07-3160 (SFD)4 P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011,
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number: 07-00003160
Property Address: 53768 VIA PISA
APN: 772-530-054- - -
Application description: DWELLING - SINGLE FAMILY DETACHED
Property Zoning: LOW DENSITY RESIDENTIAL
Application valUatl6h: SUi'/64 lam®
Applicant: Architect or Engineer:
X4-
Lic. No.: OOR SQUARE FOOT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 fcommencing with
Section 7000) of Division 3 of the Business and Professional de, and ice a is in full force and effect.
License Cl a s: Elelilense 41
Date: Q Contractor:
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).:
(_ 1 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.).
( 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
Date: 9/12/08
Owner:
LAWRENCE & JANET READ
53-768 VIA PISA
LA QUINTA, CA 92253
Contractor: O \
SOUTHERN HILLS DEVELOPMEM
<IN78150 CALLE �C;jfl
QUINTA,
CA 92253 0
2253 PICO STE 1 A qOW
(760)771-3497
Lic. No.: 838041 tiC �QG�ti�
---------------------------------------- v -----
WORKER'S 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 EXEMPT Policy Number EXEMPT
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' compen on laws of California,
and agree that, if I should become subject to t e workers' com ation ovisions of Section
�OO of the Labor Code, I shall forthwi mply with th s ovisio
Date: Applicant:
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 t mply th all
city and county ordinances and state laws relating to building construction, an hereby auth ' e represe tives
of this county ter upon the above-mentioned property for inspection oses.
Date: Signature (Applicant or Agent):
Application Number . . . . . 07-00003160
Permit
. . . BUILDING PERMIT
Additional
desc . .
Permit Fee
. . . .
2045.50
Plan Check Fee
1329.58
Issue Date
. . . .
Valuation . . . .
501764
Expiration
Date . .
3/11/09
Qty Unit Charge
Per
Extension
BASE
FEE
2039.50
2.00
----------------------------------------------------------------------------
3.0000
THOU BLDG
500,001-1,000,000
6.00
Permit
. . .
ELEC-NEW RESIDENTIAL
Additional
desc . .
Permit Fee
. . . .
248.46
Plan Check Fee
62.12
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date . .
3/11/09
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
5696.00
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
199.36
955.00
.0200
ELEC
GARAGE OR NON-RESIDENTIAL
19.10
1.00
----------------------------------------------------------------------------
15.0000
EA ELEC
TEMPORARY POWER POLE
15.00
Permit
. . . GRADING PERMIT
Additional
desc . .
Permit Fee
. . . .
15.00
Plan Check Fee
.00
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date . .
3/11/09
Qty Unit Charge
Per
Extension
----------------------------------------------------------------------------
BASE
FEE
15.00
Permit
. . .
MECHANICAL
Additional
desc . .
Permit Fee
. . . .
168.00
Plan Check Fee
42.00
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
3/11/09
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
3.00
9.0000
EA MECH.FURNACE
<=100K
27.00
1.00
11.0000
EA MECH
FURNACE >100K
11.00
3.00
9.0000
EA MECH
B/C <=3HP/100K BTU
27.00
1.00
16.5000
EA MECH
B/C >3-15HP/>100K-500KBTU
16.50
10.00
6.5000
EA MECH
VENT FAN
65.00
LQPERMIT
Application Number . . . . . 07-00003160
Permit . . . . . MECHANICAL
Qty Unit Charge Per Extension
1.00 6.5000 EA MECH EXHAUST HOOD 6.50
----------------------------------------------------------------------------
Permit . .
Additional desc .
Permit Fee . . .
Issue Date . . .
Expiration Date .
PLUMBING
243.00 Plan Check Fee . . 60.75
Valuation . . . . 0
3/11/09
Qty Unit Charge
Per
Extension
BASE FEE
15.00
27.00 6.0000
EA PLB FIXTURE
162.00
1.00 15.0000
EA PLB BUILDING SEWER
15.00
2.00 7.5000
EA PLB WATER HEATER/VENT
15.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1.00 9.0000'EA
PLB LAWN SPRINKLER SYSTEM
9.00
12.00 .7500
EA PLB GAS PIPE >=5
9.00
1.00 15.0000
EA PLB GAS METER
15.00
----------------------------------------------------------------------------
Special Notes and Comments
5696 SQ. FT. SFD THIS
PERMIT DOES NOT
INCLUDE POOL & SPA BLOCK WALLS OR
DRIVEWAY APPROACH.
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . ART IN PUBLIC PLACES -RES
754.41
DIF COMMUNITY CENTERS -RES
74.00
DIF CIVIC CENTER - RES
995.00
ENERGY REVIEW FEE
132.96
DIF FIRE PROTECTION -RES
140.00
GRADING PLAN CHECK FEE
15.00
DIF LIBRARIES - RES
355.00
DIF PARK MAINT FAC - RES
22.00
DIF PARKS/REC - RES
892.00
STRONG MOTION (SMI) - RES
50.17
DIF STREET MAINT FAC -RES
67.00
DIF TRANSPORTATION - RES
1930.00
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total
2719.96 .00 .00
2719.96
Plan Check Total
1494.45 1000.00 .00
494.45
Other Fee Total
5427.54 .00 .00
5427.54
Grand Total
9641.95 1000.00 .00
8641.95
LQPERMIT
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:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMM/MD. AMOUNT:
DATE:
RECEIPT:
CHECK#:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Hideaway Date: September 11, 2008
Owner's Name: Lawrence & Janet Read Phone No.
Project Address: 53-768 Via Pisa, La Quinta, CA 92253
Project Description: Single Family Dwelling
APN: 777-190-014 Tract #:
Type of Development: Residential XX
Total Square Feet of Building Area:
Lot #'s: 289
Commercial Industrial
5696
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: 9/11/08
Signature:
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
No e
Number of Sq.Ft. 5696
Amount per Sq.Ft. $3.78
Amount Collected $21,530.88
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Support Services
Certificate issued by: Laurie Howard, Secretary Signature: C4 -4-1-n.`.¢ H-b-� &,-�
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 (G°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. 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/Inydocs/devfees/certificate of compliance form updated 3-2007 3/9/07