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04-6845 (AR)Titif 4 4 Q" P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . . . 04-00006845 Date 10/20/04 Property Address . . . . . . 54145 AVENIDA HERRERA APN: ' 774-213-017-6 -000000- Application.description ADDITION - RESIDENTIAL Property Zoning . . . . . . . COVE RESIDENTIAL Application valuation . . . . 78795 Owner Contractor ------------------------ GIBSON LANCE C ------------------------ MOLNAR CONSTRUCTION & REMDLG 54085 HERRERA 77027 CALIFORNIA DRIVE LA QUINTA CA 92253 PALM DESERT CA 92211 (760) 345-9564 WCC: STATE FUND WC: 1615203 01/01/05 CSLB: 579391 10/31/05 CCC: B ------ Structure Information 1199 SQ. FT..CASITA , GARAGE 521 SQ. FT. ----- Construction Type . . . . . TYPE V -.NON RATED Occupancy Type . . . . . . DWELLG/LODGING/LONG <=10 Flood Zone . . . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 CBC # BEDROOMS 1.0.0 FLOOD ZONE NO GARAGE SQ FTG 521.00 FIRST FLOOR SQ FTG 1199.00 -----------------------------------------------= Permit . . . . . . BUILDING ---------------------------- PERMIT, - Additional desc Permit Fee . . . . 545.00 Plan Check Fee :354.25 - issue Date Valuat'iQn ��j�-;� 78795 Qty Unit Charge Per _�`.= ��_-, Extension BASE FEE 414 . 50 29.00 4.5000 THOU BLDG 50,001-100,000 130.50 -------------------------------------------------7-------------------------- Permit . . . . . . ELECT - ADD/ALT/REM Additional desc Permit Fee . . . . 67.39 Plan Check Fee 16..85 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1199.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 41.97 521.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 10.42 ---------------------------------------------------------------------------- Permit GRADING PERMIT Additional desc P.O. BOX 1504 • '�C�� 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 4 BUILDING & SAFETY DEPARTMENT Application Number: ��— Applicant: Applicant's Mailing Address: Architect or Engineer: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: /0 Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS 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 License No. Date Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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 or 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.). U 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.). (� I am exempt under Sec. BA P.C. for his reason Ll Date/y I —� Owner (/ O ERS' 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: Cartier Policy Number 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 comply with those provisions. ✓bate ��—Zl —C>(Jplicant ��iC.�u-� c WARNING: FAILURE TO SECURE WORKERS' COMPENSATI . OVERAGE 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. 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 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 Ouinta, 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 u on the above-mentioned property for inspection purposes. ZDateAV �0�ature (Applicant or Agent): Page 2 Application Number .. . . . 04-00006845 Date 10/20/04 Permit Fee . . . . 15.00 Plan Check Fee . . .00 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Permit . . . . . .. MECHANICAL Additional desc . . Permit Fee . . . 46.00 Plan Check Fee 8.25 Issue Date . . . . Valuation . . . . 0 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 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 ---------------------------------------------------------------------------- Permit PLUMBING Additional desc Permit Fee . . . . 85.50 Plan Check Fee 21.38 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 6.0000 EA PLB FIXTURE 24.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 4.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 12.00 ---------------------------------------------------------------------------- Special Notes and Comments 1199 SF. FT.CASITA AND GARAGE10/20/04 10 :02:11 AM JJOHNSON ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 35.43 STRONG MOTION (SMI) -'RES 7.87 Fee summary Charged ------------------------'-- Paid Credited Due Permit Fee Total -------------------- 758.89 .00 .00 ---------- 758.89 Plan Check Total 400.73 .00 .00 400.73 Other Fee Total 43.30. .00 .00 43.30 Grand Total 1202.92 .00 .00 1202.92 CERTIFICATE OF COMPLIANCE 4��1FSo�o Desert Sands Unified School District 47950 Dune Palms Road BERMUDA DUNES O RANCHO MIRAGE tJ' Date 10/21/04 La Quinta, CA 92253 INDIANWELLS P No. 26549 (760) 771-8515 d� LA QUINTADESERT y �QINDIO y� O Owner . Lance Gibson APN # 774-213-017 & 018 Address 54145 Avenida Herrera Jurisdiction La Quinta City La Quinta, Zip 92253 Permit # Tract # Study Area Type Residential Addition No. of Units 1 Lot # No. Street S.F. Unit 1 54145 Avenida Herrera 1199 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Casita Lot # No. Street S.F. At the present time, the Desert Sands Unified School District does not collect fees on garagestearports, covered patios/walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.24 X 1,199 S.F. or $2,685.76 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Cash - Lance Gibson Check No. Name on the check Telephone By Dr Doris Wilson Superintendent Fee collected /exempted by Finding Residential Payment Recd $2,685.76 Over/Under NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees o r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District(s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy - Accounting "I v10jUN ZDATION NO: 11-5-2003 /RECORDING REQUESTED BY: Lance C. Gibson 54-085 Avenida Herrera La Quinta, CA 92253 MAIL TAX STATEMENTS TO: Lance C. Gibson 54-085 Avenida Herrera La Quinta, CA 92253 COPY of Document Recorded NOV 14 2W3 3 �I on as No.. has not been compared with original, County Recorder RIVERSIDE COUNTY, CALIFORNIA: M s U PAGE SIZE DA PCOR NOCOR SMF misc. A R L COPY LONG REFUND NCHG EXAM TRA 140: 020-015 I GRANT DEED APN:774-213-017 —0 &.018-1 GRAND R& GRk411 E ARE 0441`5 OF RE SNI E THE UNDERSIGNED GRANTOR(S) DECLARES PP= WD oa\= TO HILD ME SAME DOCUMENTARY TRANSFER TAX IS $ '-0- R&T I -19(d) TNiERESi`S IN nF, PROPFfffY ❑ Computed on full value of property conveyed, or ❑ Computed on full value less value of liens or encumbrances remaining at time of sale. K City of La Quinta, Riverside County. FOR VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Lance C. Gibson, a married man as his sole and separate property hereby GRANT(S) to Lance C. Gibson, a married man as his sole and separate property the following described real property in the city of -Ta QLdnta, . County of Riverside, State of California: Lots 6 and 7 of Block 283 of MS 020/050 of Santa Carmelita at Vale La Quinta #26, as per Maps on file with the County of Riverside. This deed reflects Parcel Merger No. 2003-431 as approved by the City of La Quinta- Dated: �� 2003 Lance C. Gibson STATE OF CALIFORNIA COUNTY OF 4, \>J.� This document was fiie(` tM .recording by On this q day of , 2003, before me, (TUff ) STEWART TITLE Of CAL&ORNIA, INC. the undersigned, a Notary Public in and for said INLAND EMPIRE DIVISION as an State, personally appeared LLtvtc'z. C-', (A ) 6s0- accommodation only. It has not been exanuneo as to its execution or as to its effect upon the title or its recordability ❑ personally know to me X proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this instrument, and acknowledged to me that PIL executed it. Signatur UzU1 LVJ-1 Notary Pw&ic In An F r Said State TERRY HERRING Commission # 1370360 z z Notary Public - Ca0fornia 3i Riverside County wn. Ejires Aug 1 (This area for Official Seal) n T» APP VED B -THE CITY OF LA QUINTA COMMUNITY DEVELOPMENT DEPARTMENT Oq NOVEMBER 5, 2003. scut 7J arrtrmr