12-1336 (AR)Bin #
1
CQty of La Quittta
Building 8z Safety Division
P.O. Box 1504, 78-495 Calle Tampico
Ia.Quinta, CA 92253 - (760) 777-7012
Building Permit Application: and Tracking Sheet
Permit # 3�p
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Project Address: '7�+ ' 5A ��
A. P. N.umber. Q D
Ownu's Name:I - i 5
Address:
Legal Description:
City, ST, Zip: [
Contractor: I^
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Telephone:
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Address: q J,0LHICYSvA411 L .
ProjeaDescription:
City, ST, Zip: �(� G� C.���
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Telephone:
State Lic. # : T S 4 O CityLic. C- 51 1
Arch., Engr., Designer:
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Address:-h. v
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City, ST, Zip: t-tt
Telephone: '
State Lie. #:
Construction Type: Occupancy:
Project type (circle one): New dd'n) Alter Repair Demo
Name of Contact Person:
Sq. Ft.: 'k r-'L # Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project D Q D
2� (-APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACMG PERMIT FEES
Plan Sets
Plan Check submitted
1>,,I� Item Amount
Structural Calm
41
Reviewed, ready for corrections
1 Plan Check Deposit
Truss Coles.
Called Contact Person
Plan Check Balance _
Title24 Cates.
e
Ir-Z
Plans Piekd. P
e
� � �' Construction
Flood plain plan
Plans resubmitted
``.�
1 �� Mechanical
Grading plan
r4 Review, ready for correctionsfissue
} Electrical
Subcontactor List
Called Contact Person
j Plumbing
Plans picked up
S.M I.
H.O.A. Approval
Plans resubmitted
Gradin g
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-
v
Total Permit Fees •
Coacifella Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
Project Name: Ken & Lauren Lewis
Owner's Name: Ken & Lauren Lewis
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVELTWOAMOUNT:
MITIGATION AMOUNT:
COMM/[ND, AMOUNT:
DATE:
RECEIPT:
CHECK#:
INITIALS
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Address: 80-777 Via Savona, La Quinta, CA
Project Description: Addition to Nook of Existing Single Family
APN: 777-130-007 Tract #:
Type of Development: Residential XX
Commercial
Total Square Feet of Building Area: 72 sq. Ft
Date: January 18, 2013
Phone No.
Lot #'s:
Industrial
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: f74 Signature:
L
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
17620
Number of Sq.Ft.
Amount per Sq.Ft.
Amount Collected
Gov. Code
65995
72
EXEMPT
0.00
Project Agreement Existing Not Subject to Fee
Approval Prior to 1/1/87 Requirement
Building Permit Application Completed: Yes/No
By: Elsa F. Esqueda, Director of Facilities and Maintenance
Note:
Pursuant to AB 181 any room additions or enclosures of 500
s.f. or less are exempt from developer fees. Any mobile homes
being relocated within the same school district's jurisdiction
are exempt from developer fees.
Certificate issued by: Leticia Torres, Facilities Analyst SignatureW�,f, f
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES—ANDISTATENIEN`T 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.
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