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05-0400 (AR)D � FEB 0 7 2005 C&f4 � � CITY OF LA QUINTA J z FINANCE DEPT. a BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 OFT19 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . 05-00000400 Date 2/04/05 Property Address . . . . . . 79170 DIANE DR APN: 604-313-001-17 -26188 - Application description . . . ADDITION - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 8328 Owner Contractor ------------------------ ------------------------ MISIAK PERRY F OWNER 79170 DIANE DR LA QUINTA CA 92253 ------ Structure Information THIRD CAR GARAGE CONVERSION TO BEDROOM ----- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/LONG <=10 Other struct info . . CODE EDITION 2001 # BEDROOMS 1.00 1ST FLOOR SQUARE FOOTAGE 240.00 ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc'. Permit Fee . . . . 108.00 Plan Check Fee 70.20 Issue Date . . . . Valuation . . . . 8328 Qty Unit Charge Per Extension BASE FEE 45.00 7.00 9.0000 THOU BLDG 2,001-25,000 63.00 ---------------------------------------------------------------------------- Permit . . . . . ELECT - ADD/ALT/REM Additional desc Permit Fee . . . . 23.40 Plan Check Fee 5.85 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 240.00 .0350 ELEC NEW RES - 1 -OR 2 FAMILY 8.40 ---------------------------------=-----------------------'--=---------------- Permit . . . . MECHANICAL Additional desc Permit Fee . . . . 19.50 Plan Check Fee 4.88 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/ DUCT. ALT 4.50 ---------------------------------------------------------------------------- Special Notes and Comments Third car garage conversion to bedroom. P.O. BOX 1504 • VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: (,.s A100 I Date: Applicant: Applicant's Mailing Address: _ /7O f Architect or Engineer: Architect or Engineer's Address: PIA Lic. No.: BUILDING PERMIT DECLARATIONS 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 License No. Date Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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 th 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 or 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.). U 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 improve hereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. BA P.C. fqj reason O WORKERS' 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 Policy Number I certify that, in the performance of the work for which this permit is issued, I sh of mploy any person in any manner so as to become subject to the workers' compensation laws of California, and agreelhat, if I should become subje o t workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.,,,,V,,,7 i Date y Jpplicant C WARNING: FAILURE TO SECURE WOR RS' C SATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED TH US OLLARS ($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. 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.). Lenders Name f� Lenders Address 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 informatio I•agree to ply II city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to ente h bove-me d pro a for inspection purposes. r Ci Signature (Applicant or Agent): Page 2 Application Number . . . . . 05-00000400 Date 2/04/05 ---------------------------------------------------------------------------- Special Notes and Comments 240 sqft . ----------------------7----------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 7.02 STRONG MOTION (SMI) - RES .83 Fee summary Charged Permit Fee Total 150.90 Plan Check Total 80.93 Other Fee Total 7.85 Grand Total 239.68 Paid Credited Due ---------- ------ ---------- .00 .00 150.90 .00 .00 80.93 .00 .00 7.85 .00 .00 239.68 At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooldng, eating or sanitation) or replacement mobile ho mes. ft 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 240 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 -Neil Johnson Check No. N/A Name on the check. Telephone lending Exempt By Dr. Doris Wilson Superintendent Fee collected /exerppted by Signature icia Barbuzza Payment Recd 0.00 Over/Under NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 9D 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 instakation 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 Districtfs) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy - Accounting