08-1180 (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:
C!wW e__2&, -z_
08-00001180
81155 LEGENDS WY
762-310-008- - -
ADDITION - RESIDENTIAL
LOW DENSITY RESIDENTIAL
90000
T4tyl 4 4 Q"
Architect or Engineer:
/-OR,ey 1-4*1P_
'*- 3 5 749
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.
icense Class: 74860055 License
No.: B
Date -f -2'9-Q Dp✓Contractor. n J h/ 1 l p / /1 DyAJ1A_,)
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
fallowing 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 _ 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. , BAP.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:
LQPERIR 11T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/25/08
Owner:
DAMERON JAMES L
P O BOX 1255
EASTBOUND, WA 98245
01
T/
G
Contractor:
LANG CONSTRUCTION 0 r2
80590 CAMINO SAN GREGE
BERMUDA DUNES, CA 92203
(760) 834-9020 �9G
L i c . No.: B
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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 1889409
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
37700 of Labor Code, I shall forthwith comply with those provisions.
Date -29-0 V Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVE GE 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.
1 certify that I have read this application and state that the above information is correct. 1 agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
oIlhis county too enteer Upon the above-mentioned property forinspectionpurposes. A
/Datee- (-b&. Signature (Applicant or Agent): ,IJ' D 4 1f �� p x � i
Application Number . . . . . 08-00001180
------ Structure Information 569 SF ADDITION
-----
Other struct info . .
. . . CODE EDITION
2007
# BEDROOMS
.00
FLOOD ZONE
NO
----------------------------------------------------------------------------
1ST FLOOR SQUARE FOOTAGE•
569.00
Permit . . .
BUILDING PERMIT
Additional desc . .
569 SF ADDITION
Permit Fee . . . .
594.50 Plan Check Fee
386.43
Issue Date . . . .
Valuation
90000
Expiration Date
2/21/09
Qty Unit Charge
Per
Extension
BASE FEE
414.50
40.00 4.5000
----------------------------------------------------------------------------
THOU BLDG 50,001-100,000
180.00
Permit . . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
37.65 Plan Check Fee
9.41
Issue Date
Valuation . .
. . 0
Expiration Date
2/21/09
Qty Unit Charge
Per
Extension
BASE FEE
15.00
20.00 .7500
PER ELEC DEVICE/FIXTURE 1ST 20
15.00
17.00 .4500
----------------------------------------------------------------------------
EA ELEC DEVICE/FIXTURE >20
7.65
Permit . . .
MECHANICAL
Additional desc .
Permit Fee
19.50 Plan Check Fee
4.88
Issue•Date . . . .
Valuation . .
. . 0
Expiration Date . .
2/21/09
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 4.5000.EA
----------------------------------------------------------------------------
MECH VENT INST/ DUCT ALT
4.50
Permit
PLUMBING
Additional.desc .
Permit Fee . . . .
21.00 Plan Check Fee
5.25
Issue Date . . .
Valuation . .
. ... 0
Expiration Date
2/21/09
Qty Unit Charge
Per
Extension
LQPEMMIT - - -
w --
Application Number . . . . . 08-00001180
Permit . . . . . . PLUMBING
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 6.0000 EA PLB FIXTURE
----------------------------------------------------------------------------
6.00
Permit . . . . . GRADING PERMIT
Additional desc .
Permit Fee . . . . 15.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 2/21/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
--------------------------- -------------------------------------------------
Special Notes and Comments
569 SF RESIDENTIAL ADDITION (WET BAR,
DINING & OFFICE) TO EXISTING RESIDENCE.
TYPE V -N CONSTR. 2007 CODES
----------------------------------7-----------------------------------------
Other Fees . . . . . . . . . ENERGY REVIEW FEE
38.64
STRONG MOTION '(SMI)
- RES
9.00
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 687.65 .00
.00
687.65
Plan Check Total 405.97 .00
.00
405.97
Other Fee Total 47.64 .00
.00
'47.64
Grand Total 1141.26 .00
.00
1141.26
LQPERIMIT
et. " 1 rs-r / - #/_ - n v
Bin #
IdWi
City of La Quinta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Perm't
Project Address: gq/ 155 `e, n6 W4
Owner's Name:Ji.'
A. P. Number: 742-310-01.9-5
Legal Description: '�° r`S ^'1B Itc/607,
Contractor:
�r1lt ;per
Address: Pd. 450 /? 1 — Orc s Z.1 1.0,v
City, ST, Zip: E'A SGW4 Itfftd
f>:<»>::>::>:::<::<:<;><:::>:::>>::<.::<::<•:
Telephone: .................
Project Description: . J7<D M1 ANN qf
Address: -W o ;qp r! Or;o
City, ST, Zip: d D CA a -j
e �
Telephone(740)'"�`�'
Ot 77¢4
:: SY:i::::::i i::::::i^Sj:i:::',:`:?i•::.: ni::}::ii
• •• •
Q 0 & dioo rhe
State Lic. # :,8•• 03 6
City Lic. #: /p �]�
-
, ��
Arch., Engr., Designer: ry ��
a VA /n
Address: 9206-90 n or
City., ST, Zip: CA 922,13
Tel ePhon e 0T0 2- 7
XX -
Constru ction TY Pe: Occu anc s
Y P Y• F
State Lic. C -3
35"14-9
Project type (circle one): New Ad'n After Repair Demo
Name of Contact Person: kV kotnqSq.
