05-1845 (AR)/1r
+1 d
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number. 0.5=00001=845
Property Address: 56109 WINGED FOOT
APN: 775-350-021- - -
Application description: . ADDITION - RESIDENTIAL
Property Zoni DENTIAL
Replication v l4Dnn: 56 0 :
Applicant: IU I JUN 16 2005 (Architect or Engineer:
CITY OF U1 QUINTA
-----------------
LICENSED CONTRACTOR'S DECLARATION
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: B C8 C36censeNo.: 343335
_,,,4Date: Flo- ACortraor-
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.).
(_ 1 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.).
( 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
Owner:
JIM & BONNIE MANKE
56109 WINGED FOOT
LA QUINTA, CA 92253
Contractor:
ML CONSTRUCTION
P 0 BOX 228
LA QUINTA, CA 92253
(760)564-4447
Lic. No.: 343335
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/16/05
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
1 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 STATE FUND Policy Number 0014757-2005
_ 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 shall forthwith,:.
orthwith comp) ith those provisions.
Date: 1!� e"(j Apple
WARNING: FAILURE TO SECURE WORKERS' o,PENSATION 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 and county ordinances and state laws relating tb building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purp ses.
--- �i
Date. to a .(S7 /a"'G�Signature (Applicant or Agent):
Application Number . . . . . 05-00001845
Permit .
. .
BUILDING PERMIT
Additional desc
. .
Permit Fee . .
. .
446.00
Plan Check Fee
289.90
Issue Date . .
. .
Valuation . . . .
56560
Expiration Date
12/13/05
Qty Unit
Charge
Per
Extension
BASE
FEE
414.50
7.00
4.5000
THOU BLDG
50,0.01-100,000
31.50
Permit
ELECT - ADD/ALT/REM
Additional desc
.
Permit Fee . .
. .
39.50
Plan Check Fee
9.88
Issue Date . .
. .
Valuation . . . .
0
Expiration Date
12/13/05
Qty Unit
Charge
Per
Extension
BASE
FEE
15.00
700.00
--------------------------------------------
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
-------------------------------
24.50
Permit
GRADING PERMIT
Additional desc
.
Permit Fee . .
. .
15.00
Plan Check Fee
.00
Issue Date . .
. .
Valuation . . . .
0
Expiration Date
12/13/05
Qty Unit
Charge
Per
Extension
----------------------------------------------------------------------------
BASE
FEE
15.00
Permit
MECHANICAL
Additional desc
.
Permit Fee . .
. .
39.50
Plan Check Fee
9.88
Issue Date . .
. .
Valuation . . . .
0
Expiration Date
. .
12/13/05
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 . .
LQPERMIT
10
LQPERMrr .
I
Application Number . . . . . 05-00001845
Permit . . . . . . PLUMBING
Permit Fee . . 58.50 Plan Check Fee
14.63
Issue Date . . . . Valuation
0
Expiration Date 12/13/05
Qty Unit Charge Per
Extension
BASE FEE
15.00
4.00 6.0000 EA PLB FIXTURE
24.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
1.00 3.0000 EA PLB WATER INST/ALT/REP
3.00
3.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
9.00
----------------------------------------------------------------------------
Special Notes and Comments
700 sq. ft. csaita addition.June 13,
2005 4:08:12 PM jjohnson
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ENERGY REVIEW FEE
28.99
STRONG MOTION (SMI) - RES
5.65
Fee summary Charged Paid Credited
Due
---------------------------------------------------------
Permit Fee Total 598.50 .00 .00
598.50
Plan Check Total 324.29 .00 .00
324.29
Other Fee Total 34.64 .00 .00
34.64
Grand Total 957.43 .00 .00
957.43
10
LQPERMrr .
I
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/IND. AMOUNT:
DATE,
RFCFIPT-
CHF.r.K 0.
INITIAI S -
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Residence is at PGA.West Date: June 16, 2005
Owner's Name: Marvin Jordan Phone No.
Project Address:56-109jWLnge�FooqT La Quinta, CA
Project Description: Casita
APN: 775-350-021-4 Tract #: Lot #'s:
Type of Development: Residential XX! Commercial Industrial
Total Square Feet of Building Area: 700 sq. ft.
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: June 16, 2005 Signature:c�
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 Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Note:
Number of Sq.Ft. 700
�1 Amount per Sq.Ft. $ 2.88
Amount Collected $ 2,016.00
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Business Services
C
Certificate issued by: Elvira Mattson, Office Technician Signature:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT 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 -da- 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 othem 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 beev 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.
1i �':c;mydocsidecleev-ertilictfte ofcompliance lbrm tabled"O USf.doc 1/16/03 T