04-5408 (AR)BUILDING & SAFETY DEPARTMENT
;Box 1504. (760) 777-.7012
OF 78 49SaCALLEITAMPIC.0
FAX (760) 777-701T
LA QUINTA, CALIFORNIA 92253 INSPECTIONREQUESTS. (760).777.-71.53
BUILDING PERMIT
Application Number X0:4-00005408 Date.' 10/07/04
Property Address `80100
-VIA VALEROSA
APN: .772-250-999-1-0-` =30357
Application description ADDITION.- RESIDENTIAL
Property Zoning LOW DENSITY RESIDENTIAL
'Appl:ication..valuation 21507.
Owner�' Cgntractor s .
r«+ i•a
sF--- .----------- 'r ` : _ a ;
--------- .
1• :.,.=
TOLL'—:—`..CA--1 V TOLL BROS , INC
-C/O KEVIN D DUERMIT `'73121 ":FRED WARI'NG' DRIVE_, 4100
8901 E—114GUN AIN VIEW 20.0 PALM DESERT CA 9226:0
SCO'TT,SDALE' AZ '85258' .
WC.—IBERTY' MUTUAL:
_ WC':. . ':.WA762DO04.7230i4. '09./:01'/05 .
�.r,�•:;w: .:..:: ,. CSLBr777-699 04/30/06
-CCC::-B'
--=--- -Structure Information .376 SQ. FT. CASITA ADDITION -----
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 . 1.0.0..,
`FLOOD ZONE NO
., FIRST FLOOR SQ'FTG. 376.00
i
5 J
Pis
erm:t`, ..BUILDING:�PERMLT
:Addiati6na1---desc.:. _ ...._..._...._..__ -
Perm :t"' Fee . . .22.5.00. Plan'<Check.: Fee 146.25.
Lssie'.,Date ; Valuation 21507
Qty Unit. CYiargePer. Extension
BASE FEE. 45.00
20.00 9. 0000 THOU.. a BLDG, ..2.,,00;1-25, 000. 180:00
,t ,•
Permit. ELECT- ADD/ALT/REM.
Additional-desc
Permit Fee 28.16' Plan Check Fee 7.04
Issue. -Date. Valuation 0
Qty ...Unit, Charge"
Per. Extension
-BASE FEE 15.00
376...00. ..0350.. ELEC NEW RES, 1. OR 2.' FAMILY-
,
AMILY 13..16
r �� •�
ti
r .
P.O. Box 1504 VO1t f, (T60) 777=701-2.
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 922.53 QUM&
INSPECTIONS (760)'777-7153
BUILDING & SAFETY DEPARTMENT
Application Number. 0 If
Applicant:
Applicant's Mailing Address:
Date:
Architect or Engineer:'
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commeincing with Section 7000) of Division 3 of the Business and Professionals
Code, and my License is' full force and effect
License Class L3 License No. ?�9 9.
Date /d- / Z - O 'f Contractor / Ocy h-4070645
OWNER -BUILDER DECLARATION
I 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 structim 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 cMl penalty of not more than five hundred dollars ($500).):
U 1. 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 4nprovements are not Intended or offered for sale. if, however: the budding or Improvernept 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 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sea 7044, Business and Professions Code: The Contractors'
State. Lioense Law does not apply to an owner of property who builds or improves thereon.'and who contracts for the projects with a oontrac tors) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. BA P.C. for this ieason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:.
I have acid 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. .
_ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for wmictm this permit is
Issued. My workers' compensation insurance carrier and policy number are.
Cartier LI BERyr/ /LI ✓Ti/AA4 Policy Number tiJA 762- D 00,4'12301,4
_ 1 certify that, in the performance of the work for which thhs pemtit 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 thiat, If I should become subject to the workere compensation provisions of Section 3700 of the Labor Code. l shah
forthwith comply with those provisions.
Date
Date 10- /Z.- VY • , Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a constriction lending agency for the.perfamance of the work for which the permit is issued (Sec. 3097, ON. 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 0uinta, 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 1 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 of this county to enter upon the a tioned r inspection purposes.
Date 60 ' "0 y Signature (Applicant or Agent): ��'�
Page
2
Application Number
_ 04700005408 Date.
10/07/04
----------------------------------------------------------------------------
Permit . . . . . .
MECHAYICAL
Additional desc
Permit>Fee
�9 5.0 Plan Check Feed.
9:88
Issue'Date
Valuation . .
0
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
EA,_ MECH FURNACE <=100K
'9.00
1.00 9.0000
EA MECH B/C .<=3HP/1OOK BTU
9.00
" 1. 0 0 6.5000
EA„,-= MECHVENT FAN
6.50
Permit . ... . . .
PLUMB -NG
Additional desc
Permit Fee
49.50 Plan Check Fee
12.38
Issue Date . . . ..
Valuation.
0
' Qty Unit Charge
Per
Extension
BASE FEE
15.00
' 3.00 6.0000
EA - PLB FIXTURE
18.00
1.00. 7.5000
EA ..'..PLB WATER HEATER/VENT..
7.50
1.;00 3.0000
EA .PLB WATER INST/ALT/REP
3.00
2.00` 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
6.00
Special -Notes and.Comments
' 376 SQ. FT CASITA ADDITION.
THIS PERMIT
DOES NOT INCLUDE POOLS & SPA BLOCK
WALLS OR DRIVEWAY. APPROACH:.
,.
Other Fees
ENERGY REVIEW.FEE'
14.63
STRONG MOTION (SMI) -"RES
2.15
Fee summary Charged
Paid Credited
Due
.Permit Fee Total
342.16. .00 .00
342.16
Plan Check Total
17E.55 00 .00
175.5.5
Other Fee Total
1E.78 .00 .00
16.78
.Grand Total
534.49 .00 00
534.49
y
' Coachella Valle' Unified School District
k y This Box For District Use Only -
' 83-733 Avenue 55; Thermal, CA 92274 DEVELOPER FEES PAID
! (760) 398-5909 — Fax (760) 398-1224
1
4
1
AREA:.
AMOUNT y ,
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMMAND. AMOUNT:
DATE:
RECEIPT:
CHECK N:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education �Code 17 20)�
t Project Name. :: �,� ; f'MountamlVew / Daie: October 12, 2004
Owner's Name: Jeffrey Petoski (Toll BrojhersPhone No, 578-4589
Project Address:- Via Valerosa, aQuinta, CA 92253
Project Description: De st House
j APN:772 250 999 10 Tract #: Lot#'s:
Type of Development: esidential XXi Commercial Industrial
Total Square Feet of Building Area: 376
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 ehalf of the owner/develope
Dated: 0 - (I-- U �t Signature: J� ��
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
i 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
s Note:
Number of Sq.Ft. 376 , �� C�
I • Amount per Sq.Ft. $0.00 (F ) J
` Amount Collected $0.00 art own 0Building Permit Application Completed: Yes/No l v. l 1
By: Carey M. Carlson, Asst. Supt.; Business Services
i Certificate issued by: Marcelo. V aldez, Facilities Clerk Signature:
t
1. 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 writte n ice 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 i t 'ti 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 protestperiod: 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.
i�1 V:c%mvdocs%de�ctee %ccrtifieate of compliance fbiln Tables l O USE.doc 1/16/03 T