Ft.: Sig I
# Stories:
# Units:
Telephone # of Contact Person: (, 0 7G aL - %
Estimated Value of Project: '# .7 0,QQp
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
PAS'd
TRACKING
PERMIT FEES
Plan Sets
,3
Plan Check submitted
Item
Amount
Structural Calcs.
a
Reviewed, ready fo corrections
% S
Plan Check Deposit
Truss Calcs.
Called Contact Person
%
Plan Check Balance
Title 24 Calcs.
a
Plans picked up
/ ZS
Construction
Flood plain plan
Plans resubmitted
0141
Mechanical
Grading plan
2". Review, ready for correction issue
Electrical
Subcontactor List
Called Contact Person
2
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3' Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
L77
Total Permit Fees
Z
ks/Mp NS �P.
4-05':Achella Valley Unified'School District
83-7, 33 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
Project Name:
Owner's Name:
Jim & Janice Dameran
Jim & Janice Dameron
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMM/IND. AMOUNT:
DATE:
RECEIPT:
CHECK #:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Address: 81-155 Legends Way, La Quinta, CA 92253
Project Description: Addition to Single Family Residence
APN: 762-310-019-5
Tract #:
Date: 08/29/08
Phone No.
Lot #'s: 15
(
Type of Development: Residential —IRR Commercial Industrial
Total Square Feet of Building Area: 569 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: 08/29/08
Signature:
***•ss**•**s*s**************s****s**ss***sss-***sss*************»*ss****
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
Number of Sq.Ft.
Amount per Sq.Ft.
569sq. ft.
$ 2.97
Amount Collected $ 1,689.93
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. 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 id 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.
r
LT:c/mydocs/devfees/certificate of compliance form tablesTO USGdoc 1/16/03 T
P.1
July 28, 12008
1
Jim & J nice Datmeron
81-155 Legends Way
La Quin ta, CA 92253
Rye. Architectural Application — 81-155 Legends Way — APPROVED
Dear Mr. d: Mrs. Dameron:
The Ar hitectural Committee reviewed your plans submitted for the Room .Addition.
I am phased to notify you that the Architectural Conunittec has approved your application
as submitted. After construction is completed,mase send your k.xhibir p
"C" Compliance
P
Review .'equest, to the Operations Manager, for final inspection.
1f you s could have any questions in regard to this correspondence please do not hesitate to
contact the Association at any time.
On Beha -oche PGA WEST,4 sadaton
AM );& rMl / T andscr fie CmrerNillee
�AA
By: )arn a Saldivar
PG, WE, Fairways, Operations Manager
For the. Architectural Committee
Cc: File
i
IIi
Post Off le Box 1690 • La Quinta, California 92247 • Pl one (760) 776-5100 • Fax (760) 776-5111
.. y � +J%s.....r . :. i.... � K'�.-^ '�- ..,� ., fit.- . .•�� � � _
SPECIAL INSPECTION REPORT
11WIMEK REGISTERED INSPECTOR'S DAILY REPORT
• / • • 1
Geo -Engineers.
BUILDING PERMIT NUMBER
PLAN FILE NUMBER
COVERING WORK PERFORMED
WHICH REQUIRED APPROVAL BY
THE SPECIAL INSPECTOR OF
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ GLUE. LAM. FABRICATION
❑ PRE -STRESSED CONCRETE ❑ REINFORCED GYPSUM ❑ POST -TENSIONED CONC.
❑ REINFORCED MASONRY ❑ PILE DRIVING U OTHER E
JOB ADDRESS
- ISS L C_ s a �.- o. aS
PROJECT NUMBER
DATE
20_Qf�
OWNER OR PROJECT. NAME
ARCHITECT
CONSTR. MATT. (TYPE GRADE, ETC.)
DESIGN STRENGTH
I SOURCE OR MFGR.
ENGINEER
�--P•Tzm l C
DESCRIBE MAT'L. (MIX DESIGN, RE -BAR GRADE & MFGR., WELDING, ETC.)
S c� 2 Z C.
GENERAL CONTRACTOR `
►.� _�'�r.1 S
CONTR. DOING REPORTED WORK
I
i
LA9-. RECEIVING & TESTING CONSTR., MAT'L. SAMPLES
ITEM
NO.
LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC.
INCLUDES INFORMATION ABOUT. AMOUNT OF MATERIAL PLACED OR WORK PERFORMED; NUMBER, TYPE & IDENT. NO'S OF TEST SAMPLES
TAKEN; STRUCT. CONNECTIONS, WELDS MADE, H.T. BOLTS TORQUED, CHECKED, ETC.
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`CONFORMS to JOB SPECIFICATION
❑ DOES NOT CONFORM to JOB SPECIFICATION
SIGNATURE OF REGIST ED INSPECTOR
❑ PROGRESS REPORT ONLY I -e4Ll,?` f 1 r` n'r-n
NAME OF REGISTERED
INSPECTOR (PRINT)
DATE
Form No. 2180 - Pioneer Printing (760) 353-5401
REGISTRATION NUMBER
LEA NUMBER