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05-2281 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: C005--00002281- 81030 LEGENDS WY 762-300-009- - - ADDITION - RESIDENTIAL LOW DENSITY RESIDENTIAL 22786 T4ht 4 4 Q" Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 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 she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by Y licant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$500).: 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure isnot 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 I hereby affirm under penalty of perjury that theta a con work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPER111IT :NDING AGENCY lending agency for the performance of the Owner: DAVIS JERRY D 81-030 LEGENDS WAY LA QUINTA, CA 92253 Other struct info . Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/17/05 DITION 2001 CBC Lic. No.: --------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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 NO Policy Number E FOOTAGE 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 to become subject to the workers' compensation laws of California, and agree that, if I sho d b omesubject to the wor s' compensation provisions of Section 700 of the Labor C e, I s all forthwith comply Wk t se provisions. . Date: rApplican�-t WARNING: FAILURE TO SECURE W R RS' CO ENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI 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 buildi onstruction, and hereby authorize represe a i s of this ccoouunnty do;e/!n_ter upon the above-mentioned prope , for i spection purposes. Ogte: ( f// Sig -nature a (Applicant or Agentl: r ] LQPERMIT Application Number . . . . . 05-00002281 Permit . . . BUILDING PERMIT Additional desc . Permit Fee 234.00 Plan Check Fee 152.10 Issue Date Valuation . . . . 22786 Expiration Date 2/13/06 Qty 'Unit Charge Per Extension BASE FEE 45.00 21.00 9.0000 THOU BLDG 2,001-25,0.00 -----------------------------------=---------------------------------------- 189.00 } Permit . . . ELECT - ADD/ALT/REM. �. Additional desc . - Permit Fee . . . . 24.87 Plan Check Fee 6.22 Issue Date . . . . Valuation . . . . 0 Expiration Date 2/13/06 t6 Qty Unit Charge Per Extension BASE FEE 15.00 282.'00 .0350 ELEC NEW RES - 1 OR 2 ---------------------------------------------------------------------------- FAMILY 9.87 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation 0 Expiration Date 2/13/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH APPL REP/ALT/ADD 9.00 ---------------------------------------------------------------------------- Special Notes and Comments addition to existiong casita 282 sq. ft. August 17, 2005 9:29:12 AM jjohnson' -------------------------------------------------------------=-------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE .15.21 STRONG MOTION (SMI) - RES 2.27 Fee summary _Charged Paid Credited --------------------------------------------------------- Due Permit Fee Total 282-.87 .00 .00 282.87. Plan Check Total 164.32 .00 .00 164.32 Other Fee Total 17.48 .00 .00 17.48 Grand Total 464.67 .00 .00 464.67 LQPERMIT OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer and you are subject to several obligations include State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contracts are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors ^may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 FAX: 0) 777-7011 6�' ER'S S NATURE/DATE �j PROPERTY ADDRESS PERMIT NUMBER(S) lN..._ 2N7�"C,4r' �fl �UeST %�tiUe' /���/t/gr'� I D `% City of b Quinta- Building-TI-.", 8( Safety Division Pennit it r P.O. Box 1504, 76-495 Calle Tampico / Z� I D� La Quints, CA 92253 - (760) 777-7012 Building Permit APPlication and P Track►ng Sheet Project Address: �� /�� �/ zQC�,O 7 PS er's Name: '/ 1D�v` r A. P. Number: 2 .. 3u) -_U� Address: / G Legal Description: City, ST, Zip: L Contractor: Q Telephone: Address: Project Description: City, ST, Zip: Telephone: G � . S � l �O State Lic. # : City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: • Con st rU Ctl OR T•Pe . . Occupa t.• nc Stato Lic. #- - Name of Contact Person:- e Project ct type (circle c ne )- New Add'n Alter Repair Demo . / Telephone # of Contact Person: (� �(� 7 �L� Sq. Ft.: # Stories: # Units: Estimated 3OP Value of Project: ft APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Rerl'd Rec'd TRACKING' Plan Sets Plan Check submitted l c /0� PERit11T I`EES Item Structural Calcs. Reviewed, read}, r corrections // Zg16S Plan Check Deposit Amount 2 Truss'Calcs. Title 2'4 Calcs. Called Contact Perso l Plan Check Balance Plans picked up Flood plain plan Plans resubmitted Construction Grading plan 2"' Review, Mechanical ready for correction issue 'Electrical Subcontactor List Called Contact Person Grant Deed Plans picked up Plumbing S.l•LI. - H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ,,� Review,'read% for corrections/issue Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue v� A.I.P.P. School Fees Total Permit Fees Q 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 APEA: AMOUNT LEVEL ONE AMOUNT: LEVELTWOAMOUNT: MITIGATION AMOUNT: COMM/MD. AMOUNT: nATF: RFCFIPT- r1HFrX U• INITIAIS- CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: Residence is in PGA Date: August 17, 2005 Owner's Name: Jerry Davis Phone No. Project Address: 81-030 Legends Way La Quinta, CA Project Description: Addition to residence APN: 762-300-009 Tract #: Lot #'s: Type of Development: Residential I X! Commercial Industrial Total Square Feet of Building Area: 270 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: August 16, 2005 Signature: 114e— d 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 t Number of Sq.Ft. 270 Amount per Sq.Ft. $ 0.00 Amount Collected $ 0.00 Building Permit Application Completed: Yes/No By: Carey M. Carlson, Asst. Supt., Business Services Agreement Existing Not Subject to Fee Prior to 1/1/87 Requirement Note: Any addition that is 500 sq. ft. or less is exempt from; Developer Fees f-�� Certificate issued by: Elvira Mattson, Office Technician Signature: &,Iz� 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 -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. h1V:crmydocs;devtcesleertiiic•atc ot'compliance firm uthlecl"t:? 1.)sI>.doe 1/16/03 T