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05-2452 (AR)P.O. BOX 1504 4 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Application Number: Q5-00002452 Owner: Property Address: 45185 DESERT HILLS CT D d WEISMAN ANDREW M APN: 604-280-015-2 -23935 - 45185 DESERT HILLS CT Application description: ADDITION - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 26059 qFp 12 2005 CITY OF LA CUINTA Contractor: Applicant: Architect or Engineer: FINANCE N R N CONSTRUCTION WCC: EXEMPT WC: EXEMPT 03/31/06 /} CSLB: 841905 06/30/06 ----------------- 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 Professional Code, and my License is in full force and effect. '/License Class: i Date: 'a '0 ntractor: 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.). (_) 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.). 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 Date: 9/12/05 ------------------------------ WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: ' 1 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 B Policy Number 200 _ 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 3700 of the Labor Code, I s all hw' it hose provisions. Dat A40 �+ Applicairf: 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 nd county ordinances and state laws relating to building const r ti and hereby authorize representatives o his county to e�nte'r upon the above-mentioned pro cti u Date: 'A%/ ignature (Applicant or Agent): Application Number . . . . . 05-00002452 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 265.00 Plan Check Fee 172.25 Issue Date . . . . Valuation . . . 2.6059 Expiration Date .. 3/11/06 Qty Unit Charge Per Extension BASE FEE 252.00 2.00 ----------------------------------------------------------------------------- 6.5000 THOU BLDG 25,001-50,000 13.00 Permit . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 30.75 Plan Check Fee 7.69 Issue Date . . . . Valuation . . . . 0 Expiration Date'. 3/11/06 Qty Unit Charge Per Extension BASE FEE 15.00. 450.00 -------------------------------- .0350 ELEC =--------- NEW RES -.1 OR 2 FAMILY =--------------------------------- 15.75 Permit. GRADING PERMIT Additional desc . Permit Fee 15.00 Pian Check Fee 00 Issue Date . . . . Valuation 0 Expiration Date 3/11/06 Qty Unit Charge Per Extension ---------------------------------------------------------------------------- BASE FEE 15.00 Permit MECHANICAL Additional desc . Permit Fee. . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation 0 Expiration Date 3/11/06 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 . . . . 36.00 Plan Check Fee . Issue Date . . . . Valuation . . LQPE"IIT 9.00 0 Application Number . . . . . 05-00002452 Permit . . PLUMBING Expiration Date 3/11/06 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 6.0000 EA PLB FIXTURE 18.00 1.00 3.0000.EA --------------------- PLB WATER INST/ALT/REP 3-.00 -----------------------------------------=------------- Special Notes and Comments 450 sq. ft. addition September 12, 2005 10:59:21 AM jjohnson --------------------------------------------=------------------------------- Other Fees . . . . . . ENERGY REVIEW FEE 17.23 STRONG MOTION (SMI) - RES 2.60 Fee summary Charged Paid Credited Due ---- Permit Fee Total 370.75- ----- --------------- .00 ---------- .00 370.75 Plan Check Total 194.94 .00 .00 194.94 Other Fee Total 19.83 .00 .00 19.83 Grand Total 585.52 .00 .00 585.52 LQPERMIT Bin# City of La Quinta Building Safety &r Safe Division P.O. Box 1504, 78-495 Calle Tampico 6 Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit 2 OS Project Address: S - %� ,S i s Owner's Name: , Se Mtn, A. P. Number: �j j, �- 2— fj (5 ' Address: " Legal Description-L,-I•- 2, City, ST, Zip: LQ OU 1 "r: ct Contra o ns �r�f'rJ fV 6a n Telephone: Address: F 0� IM ` t Project Description: City, ST, Zip' UeAi 0` CA' 2Z 11 ` J e, JJ41A,. d !"C ryo W 14k Tele hone: D P S 0 9 7 s3 ....................Q..............::: D .s dee State Lie. # City" Lic. #: fQ% 7 of Arch., Engr., Designer: Address: s '"r, 0 2`G (�,/SS€S ase 3w��✓ City, ST, Zip: Telephone: Construction Type: _r0 rMt Oc cu ancv: State L,c. Project one):. New Iter Repair Demo Name of Contact Person: NO Sq. Ft.: �J"Q # Stories: # Units: Telephone # of Contact Person: (>� — ��� Estimated" Value of Project: ZQ,wa APPLICANT: DO NOT WRITE BELOW THIS LINE ti Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted 6 item Amount Structural Coles. Reviewed, ready f r corrections Pan Check Deposit Truss Calcs. Called Contact Pers Plan Check Balance Title 24 Calcs. Pians picked up Construction Flood plain plan r Plans resubmitted Niechanical .Grading plan 2w' Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up SAI.I. II.O.A. Approval Plans resubmitted Grading IN HOUSE:- Jrd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees City La Quinta Zip 92253 Permit # Tract # Study Area Type Residential Addition No. of Units 1 Lot # No. Street Unit 1 45185 Desert Hills Unit 2 Unit 3 Unit 4 Unit 5 Comments S.F. 450 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 Lot # No. Street S.F. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered pabos/walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 450 S.F. or $0.00 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 Exempt - Nick Morris Check No. Name on the check Telephone Funding Exempt By Dr. Doris Wilson '. Superintendent Fee collected /exempt y.Sh ron M Gilvrey Payment Recd 0.00 1_ -r .10ver/Under Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), tiserve to notify you that the 90 -day approval period in which you may protest the fees o r 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 if Duplicated Embossed Original -Building DepartmenVApplicant Copy - ApplicanVReceipt Copy -Accounting