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