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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. s "E a Piz S A.A IftE t l :.! 1 W E 1-1V7 E ' '1 ST S i C 7a S' F- vvi T c n. s - Utz - ZTZ <p L S I r 4 tv � 4 `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