION - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
150000
Ta�/
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
�, J�,� A) 1H -
------------------
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.
LicenseClass: B, C9, 10,2.0-- ense No.: 581636
Date: 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).:
(_) 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 _ I 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: 2/24/14
Owner:
SHAWM HOLOUBEK
Contractor: UF
SIPOVAC CONSTRUC 72651 THEODORAj
PALM DESERT, CA 22 0 2071(760)567-2347
Lic. No.: 58163 C....._
-----------------------------------------------
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
ssued.
_ 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 9087965-14
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 worW' compensation provisions of Section
3700 of "thye Labor Code, Ishal�l fLonithwith comply t hhose provisions.
a'te / App iI cant:
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 ($100,0001 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 ISO 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/court to enter upon the above-mentioned property for inspecti purposes.
Dk Z Z Signature or Agent):
I _i
Application Number . . . . . 13-00001390
Permit
. . .
ROOM ADDITION 2013
Additional
desc .
Permit Fee
243.10
Plan Check Fee
.00
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date . .
. 8/23/14
Qty
Unit Charge
Per
Extension
1.00
120.1200
LS MISC
ROOM ADDN, 1ST 100 SF
120.12
2.00
----------------------------------------------------------------------------
61.4900
EA MISC
ROOM ADDN, ADDL 500 SF
122.98
Permit
. . .
ELECTRICAL 2013
Additional
desc . .
Permit Fee
. . . .
178.99
Plan Check Fee
.00
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
8/23/14.
Qty Unit Charge
Per
Extension
1.00
23.8300
LS ELEC
FIXTURES, FIRST 20
23.83
1.00
143.0000
LS ELEC
NEW RES, FIRST 1 KSF
143.00
1.00
--------------------------------------------------=-------------------------
12.1600
EA ELEC
NEW RES, ADD'L 1 KSF
12.16
Permit
MECHANICAL 2013
Additional
desc .'.
Permit Fee
. .
95.34
Plan Check Fee
.00
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
8/23/14
Qty Unit Charge
Per
Extension
1.00
35.7500
EA MECH
FURNACE
35.75
1.00
35.7500
EA MECH
CONDENSER/COMP
35.75
1.00
11.9200
EA MECH
VENT FAN
11.92
1.00
----------------------------------------------------------------------------
11.9200
EA MECH
EXHAUST HOOD
11.92
Permit
PLUMBING 2013
Additional
desc .
Permit Fee
131.12
Plan Check Fee
00
Issue Date
. . . .
Valuation
0
Expiration
Date
.8/23/14
Qty Unit Charge
Per
Extension
8.00
11.9200
EA PLBG
FIXTURE/TRAP
95.36
t 1.00
11.9200
EA PLBG
ROOF DRAIN
11.92
1.00
11.9200'EA
PLBG
WATER INST/ALT/REP
11.92
1.00
11.9200
LS PLBG
GAS SYS, 1-4 OUTLETS
11.92
LQPERMIT
LQPERMIT
Application Number
. . . . . 13-00001390
----------------------------------------------------------------------------
Special Notes and
Comments
REM / ADDITION NEW
ADDITION OF 1175 SQ.
FT. WITH 304 SQ. FT.
PATIO COVER INT
REMODEL. HOME NOT
FIRE SPRINKLED. ALL
CONST TO BE PER 2010
CALIF BULIDING
CODES.CONVENTIONAL
LIGHT FRAMED CONST.
November 25, 2013
2:45:59 PM JJOHNSON.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
6.00
HOURLY PLAN
CHECK
668.00
PLAN CHECK,
ELECTRICAL
71.02
PLAN CHECK,
ROOM ADDITION
203.06
PLAN CHECK,
MECHANICAL
52.43
PLAN CHECK,
PLUMBING
143.03
STRONG MOTION (SMI) - RES
15.00
Fee 'summary
-----------------
Charged Paid
--------------------
Credited
--------------------
-Due'
Permit Fee Total
648.55 .00
.00
648.55
Plan Check Total
.00 .00
.00
.00
Other Fee Total
1158.54 .00
.00
1158.54
Grand Total
1807.09 .00
:00
1807.09
1N3Wd013/13a A1-INf1WW0J
VLNInb VIJO ALLI
Bin#
- be
City of La Quinta o E leo
Building 8L Safety Division
P.O. Box 1504, 78-495 Calle Tampico q I
La Quinta, CA 92253 - (760) 777-701 / 3 0 3 d
Building Permit Application and Tracking Sheet
Permit #
3 (�
Project Address: -7 p j( `* -Ae'la
Owner's Name:
A. P. Number: 771 —ley Z —o el'
Address: z0f- Alt 74,
Legal Description:
City, ST, Zip: Cj i( CA- -
Contractor: •2 S
Address:
< s>:<:s::>::s:<::::
Telephone:
Project Description:
City, ST, Zip:
A O 0
Telephone:
"Lie.
