07-1612 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
�{ LA QUINTA, CALIFORNIA 92253
Application Number: 07-00001612
Property Address: 81895 GOLDEN STAR WY
APN: 764-280-999-89 -300235-
Application description: ADDITION - RESIDENTIAL
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 25038
Tit!t
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MITCHELL
81895 GOLDEN STAR WAY
LA QUINTA, CA 92253
Contractor:
Applicant: Architect or Engineer: CLASSIC BUILDERS,
Pe 45475 CLUB DRIVE
INDIAN WELLS, CA
(760)333-1935
Lic. No.: 691405
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: /B �J Li No.: No.: 691405
Date: O $ontractor:' [.�( -
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 whodoes 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, 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.).
(_ ) 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:. 10/15/07
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' compensation laws of California,
and agree that, if 1 should become subject to the workers' compensation provisions of Section
/fit1377000 of the Lath e, 1 shall forthwith comply with those provisions.
Date/ �7B '� / Applican • 6� • e^i'�� _,
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 to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
p t
of this county to enter upon the above-mentioned proy for inspection osas.
Date/����111���777
Signature (Applicant or Agerl
G
Application Number .
. . . . 07-00001612
------ Structure Information
300SF CASITA ADDITION/V-NR/RES-3/CLASS
A -----
Other struct info
CODE EDITION.
2.001/2005
# BEDROOMS
1.00
FLOOD ZONE
NO
PATIO SQ FTG
60.00 -
----------------------------------------------------------------------------
1ST FLOOR SQUARE FOOTAGE
300.00
Permit . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
258.50 Plan Check Fee
168.03
Issue Date . . . .
Valuation . .
. . 25038
Expiration Date
4/12/08
Qty Unit Charge
Per
Extension
BASE FEE
252.00
1.00 6.5000
----------------------------------------------------------------------------
THOU BLDG 25,001-50,000
6.50
Permit . . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
25.50 Plan Check Fee
6.38
Issue Date
Valuation
0
Expiration Date
4/12/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
300.00 .0350
------------------------------
ELEC NEW RES-- 1 OR 2 FAMILY
=----------------------=----------------------
10.50
Permit . . .
MECHANICAL
Additional desc
Permit Fee . . .
_
44.00 Plan Check Fee
11.00
Issue Date
Valuation . .
. . 0
Expiration Date
4/12/08
Qty Unit Charge
,Per
Extension
BASE FEE
15.00
1.00 9.0000
-EA MECH FURNACE <=100K
9.00
1.00 4.5000
EA MECH VENT INST/ DUCT ALT
4.50
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 . . . .
42.00 Plan Check Fee
10.50
LQPERMIT
(41b
r Application Number . . . . . 07-00001612
Permit . . . . . . PLUMBING
Issue Date Valuation
. . .
. 0
Expiration Date 4/12/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
4.00 6.0000 EA PLB FIXTURE
24.00
1.00 3.0000 EA PLB WATER INST/ALT/REP
3.00
----------------- -----------------------------------------------------------
Special Notes and Comments
300SF CASITA ADDITION/V-NR/RES-3/CLASS
A -FR. THIS PERMIT DOES NOT INCLUDE
BLOCKWALLS. 2001 CBC, CPC, CMC, 2004
CEC, 2005 ENERGY. October 15, 2007
11:52:58 AM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ENERGY REVIEW FEE
16.80
STRONG MOTION (SMI)
- RES
2.50
Fee summary Charged Paid Credited
---------------------------
Due
--------------------
Permit Fee Total 370.00 .00
----------
.00
370.00
Plan Check Total 195.91 .00
.00
195.91
Other Fee Total 19.30 :00
.00
19.30
Grand Total 585.21 .00
.00
585.21
0
LQPERN11T
Bi" #
City of La Quinta
Building 8T Safety Dlvlslon
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit , 1 a'
Project Address:'Owner's
Name: l I
A. P. Number: 4 - 5o 0 .0.X1
Address-
Legal Description:
City, ST, Zip:
Contractor: CLASU I I- IM/V ;
Telephone: 7 j 0 52.P3- t `? 3
Address: C wis bkProject
Description:
City, ST, Zip: i �,':• /O
/ 0
Telephone: 3 .. f 9 3
State Lie. # : / L1,6 S .
City Lie. #:
14
Arch., Eng., Designer: P, p a L
•oe
Address: % -$5=� t
City, ST, Zip: XOCL ift bffma
Telephone: 4c7-791--o.4-3Y
State Lie. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: RO bb L F-0 I Z A JLDt
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: -77:2- 0 51q
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd •.
Reed
TRACEING .
PERMIT FEES
Plan Sets
aC
Plan Check submitted f1d11G7
Item
Amount
Structural Cales.
Reviewed, ready for corrections 4qPlan
Check Deposit
Truss Caics.
Called Contact Person
Plan Check Balance
Energy Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted a 1
Mechanical
Grading, plan
2A Review, ready for corrcetions/issue-Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`' Review, ready for corrections/issue /S
Developer Impact Fee
Planning Approval
Called Contact Person { 7
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
i . .F%r7 ,
0
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
LEVELONEAMOUNT:
LEVELTWOAMOUNT:
MITIGATION AMOUNT:
COMM/IND.AMOUNT:
DATE:
RECEIPT:
CHECK #:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Rittchell Date: October 1, 2007
Owner's Name: Mitchell Phone No. (760) 333-1935
Project Address: 81-895 Golden Star Way, La Quinta Ca 92253
Project Description: Casita Addition
APN: 764-500-021 Tract #: Lot #'s:
Type of Development: Residential !XXL Commercial Industrial
Total Square Feet of Building Area: 300 sq. feet
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: 10/1/07
Signature:
ssssss*s*s****ss*s*t**s*sssss*sssssss*****s***s*sssssss*sss*ss*s**s**s*
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: Pursuant to AB -181, any mobilehomes being replaced
Number of Sq.Ft. 300 sq. ft. or relocated within the same school district are exempt from
Amount per Sq.Ft. $ 0.00 developer fees. Any additions of 500 sq. ft. or less is also
Amount Collected $ 0.00 exempt from developer fees. (Unless additions are on a
structure that is under construction.)
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Support Services
Certificate issued by: Leticia C. Torres, Facilities Analyst
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January'41, 997, 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 exacti000s ("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/mydocs/devfees/certificate of compliance form tablesTO USE.doc 1/16/03 T