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04-4824 (SFD)D '��I�II AUS a- 1 200 ►' 'w • 4Q" 4 CITY OF LA 9.14 � I tYl'AIANC:t u'rz". BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUIN,TA, CALIFORNIA` 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number. 04-00004824 Date 8/05/04 Property Address,°. ' 52465 VIA DONA APN: 772-480-007- - - Application description . . . DWELLING - SINGLE FAMILY DETACHED Property Zoning . . . . . . . LOW DENSITY RESIDENT=AL Application valuation . . . . 448787 Owner Contractor DUANE JENSON OWNER 8842 HIGHFIELD RD. PARK CITY UT-. PARK CITY UT 84068 ------ Structure Information 4982 SQ. FT. SFD ----- 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 4.00 FIRE SPRINKLERS NO GARAGE SQ FTG 1283.00 PATIO SQ FTG 1586.00 NUMBER OF UNITS 1.00 FIRST FLOOR SQ FTG 4982.00 ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 1861.00 Plan Check F=e 1209.65 Issue Date . . . . Valuation . . . . 448787 Qty Unit Charge Per Extension BASE FEE 639.50 349.00 3.5000 THOU BLDG 100,001-500,000 1221.50 ---------------------------------------------------------------------------- Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 230.03 Plan Check Fee 57.51 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 4982.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 174.37 1283.00: .0200 ELEC GARAGE OR NON-RESIDENTIAL 25.66 ,e P.O. Box 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: K e - Applicant: 1-)llAn1/;_�: S- J­r7_� Applicant's Mailing Addre s: SIL(- 4,0&,5 61T�9� y Date: Ariter oginee5y/A1�L,'0r7) - Lic. NO.: C 8 3 9z BUILDING PERMIT DECLARATIONS 2223 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 1 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 civif penalty of not more than five hundred dollars ($500).): U 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 U I am exempt under Sec. B.& .C. for this reason Date - Owner W RKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the follow6ntto cl rations: _ I have and will maintain a certificate of cons elf -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 oft 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 Californ' : an agree that, if I should b o e subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those p wsion Date Applica WARNING: FAILURE TO SECURE WORKERS' COMPENSAT COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLA ( 00,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AN A ORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lendingagency 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 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 tonc Ilanon. I certify that I have read this application and state that the abo nfornlationis correct. I agree to ply with all city and county. ordinances and state laws relating to building construction, and hereby authorize representatives of this cou t to enller up on the above-rg*ntig d property for inspection purposes. Date Signature (Applicant or Agent): Page 2 Application Number 04-00004824 Date 8/05/04 Qty Unit Charge Per Extension 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 ---------------------------------------------------------------------------- Permit GRADING PERMIT Additional desc . . Permit Fee 15.00 Plan Check F`ee .00 Issue Date Valuation 0 Qty Unit Charge Per Extension =---------------------------------------------------------------------------- BASE FEE 15.00 Permit . . . . . . MECHANICAL Additional desc . Permit Fee 139.00 Plan Check Fee 34.75 Issue Date Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 9.0000 EA MECH FURNACE <=100K 36.00 4.00 9.0000 EA MECH B/C <=3HP/100K BTU 36.00 - 7.00 - 6-.5000 EA MECH VENT FAN - - - - - 45.50- .1.00 6.5000 EA MECH EXHAUST HOOD 6.50 ------------------- Permit ------- ----------- PLUMBING ---------------------------- ----------- Additional desc . Permit Fee 252.75 Plan Check Fee 63.19 Issue Date . . . . Valuation 0 Qty Unit .Charge Per Extension BASE FEE 15.00 26'.00 6.0000 EA PLB FIXTURE 156.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 6.0000 EA PLB ROOF DRAIN 6.00 2.00 7.5000 EA PLB WATER HEATER/VENT 15.00 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 9.00 .7500 ,EA PLB GAS PIPE >=5 6.75 1.00 ------------------------7--------------------------------------------------- 15.0000 EA PLB GAS METER 15.00 Special Notes and Comments - NEW 4982 SQ. FT. SFD. THIS -PERMIT DOES - -- l Page 3 Application Number 04-00004824 Date 8/05/04 ------------------------7--------------------------------------------------- Special Notes and Comments NOT INCLUDE POOLS & SPA, BLOCK WALLS AND DRIVEWAY APPROACH.PERMIT WAS ADJUSTED TO SHOW'$500 PLAN CHECK DEP. ---------------------------------------7------------------------------------ Other Fees . . . . . . . ART IN PUBLIC PLACES -RES 621.96 DIF COMMUNITY CENTERS -RES 97.00. DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 120:97 DIF FIRE PROTECTION=RES 97.00 GRADING PLAN CHECK FEE 00 DIF LIBRARIES - RES 225.00 DIF PARK MAINT FAC - RES 5.•00 DIF PARKS/REC - RES 502.00 STRONG MOTION (SMI) - RES 44.87 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Paid Credited Due ----------------- Perm t _Fee_Total__.._____ ---------- 24:97.,78.. ------------------------------ -. 0.0:=.__-._.__..__:.. ..0�). —_-2492..78 _. _ ..._. Plan Check Total 1365.10 500.00 .01) 865.10 Other Fee Total 3192.80 .00 .01) 3192.80 Grand Total 7055.68 500.00 .01) 6555.68 Total Permit Fees s'# City of La Quin -.a Building at Safety Division Permit # P.O. Box 15041, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and T-acking Sheet Jf Project Address: - 5 r's Name: A. P. Number. TAddress: ?' deloLeeal Description: X-07- l0�[v 0T. Zip:Contractor: nOct v� -C- tT rL)S�one: 7 - 3 g x Address: - S Q / kk e✓ Q 0 SJ Project Description: ]� City? ST. Zip: X Telephone: State Lic. it - Citv Lic. : Arch.. Engr., Designer: G Address: City. ST. Zip: Telephone:- _ Construction Type: Occupancy: State Lic. #: Project" (circle one): New Add'n Alter Repair Demo X Name of Contact Person: Sq. Ft.: # Stories: is # Units: Telephone # of Contact Person: ��� 3 �� stimated Value of Proiect: 3 APPLICANT: DO NOT WRITE BELOW THIS LINE Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Structural Cales. Amount Reviewed. ready for corrections Plan Check Deposit Truss Calcs Called Contact Person Plan Check Balance Energy Cales. Plans picked up Construction Flood plain plata Plans resubmitted hfeckanical Grading plan 2' Review, ready for correctionslissuc Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up SA1.L H.O.A. Approval Plans resubmitted Grad ng IN HOUSE:- a"' Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.PP. Pub. Wks. Appr Date of permit issue School Fee::s Total Permit Fees Ull I. Y Ur LH UUIIV 1 H �U13-1.U1V 1 MALA 1 UK L10 1 oft JOB ADDRESS .S �- �i'6 � 11i,4 DOW 4- PERMIT NUMBER Cpl - V YiY OWNER --!Q vANE. BUILDER o w�� ✓�.+'/"�� This form shall be posted on the job with the Building Inspection Card at all times in a corigbicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance 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/ 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 businesslicense 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 including 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 Adminstration). For more specific information about your obligations under Stare 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 contractors 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 06-0�777-7012 FAX 760) 777-7011 OWNER'S SIGNATURE/DATE ,201 PROPERTY A699 SS PERMIT NUMBER(s) WEDDLE SURVEYING MAPPING, INC. Boundary • Construction • Topographic • Aerial Surveys • ALTA Surveys • GPS • Consulting October 15, 2004 Mr. Timothy R. Jonasson Public Works Director / City Engineer City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253-1504 Re: Pad/Form Grade Verification City of La Quinta Lot 123 Tract No. 29894-2 Amended THE HIDEAWAY APN 772-480-029 Dear Mr. Jonasson: 0 Flo S 44 km We have performed a field survey to determine the vertical location of the building pad and form for the above referenced project. The elevation's observed are as follows: PAD (DESIGN) PAD (AS -BUILT) 1008.2 1008.3 FORM (DESIGN) FORM (AS -BUILT) 1008.70 1008.80 These field observations are in substantial conformance with the precise grading plan prepared by ESSI SHAHANDEH, CIVIL ENGINEER, dated 10/14/04, approved by the City of La Quinta Building & Safety Department 10/14/2004 and the building horizontal location substantially conforms to the required setbacks and site layout as shown on the approved site plan. Sincerely, �p \�qND ,& WEDDLE SURVEYING MAPPING, INC. O NO. 6570 m EXP. 09/30/05 David L. Weddle, President L.S. 5570, Exp 9/30/05 �oFCA��F� P.O. Box 10418 • Palm Desert, CA 92255-0418 73-960 Hwy. 111, Ste. 6 • Palm Desert, CA 92260 • 760.346.3748 E -Mail: WedSury@aol.com • Fax 760.346.3749 BOX 1504 Builin20 78 4 5 CALO APPLICATION ONLY Adddresg SZ'4e'o5 ' (J� A" ���� I L.4 pulfl ' LA OUINTA, CALIFORNIA 92253 AOt 9-CKN.16N BUILDING: TYPE CONST. OCC. GRP. Mailing ­7 -7 2 (� t/� — o o-7 Address 884 Z /��4iEFie�A t2D. A.P. Number 9 City ()A-0Zk cry Zip Tel. Legal Description LDT �2 3 Z 8 o17 2SJ_1186 S� N V Q �� ( Li Contractor Project Description I 6wLye a_ ttr,,l�rn City State Lic. City & Classif. Lic. # Arch., Engr., Designer S N C, I L o 1J Address Tel. 90Sq 5-5 02 City Zip ,State Lic. # LICENSED CONTRACTOR'S DECLARATION ereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70 of Division 3 of the Business and Professions Code, and my license is in full force and OWNER -BUILDER DECLARATION I hereb ffirm that I am exempt from the Contractor's License Law for the fo owing reason: (Sec. 031.5, Business and Professions Code: Any city or county which r ulres a permit to constr t, alter, improve, demolish, or repair any structure, prior to its is ante also requires the appli nt for such permit to file a signed statement that he is license pursuant to the provisions of th Contractor's License Law, Chapter 9 (commencing with S ction 7000) of Division 3 of the Busr ss and Professions Code, or that he is exempt therelr ,and the basis for the alleged exemph n. Any violation of Section 7031.5 by any applicant f a permit subjects the applicant to a civil p alty of not more than five hundred dollars ($50 . ❑ I, as owner of the prop y, or my employees with wages as their so compensation, will do the work, and the structure not intended or offered for sale. (Sec. 7 44, Business and Profes- sions Code: The Contractor License Law does not apply to an o ner of property who builds or improves thereon and who oes such work himself or through is own employees, provided that such improvements are n t intended or offered for sale. ,however, the building or im- provement is sold within one ar of completion, the own -builder will have the burden of proving that he did not build or i rove for the purpose of ale). ❑ 1, as owner of the property, am clusively 'ontractin th licensed contractors to construct the project. (Sec. 7044, Business Od Professions Co e: The Contractor's License Law does not apply to an owner of property whip builds or imp ves thereon, and who contracts for such projects with a contractor(s) license ursuant to a Contractor's License Law.) ❑ I am exempt under Sec. B. & PC. for this reason Date Owner X /WORKERS'COMPENSATION ORKER'S MP SATION DECLARATION herebt I have a c Tcate of onsent to self -insure, or a certificate of Worker's Compensatce, or a c ified copy t ereof. (Sec. 3800, Labor Code.) Policy No.ompany ❑ Copith th ity. ❑ Certified co is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This sectiof be completed it the permit is (br one hundred dollars ($100) valuation or less).certife performance of the work for w ich this permit is issued, I shall not employ anyany manner so as to become suble6t to Workers' Compensation Laws of California. Date Owner NOTIC TO APPLICANT If, after making this Certificate of Exemption you should become subj t to the Workers' Compensation provisions of the Labor Code, you must forthwith co /y with such provisions or this permit shall be deemed re Joked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for tha performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validaNd, and is subject to expiration if work thereunder is suspended for 180 days. 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 city to enter the above -mentioned property for inspection purposes. Signature of applicant Date_ Mailing Address City, State, Zip Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS AMOUNT ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: I I Validation: WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE Coachella Valley Unified School District P.O. Box 847, Thermal, CA 92274 (760) 398-5909 — Fax (760) 398-1224 Project Name: Owner's Name: Project Address: This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT LEVEL ONE AMOUNT LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMMIIND. AMOUNT- DATF RFCFIPT- CHFCKN INITIALS CERTIFICATE OF COMPLIANCE (California Education Code 17620) Residence is at the Hideway Duane Jenson 52-465 Via Dona La Quinta, CA 1 SFDs APN: 772-480-007 Type of Development: Residential Tract Rq Commercial Total Square Feet of Building Are 4,982 sq. ft. Date Phone No. Lot #'s: August 10, 2004 Industrial 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�pn behalf of the owner/developer. Dated: August 10, 2004 Signature: *********************************************************************** 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 Note: Number of Sq.Ft. Amount per Sq.Ft. 4,982 $ 2.68 Amount Collected $13,351.76 Building Permit Application Completed: Yes/No By: Carey M. Carlson, Asst. Supt., Business Services Certificate issued by: Elvira Mattson, Office Technician Signature: Afo-loozo, Ll I 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. MV:c/mydocs/devfees/certificate of compliance form tables.doc 1/16/03 T Tiht " Building & Safety Department 78-495 Calle Tampico PO Box 1504 La Quinta, CA 92253 (760) 777-7012 voice — (760) 777-7011 fax CERTIFICATION OF BUILDING AREA STREET ADDRESS OF JOB: 52-465 VIA DONA APN: 772-480-007 DESCRIPTION OF WORK: SINGLE FAMILY RES. SQUARE FOOTAGE: 4982 SF OWNER'S NAME: DUANE JENSON CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR C DATE�L=-�-- BY Coachella Valley Unified School District 83-733 Avenue 55 P0Box 847 Thermal, CA 92274 (760) 398 5909 SCHOOL FACILITY FEES COLLECTION HOURS: 8.00 A. M. - 4.00 P. M. Monday - Friday PLEASE NOTE: FEES MUST BE PAID IN CHECK OR CASHIERS CHECK. NO CASH. For questions regarding this letter, please call: Ed Randall, Counter Technician (760) 777-7012 05/24/04 09:29 FAX 801 262 6262 JENSON SERVICES Z001 GARY L. ORSO ASSESSOR -COUNTY CLERK -RECORDER RIVERSIDE COUNTY COUNTY ADMINISTRATIVE CENTER 4080 Lemon Street Post Office Box 12004 Riverside, CA 92502-2204 Telephone (909) 955-6200 051907953-5 Date Notice Mailed: 01-01-2004 Supplcrnental Aesecstnent ##: 051907953-5 JENSON, DUANE Assessment j#. 772480029-3-1-12..00- JENSON, TERESA Street Address or Legal Description, 8842 HIGHFIELD RD SEE ASSESSORS MAP PARR CITY UT 84098 ... 1�TIC1r OF,.SUPP1,hMENTAI�ASSES.SM NT Qne_ or more_ Suppl_emental__Assessments have b'= (enrolled for the property identified above. The calculation' of the r amount is shown in Section 1 below- The supplemental assessment is caused by one of the following events as indicated: New Full Taxable Value Fx]ChOwne,shi, angein Recorder's 314,300 Date 02-07-2003 No. 91712 TOTAL 314,300 Land Structures Value of New'Construction F1New Construction . Complom Date TOTAL Land Structures The supplemental assessment is made in accordance: with Article XIIIA of the California Constitution that requires reappraisal of property upon change in ownership or completion of new construction. Important information conceming the Supplemental Assessment exemption, and your right to file an Application for Value Change is located on the back. If the Supplemental Assessment is a negative amount, the Auditor may make a refund of a portion of taxes paid on assessments made on the current roll, or the roll being prepared, or both - The amount of Supplemental Assessment is the dii3.'crence between the New Full Value and the sum of 1) the Full Taxable Value on the Roll and 2) the total or Prior Supplemental Assessment(3) which have occured during the same assessment year--- __ A special property tax bill, or refund, based on the:unounts of the Supplemental Assessments noted below, will be mailed to the name and address noted at the top of this form. Please read the rcrerse side for other important supplemental assessment information and for information about your right to file an appeal on the later "regular' assessment which will be bawl on the "New Full Taxable Value" shown on this form. 1. CalcWation of Supplemcnt t Assessment(s) NEW FULL TAXABLE VALUE Less: Full Taxable Value on Roll Less: Amount of Prior Supplemental(s) AMT. OF SUPPLEMENTAL ASSESSMENT 2- Exemption: Current Roll Roll Being Prepared PROPERTY IN First Supplemental Assessment Fiscal Year 2002-2003 314,300 40,155 274,145 Amount Second Supplemental Assesmnent Fiscal Year 2003-2004 VALUE 314,300 40,958 273,342 ASR-739-20 (REV 03/99) (3-LEASE SEE RU RSE SIDE) 9000162 05/24/04 09:29 FAX 801 262 6262 JENSON SERVICES Z 002 GARY L. ORSO RIVERSIDE ASSESSOR -COUNTY CLERK -RECORDER COUNTY ADMINISTRATIVE CENTER P_O- BOX 12NM 4080 LEMON STREET RIVERSIDE, CA 92502-2204 Telephone: (909) 955-6200 Website- www.riverside.asrclkreC.COM wove. INFORMATION ABOUT SUPPLEMENTAL ASSESSMENTS Proposition 13 requires County Assessors to reappraise property whenever the property changes ownership, or whenever new construction occurs. Until legislation in 1983, the new value did not appear on the regular property tax bill until 4 to 16 months later. Supplemental assessments immediately enroll the new value to the tax Roll for the year in which the appraisal was made - Since July 1, 1983, most changes in the ownership of real property and completion of new construction will have resulted in supplemental tax bills. . RR Effective on September 10,1984, if subsequent changes in ownership occur before a supplemental tax bill has been issued on a prior supplemental assessment on the same property, taxes will be prorated between the individual owners involved, based on the actual period of ownership. This may apply if there is a value appearing in the box labeled "Less: Amount of Prior Supplemental(s)" which is In Section 1 on the enclosed Notice of Supplemental Assessment. On the enclosed Notice of Supplemental Assessment, it ifre "AMOUNT OF SUPPLEMENTAL ASSESSMENT" is equal to zero (0), no additional taxes will result from this action. However, if therg is a value in the box labeled�1L Amount of Prior _ Supplemental(s)" thn you may be liable for a pro -rated portion of the taxes based on prior lain This would be in compliance with Revenue and Taxation Code Secti?n 75.54(c)> as explained in the preceding paragraph. NOTE: SUPPLEMENTAL TAX BILLS MAY BE SENT OUT CORRESPONDING NOTICES. SUPPLEMENTAL TAX BILLS ARE IN ADDITION 1'0 T14E TAXES DUE ON THE PROPERTY. Automated Telenhone Response System and Internet Accessibility A 24 hour automated, toll free information line is available for Riversid, 10 digit assessment numbers. To reach this number in the MetropoM outside the metropolitan area but within either the 909 in 760 area rod or to contact us through the Intemet at www.Riverside)L%sessor.00m Office L Cations Telephone Numbers and Hours: BLYTHE 270 N. Broadway Blythe. CA 92225-1608 (760) 921-7888 Wednesday Only 9AM-12PM&1 PM-4PM INDIO 82676 Highway 111. #113 Indio, CA 92201-5994 (760) 863.7800 Monday through Friday 9AM-12 PM & 1 PM-4PM ACR 129P-AS2SU0 (Rev- 02MO03) ONE MONTH OF THE DATES SHOWN ON THE PROPERTY TAX BILL AND ANY OTHER PROPERTY County residents with touch tone telephones and their Riverside area, dial (909) 955-6200. County residents may dial 1(800) 746-1544- Those wishing information RIVERSIDE 40M Leman Street. 10 F HEMET aor 000 North State Street Riverside, CA 92501 Hemet, CA 92543-1496 909 T66-2500 Monday Monday through Friday through Friday 9AM-4PM 9AM-12PM&1 PM-4PM PALM SPRINGS 3255 E. Tahquilz Canyon CULA TT1E12 County Center Drive, #230 Way Palm Springs, CA 1122 -6962 Temecula, 2591-6027 (760) 77&-2400 ( ) 00-6200 Monday through Friday 9AM-1'2PM&1PM Monday through Friday 4PM 9AM-12PM&1 PM-4PM 05/24/04 09:30 FAX 801 262 6262 JENSON SERVICES 16003 VXEMPTIONS: Homeowners' and Veteran: Any owner claiming to be eligible for a Homeowners', Veteran, or Disabled Veteran exemption must file a claim on or before the 30th calendar day following the date of rnaiiing of the notice as shown on the reverse side of this form. If there is already an exemption on the roll for this property (see over), your claim for exemptiou will be applicable to the neat regular roll. If no exemption or an exemption amount less thy, exemption amount to which you may be entitled exists on the current roll you may be eligible for an exemption on the Supplemental Assessment. If you have not received a claim form, or if you have any questions regarding exemptions, contact one of the Assessor's offices listed below or call Exemptions in Riverside at (909) 955-6200. All other exemptions: Any organization(s) claiming to be eligible for a IA'elfarc, Religious or Church exemption must file a claim on or before the 30th talender day following the date of wailing of the notice as shown on the reverse side of this form. If you have any questions regarding Welfare, Religious or Church exemptions, call our Exemptions section in Riverside at (909) 955.6200. ASSESSMENT APPEALS: If you do not agree with the New Full Taxable Value or the Value of New Construction of the property as indicated on the reverse side of this form, please discuss the value with the ,Assessor's appraisal staff at the Assessor's office nearest to your property. Application for Changed Assessment not agreed upon. with the Assessor must be filed with the Clerk of the Assessment Appeals Board, County Administrative, Center, 4080 Lemon Street - 14th Floor, Post Office Box 1147, Riverside CA 92502-1147 within 60 Wender days from the date of mailing of this notice as shown on the reverse of this form. If an Application for Changed Assessment has been accepted by the Assessment Appeals Board and a value change has been agreed upon as proper between you and the Assessor, a written stipulation by both parties may be submitted to the Assessment Appeals Board per Section 1607 of the Revenue and Taxation Code. If, for any reason, you fail to file an appeal of the Supplemental Assessment within the 60 day period, you may still appeal the regular assessment for the coming tax year at any time between July 2 and September 15. The value determined shall be conclusively presumed to be the base -year value unless an application for equalization is filed during the regular equalization period for the year The assessment is placed on the roll or in any of the three succeeding years. Once an application is filed, the base -year value determined pursuant to that application, shall be conclusively presumed to be the base -year value for that assessment. REGULAR ASSESSMENT ROLL VALUES: The amount shown on the reverse of this form as the "New Full Taxable Value" for supplemental assessment will be: adjusted by the appropriate inflation factor, not to exceed 2% per year, to determine the property's value for the next "regular" assessment roll. - The ±Axab?e.vak>P -ZxeaLpmpwtLc z11 btthelessm.of_iis base-yea=-value-cosngound apnuall�since tide base yW b�. an inflation factor net to exceed 2% per year or its full crash value, as of lien date, taking into account reductions in, value because of damage, destruction, depreciation, obsolescence, removal of property or other factors causing a decline in value. A copy of the roll shall be made available for inspection by all interested parties during regular office hours - Office Locations, Telephone Numbers and Hours_ BLYTHE RIVERSIIDE HEMET 270 N. Broadway 4080 Lemon Street, 1st Floor 880 North Statc Street Blythe, CA 92225-1608 Riverside, CA 92501 Hemet, CA 92543-1496 (760) 921-7888 (909) 955-6200 (909) 766-2500 Wednesday Monday through Friday Monday through Friday 9AM-12PM&IPM'-4PM 9AM-4PM 9AM-12PM&1PM-4PM INDIO 82675 Hwy 111, #113 Indio, CA 92201-5994 (760) 863-7800 Monday through Friday 9AM-12PM&1PM-4PM PALM SPRINGS 3255 E. Tahquitz Canyon Way Palm Sprb-tp, CA 92262-6962 (760) 778-2400 Monday tltrough Friday 9AM-12PM&1PM-4PM TEMECULA 41002 County Center Drive, #230 Temecula, CA 92591-6027 (909)600-6200 Monday through Friday 9 AM - 12 PM & ], PM - 4 PM nsR-r39-20 (REY 03"9) www.co-riverside.ra.us/depts/3= Permit # Project Address: A_ P. Number: Legal Description: Contractor: a ro -E Address: !�2-77-i—K City, ST, Zip: �/� Telephone: State Lic. # Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Telephone # of Contact Person # Submittal Req'd Plan Sets Structural Calcs. Truss Calcs. Title 24 Calcs. Flood plain plan Grading plan Subcontactor List Grant Deed H.O.A. Approval IN IIOUSE:- Planning Approval Pub. Wks. Appr School Fees Vl �9 City of La Quinta Building U Safety Division P.O. Box 1504, 78-49S Calle Tampico La Quinta, CA 922S3 - (760) 777-7012 Building Permit APPlication and Tracking Sheet OQ N Owner's Name: �-S 'Address: City, ST, Zip: 5• Jp��(1� (`� /� Telephone: W��%%/ � r/R lid S� Project Description: u f.L Lic. #: :,!q-u e, (I R vq- - Construction T e. } P c O cu P an c• Project type (circle one): New Add'n Alter Repair Demo N (/7 S+ Ft.: # Stories: # Units: 1- 3 b {S Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE Rec'd TRACKING PERMIT FEES Plan Check submitted Item Amount Reviewed, ready for corrections flan Check Deposit Called Contact Person Plan Check Balance Plans picked up Construction Plans resubmitted •echanicat 2"' Review) ready for correcti srssue Electrical Called Contact Person Plumbing Plans picked up S.M.I. Plans resubmitted Grading 'rd Review, ready for corrections/issue Developer Impact Fee Called Contact Perso A.I.P.P. Date of per issue 7/� 05 �� © Cn���i � Total Permit Fees P 7 5��