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06-3238 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 06-00003238 Property Address: 60595 WHITE SAGE DR APN: 764-270-999-71 -300231- Application description: ADDITION - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 15172 T4ht " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: l Owner: PAUL BOTTIAUX 60595 WHITE SAGE DR. LA QUINTA, CA 92253 (714)420-0530 Contractor: CLASSIC BUILDERS, INC. 45-475 CLUB DRIVE INDIaN WELLS, CA 92210 (760)772-1991 Lic. No.: 691405 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/08/06 ------------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: B L' ense No.: 691405 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 9a /_ tractor: : �. _r 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EXEMPT Policy Number EXEMPT following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labo Code, I shall forthwith comply with those provisions. 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).: e: plicant: (_) 1, 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 WARNING: FAILURE TO SECU WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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, 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 _ 1 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 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 and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the ove-mentioned p [y for inspectio /p ose D�t :�/i3v Si ture (Applicant or Age _ C.G/�� Application Number . . . . . 06-00003238 Permit . . . . . . ELECT - ADD/ALT/REM Additional desc . . Permit Fee 23.93 Plan Check Fee 5.98 Issue Date . . . . Valuation 0 Expiration Date . . 5/07/07 Qty Unit Charge Per Extension BASE FEE 15.00 255.00 ---------------------------------------------------------------------------- .0350 ELEC NEW RES - 1 OR 2 FAMILY 8.93 Permit . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 171.00 Plan Check Fee 111.15 Issue Date . . . . Valuation . . . . 15172 Expiration Date . . 5/07/07 Qty Unit Charge Per Extension BASE FEE 45.00 14.00 ------------------------------------------------------ 9.0000 THOU BLDG 2,001-25,000 Z. 126.00 . . . MECHANICAL Additional desc . Permit Fee . . . . 39.50 Plan Check Fee 9.88 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 5/07/07 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 1.00 ---------------------------------------------------------------------------- 6.5000 EA MECH VENT FAN 6.50 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 61.50 Plan Check Fee 15.38 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/07/07 Qty Unit Charge Per Extension BASE FEE 15.00 5.00 .6.0000 EA PLB FIXTURE 30.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 2.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 6.00 LQPEUIIT _:O - LQPERAIIT Application Number . . . . . 06-00003238 ---------------------------------------------------------------------------- Special Notes and Comments 255 SQ. FT. CASITA AND 44 SQ. FT. PATIO.November 1, 2006 3:02:32 PM JJOHNSON ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 11.12 STRONG MOTION (SMI) - RES 1.51 Fee summary Charged Paid ---------- Credited ---------- Due ----------------- Permit Fee Total ---------- 295.93 ---------- .00 .00 295.93 Plan Chccls Total 113.39 .00 nn 149 "19 Other Fee Total 12.63 .00 .00 12.63 Grand Total 450.95 .00 .00 450.95 2� City of La Quinta Building U Safety Division P.O. Box 1504, 787495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # ll_ � lY' �2 Project Address: 105-2 [��� S , I 411. Owner's Name: L A. P. Number: 33 ._.-Q 'Address: / Legal Description: Contractor: City, ST, Zip: Telephone: • Address: Project Description: City, ST, Zip: Telephone: State Lic. # : City Lic. #: Arch., Engr., Designer: • JIM Address: City, ST, Zip: Telephone: Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: �(,{(� ux Sq. Ft.: # Stories#Units: Telephone # of Contact Person: 7 ' q t94 - -711 7 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING. PERMIT FEES Plan Sets Plan Check submitted 5 Item Amount Structural Calcs. Reviewed, ready for corrections Plan.Check Deposit Truss Cales. Called Contact Person Plam Check Balance Energy Cales. d Plans picked up Construction Flood plain plan Plans resubmitted Z p6 Mec_ianical Grading plan gnu Review, ready for correction ssue `• Elec_rical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up SALI. H.O.A. Approval Plans resubmitted Grating IN HOUSE:- '"' Review, ready for corrections/issu Developer Impact Fee Planning Approval Called Contact Person A.I .?.P. Pub. Wks. Appr Date of permit issue School Fees Totil P f.5� dCf�Du� �Iy�D� ���F1�a(o -�VCp D�� 103 q��2 y15 1z VC l0/2�(66 57lLAPPR�v o� 572 ZFG �a 60( is ow Ir 1 IL19 • coo APPROwe F r -AI °Coachella Valley Unified School District 83-733 Avenue 55, Thermal, CA 92274 (760) 398-5909 — Fax (760) 398-1224 This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT LEVEL ONE AMOUNT: LEVELTWOAMOUNT MITIGATION AMOUNT: COMM/MD. AMOUNT: DATE: RECEIPT: CHECK #: INITIALS: CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: PAUL BOTTIAUX Dzte: NOVEMBER 3, 2006 Owner's Name: PAUL BOTTIAUX Phone No. (714) 420-0530 Project Address: 60-595 WHITE SAGE AREA DR. Project Description: ROOM ADDITION APN: 764-330-027 Tract #: Lot #'s: Type of Development: Residential XX Commercial Industrial Total Square Feet of Building Area: 255 sq. feet Certification of Applicant/Owners: The person signing certifies that the above information is -orrect and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on behalf of the ownerMeveloper. Dated: 11/03/06 Signature: PAUL BOTTIAUX (RECEIVED BYFAX) 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 Gov. Code Project 17620 65995 Approval Number of Sq.Ft. 255 sq. ft. Amount per Sq.Ft. $ 0.00 Amount Collected $ 0.00 Building Permit Application Completed: Yes/No By: Carey M. Carlson, Asst. Supt., Business Services Certificate issued by: Leticia C. Torres, Facilities Analyst Agreement Existing Not Subject to Fee Prior to 1/1/87 Requirement Note: Pursuant to AB -151, any mobilehomes being replaced or relocated within the same school district are exempt from developer fees. Any additions of 500 sq. ft. or less is also exempt from developer fees. (Unless additions are on a structure that is under construction.) NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENX 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 )0 -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. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. MV:c/mydocs/devfees/certificate of compliance form tablesTO USE.doc 1/16/03 T