State Lie. # :
City
V Vf,g
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:Construction
'tit; I;i%/'Y{:+.<fl..<i:i::::iiiry:i}�?:::i %ii:
:<:u:.?::<•::f:<::;:.>::»»>:':'•:i:•i:ii:.:;<
Type: _ Occupancy.
State Lic. #:
Project type (circle one): New Alter Repair Demo
Name of Contact Person: s e
Sq. Ft.:, 01p0
# Stories:
# Units:
Telephone #,of Contact Person: d -- Z
Estimated Value of Project: /SO p
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKNG
PERMIT FEES
3
Plan Sets
Plan Check submitted Q
Item
Amount
Structural Calcs.
Reviewed, reador corrections
Plan Check Deposit
Truss Calcs.
Called Contact r(
Plan Check BalanceIa,
Title 24 Calcs.
Plans picked up AtvPtrauj it lu
Construction
Flood plain plan
Plans resubmitted 12lotJuts
Mechanical "
Grading plan
2°" Review, ready f r corrections/ sue `
Electrical
Subcontactor List
Called Contact Person Ikk
Plumbing
Grant Deed
Plans picked up �a,� If'�11
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
, `
�-�
'"' Review, ready r cord rectionsfi a hk
Dcveloper Impact Fee
Planning App* rovalCalled
Contact Pers •
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Iq
9WWK2. tV& 1,14%, PAO UP. 2-
n-I,P
Date
7/24/14
No.
32210
Owner
Shawn Holoubek
Address
78550 Avenida La Fonda
City
La Quinta Zip
Tract #
5 -
Type
Residential Addition
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
Lot # No. Street
Unit 1 78550 Avenida La Fonda
Unit 2
Unit 3
Unit 4
Unit 5
APN #
Jurisdiction
Permit #
No. of Units
S.F. Lot # No.
82 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
Q BERMUDA DUNES
CAI RANCHO MIRAGE d
�J INDIAN WELLS
V' PALM DESERT
tyi LA QUINTAy
1!*IN0 Se
)
770-142-012
La Quinta
1
Street S.F.
Comments Paid for 1,175 sf addition on cert #31988 on 2/24/14. Additional 82 sf added to total 1,257 sf.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $3.36 X 82 S.F. or $275.52 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By CC/Bank of America - Bob Sipovak Check No. 005361214
Bank Name/Recipient of Certificate Telephone
Funding Residential
By
Dr. Gary Rutherford
Superintendent
Fee collected
Signature
NOTICE: Pursuant to Government Code S on 66020(d)(1), this *ill serve to notify you that the 90 -day approval period in which you may protest the fees
or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting
Payment Recd x'-;$0.00 nw 'i
_
$275.52 .ever/Udder'
5 -
NOTICE: Pursuant to Government Code S on 66020(d)(1), this *ill serve to notify you that the 90 -day approval period in which you may protest the fees
or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting
Date 2/24/14
No. 31988
Owner Shawn Holoubek
Address 78550 Avenida La Fonda
City La Quinta Zip
Tract #
Type Residential Addition
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
Jurisdiction
Permit #
No. of Units
Q BERMUDA DUNES
Gn RANCHO MIRAGE b
�J INDIAN WELLS
V' PALM DESERT
LA QUINTA 4�'
QINDIO L�
770-142-012
La Quinta
1
- Lot # No. Street ' S.F. Lot # No. Street S.F.
Unit 1 78550 Avenida La Fonda 1175 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain fac0ities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $3.20 X 1,175 S.F. or $3,760.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By CC/Bank of America - Bob Sipovak Check No.
Bank Name/Recipient of Certificate Telephone
Funding Residential
By Dr. Gary Rutherford
Superintendent A
Fee collected /exem
Signature
NOTICE: Pursuant to Government Code Sction 66020(d)(1), t s wil serve to notify you that the 90 -day approval period in which you may protest the fees
or other payment identified above will begin from the dat on ich the building or installation permit for this project is issued, or from the date on
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting
Payment Recd I$0.00
-
?fiver/Under,'
$3760.00 w' . �
=
Signature
NOTICE: Pursuant to Government Code Sction 66020(d)(1), t s wil serve to notify you that the 90 -day approval period in which you may protest the fees
or other payment identified above will begin from the dat on ich the building or installation permit for this project is issued, or from the date on
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting