12-1000 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12_7�QQ0.0.1000
Property Address: 48.74.7 -=VISTA PALOMINO
APN: 649-540-017= - -
Application description: ADDITION RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL'
Application valuation: 30542
Applicant: Architect or Engineer:
aF�lwG2�w
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (160) 777-7011
INSPECTIONS (760) 777-7153
)3/12
Owner:
HAY BILL R
48-747 VISTA PALOMI
LA QUINTA, CA 92253
Contractor:
Owner
- - LICENSED CONTRACTOR'S DECLARATION _
- WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with -
I hereby affirm under penalty f rjury one of the following declarations: -
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. -
; _ I have and wil a' tain a certificate of consent to self -insure for workers' compensation, as provided
License Class: ' - License No.: -
_ for Se io 700 of the Labor Code, for the p fo ance of the work for which this permit is
for
..
iss ed, .. ..
Date: Contractor:
_ I hav a aintain workers' compensation ' surancF, as required by Section 3700 of the Labor
• - - - _
performance of the work for ich this/permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
ran arrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the.
Carrier - Policy mber j
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
1 rT in the performance of,the w for w -Eh this permit is issued, I shall not employ any
construct, alter, improve; demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to beco subject o the workers'.compensation laws of California,
' permit to file a signed statement that he or she is licensed puisuant to the provisions of the Contractor's State
and agree that, if I should become ub-ect he workers' compensation provisions,of Section
License Law (Chapter 9 (commencing with Section 7000) of Division of the Business and Professions Code) or
3700 of the Labor Code, I a amply with those provisions.
. that he or sheis 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).:.Dat/
icant:
(_ I 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 -
WARNING: FAILURE TO SECURE WOR S' C N TION COVERAGE IS UNLAWFUL, AND SHALL
• Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENAL S NO IVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000)- IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED. FOR IN -
improvements are not intended or offered for sale. If, however, the building or improvement is sold•within -
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
- one year of completion, the owner -builder will have th burden of,proving that he or she did not build or
J improve for the purpose of sale.).
APPLICANT ACKNOWLEDGEMENT
1� I, as owner of the property; am exclusively contr ' g ' h licensed contractors to construct the project (Sec.
(14)'
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: Th ontr rs' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
_. property who builds or improves thereon, nd w tracts for the projects with a contractor(s) licensed
- 1 .. Each person upon whose behalf this application is made, each person at whose request and for
' .pursuant to the Contractors' State Licen Law
1 whose benefit work is performed under or pursuant any permit issued as a result of this application,
1 _ ) I am exempt under Sec. , B.&P.0 for t ' ea n
the owner, and the applicant, each agrees to, and I defend, indemnify and hold harmless the City
-
of La Quinta, its officers, agents and employees fo y act or omission related to the work being
' /a �A. ' J�
performed under or following issuance of r i
Date: / / caner... -
2. Any permit issued as a result of tAaon s null and void if work is not commenced
within 180 days from date of isp , or cessation of work for 180 days will subject
C NST U N DING AGENCY
permit to cancellation.
I hereby.affirm under penalty of perjury that there is a o uction lending agency for the performance of the
I certify that I have read this application and si formation is correct. I agree to comply with allwork
for which this permit is issued (Sec. 3097, Civ.
city and county ordinances and state laws reluction, and hereby authorize representatives
Name:/1c
of [hi aunty to enter upon he above-mentioo s tion purposes.Lender's
ate: gnatura (Applicant or A '
Lender's Address: ri
LQPERMIT
Application Number
12-00001000
------ Structure Information
378SF ADDITION TO CASITA [ENGINEERED] -----
Other struct info
CODE EDITION 2010
# BEDROOMS
1.00
FLOOD ZONE NO
"
GARAGE SQ FTG
38.00
IST FLOOR SQUARE FOOTAGE
378.00
Permit
ELECT - ADD/ALT/REM
.Additional desc ..
Permit Fee . . .
28.23 Plan Check Fee .'
7.06
Issue Date
Valuation
0
Expiration Date..
6/01/13
Qty. Unit Charge
Per.
Extension -
BASE FEE
15.00
378.00 `> .0350
ELEC NEW RES - 1 OR 2 FAMILY
13.23 "
Permit
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
291.00-Plan'Check Fee'.
189.15
Issue Date
Valuation
30542
Expiration,Date
6/01/13
Qty Unit Charge
Per
Extension
BASE, FEE
252.00
6".0-0 6..5000
THOU BLDG 25,001-50,000 ..
39.00.
.Permit . . .
MECHANICAL
Additional desc
Permit Fee
44.00 Plan Check Fee :,
11.00
Issue Date
Valuation
0
Expiration Date
6/01/13 '
Qty Unit Charge
Per
Extension ;
BASE FEE
15.00,
1.00 9.0000
EA MECH FURNACE <=100K
9.00 .
1.00 4.5000
EA MECH VENT INST/ DUCT ALT
4.50
1.00 9.0000
EA MECH B/C <=3HP/100K BTU
9,.00
1.00 6.5000
EA. MECH VENT FAN
6.50
Permit. . .
PLUMBING
Additional desc .
Permit Fee
58.50 Plan Check Fee
14.63
LQPERMIT
Application Number . . . . 12-00001000
Permit PLUMBING
Issue Date Valuation
0
Expiration Date 6/01/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
5.00 .6`0000 EA PLB FIXTURE
30.00
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 3.0000 EA PLB GAS PIPE i-4 OUTLETS
3.00
-----Special Notes and Comments
378SF CRAFT ROOM ADDITION TO"EXISTING
CASITA BUILDING/VB/RES-3/CLASS-A-FR
_
[ENGINEERED] THIS PERMIT DOES NOT
INCLUDE ALTERATION TO THE EXISTING
CASITA. MINOR ADJUSTMENT 2012-657 FOR 10
PERCENT INCREASE IN THE .ALLOWED FLOOR
AREA. 2010.CALIFORNIA BUILDING CODES.
November 30, 2012 2:54:07 PM AORTEGA
-------------------_--------------------------------------------------
Other Fees BLDG STDS ADMIN (SB1473).
-
2.00
ENERGY REVIEW FEE
18.92
STRONG MOTION (SMI) ., RES
3.05
Fee summary'Changed Paid Credited,
Due
Permit Fee Total 421.73 .00 .00
421.73 "
Plan Check Total 221.84 .00, .00_
221.84
Other Fee Total 23.97 .00 .00
23.97
Grand•Total 667.54- .00 .00
667..54
LQPERMIT .. .. "
Bin
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'P�t #
Projecx,Addeess: g"
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e
Ciel of La (?uln
-BtI kft 81 Safety Divisiail
PA Box 1504,:78-495 Cane Tampfw
4 QuInta, CA 92253 -:(760) 777-7012
Building Permit Application* and Tracidng Sheet
- a ✓✓i 1/�
1 S Q. Owner`s Name . r 3
A P. Numbtr `c9
Aaaress: -`jCf 1 VIS U I o.�► '�
Legal Description:
City. ST. Zip: L-01, Ul✓ i O�..� Cis I 2
Conhwtgr. �,�j� �� i
JJ I=r
Telephone: @ Z -
Address:
Pmject Description:
City. n zip.a
J
Telephone
G I /1 l� l� ✓1
State Lia # : {Sty Lia #; C
Addresw 7 "1 Sr. i0
lle
City, ST. Zip:
Tclephoao ?�D . - Y7U
State Lia #:
Name of Con= Person.
Co�trudion 1�ga:. Ooa�aacy:
Pmjeot type (eardo ane): New Add'n Alter Regan• Demo
SW IL: # Stories: #Unity
Telephone # of Contact person:
Ewmatod Vahte of Project V-
0 Submittal Raga
q
APPLICANT: DO NOT WRITE SHAW THIS, UNE
Reed TRACKING PBRM[P.FSES
Plan Cheksabmltted• - Item r - Amount
sumd'aaal calcs.
Q .14.
a
Reviewed, ready for curtecdcus Plan CbakDgwit, .
1ft=CdcL
q 11
a
. Called Conger Person plan CheelcBalanee_
MaeU (ales.
a
Plans picked up Constmcdoff
2
Plans resubmitted •- . (D 10 �: M� - .
G=am plau
Z'! RWtw, ready r rnetio u sue +�^/ Electrical
SabwatactorList
CalledCoutactPerson toy - P6nbing
Grant Decd
Pians picked up
H.O.A. Approval
Plans resabmitbed Grading
Review; ready for tarrectio t Developer Impact Fee"
Called Cotrtaet Person
Pub. Wks. Appr •
Date of permit issut ,
School Fees
Total Permit Fees
sufmwnw
11M1j 'Pa0�vs8v SueiP6 tai 1raR�- 1 4,111ua.
a^ -Z — , 4 111 13
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
zIS
os o
47950 Dune Palms Road. ¢ BERMUDA DUNES r
_
Date 12/3/12 La Quetta,C/) RANCHO MIRAGE CA 92253 N INDIAN WELLS
PALM DESERT
No. 31492 (760) 771$515 LA OUINTA V
`� QINDIO y7
Owner' Bill & Kay Hays APN # 602-200-017
Address 48-747 Vista Palomino - Jurisdiction La Quinta
City La Qunita Zip 92253 Permit #
Tract # No. of Units _ 1'
Type Detached Guest House
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 48747 Vista Palomino 378 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
A Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
in the amount of $0.00 X' 378 S.F. or $0.00 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 Andrew Abarca Check No. 0.00
Bank Name/Recipient of Certificate Telephone 760-766-5088
Funding Residential
a
By Dr. Sharon P. McGehee
Superintendent
Fee collected /exempted by Espe Lara ' , Payment Recd $o.0o k
1��OverlUnder
Signature
NOTICE: Pursuant to Go mment Code Section 66020(d)(1), this Will serve to notify you that the 90 -day approval period in which you may protest the fees
or 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 without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy= Accounting