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07-2893 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO r LA QUINTA, CALIFORNIA 92253 t t Application. Number: 07-00002893 Property Address: 78144 LAGO LA QUINTA DR APN: 646-200-006 - Application description: ADDITION - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 10000 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: WENTWORTH CHARLES W 78-144 LAGO DR. LA QUINTA,. CA 92253 Contractor: Applicant: Architect or Engineer: K M SERVICE INC 41721 NEVIS PL BERMUDA DUNES, CA 92203 (760)861-2743 Lic. No.: 813897 M 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 Busine 6 and Professionals Code, and my License is in full force and effect. License Class: 13 License No.: 813897 Date:/q Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 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).: (_) 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.). (_) 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 ISec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERA11T VOICE (760) 777-7012 FAX (760) 777-7011 ES];S (760) 777-7153 12/12/07 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I 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 2290023960 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 3700 of the Labor de, I shall fort with c mply with those provisions. 1 Date, 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 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. 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 bu' Bing cons coon and hereby authorize representatives of this count to nter upon the above-mentioned pro rty for i p tion poses. Dater Signature (Applicant or Agent 0 .Y Application Number . . . . . 07=00002893 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 117.00 Plan Check Fee .' 76.05 Issue Date . . . . Valuation . . . . 10000 Expiration Date 6/09/08 Qty Unit Charge Per Extension BASE FEE 45.00 8..00 9.0000 THOU BLDG 2;001-25,000 ---------------------------- ----------------------------------------------- 72.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 17.10 Plan Check Fee 4.28 Issue Date . . . Valuation 0 Expiration Date 6/09/08 Qty Unit Charge Per Extension BASE FEE 15.00 60.00 .0350 ELEC NEW RES - 1 OR 2 -=-------------------------------------------------------------------------- FAMILY 2.10 Permit . . MECHANICAL Additional desc . Permit Fee 24.00 Plan Check Fee,. 6.00 - Issue nate Valuation . . . . 0 Expiration Date 6/09/08 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH APPL REP/ALT/ADD 9.00 ----------------------------------------------------------------------------- Special Notes and Comments 60 SQ. FT. ADDITION AND REMODEL ---------------------------------------------------------------------------- Other Fees . . . . . ENERGY REVIEW FEE 7.61 STRONG MOTION (SMI) - RES 1.00 Fee summary Charged Paid Credited -------------------- ---------- Due --------------------------- Permit Fee Total 158.10 .00 .00 158.10 Plan Check Total 86.33 .00 .00 86.33 �• Other Fee Total 8.61 .00 .00 8.61 Grand Total 253.04 .00 .00 253.04 LQPERMIT Bin # City of La Quinta pj� -26d Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: Owner's Name: Nw es 0-2", A. P. Number: G A D LA &1pJTa Address: Legal Description: *4Mr Ifo Contractor: iu RV j e ` City, ST, Zip: Telephone: Address: r-{(-:724 Vii:✓ ISS P I: Project Description: �� I o, �, — Ttk 06 Et - City, ST, Zip: �� rL '7Z2-03�e-�— Telephone: -74?0 - %I— Z7Y 3 State Lic. # : a 1 3Sq % City Lic. #: Arch., Engr., Designer: - O • Address: City, ST, Zip: Telephone: Construction Type: 5 Occupancy: S x1�11 State Lic. #: Project type (circle one): New kddnAlter Repair Demo Name of Contact Person: Sq. Ft.: GO # Stories: # Units: t Telephone # of Contact Person: $lp (- 27143 Estimated Value of Project: Q QQ ®^ APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Rec'd TRACIURr.� PERMIT FEES Plan Sets Plan Check submitt I'S Item Amount Structural Calcs. Reviewed, read for corrections Plan Check Deposit Truss Calcs. Called Contact erso ///Z.)- Plan Check Balance Energy Cales. p� Plans picked up i Construction Flood plain plan Plans resubmitted 1 Mechanical Grading plan 2"" Review, ready for corrections/issue ��(�p7 ectrical Subcontactor List Called Contact Person 12 Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '`" Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees • I Total Permit Fees I'A Vk w �/wn l3V", 3�I 3 I55 o CGN'tIQ(3 auzT w _)&--n,Tfo 1✓ , u — r t^' c_. e CERTIFICATE OF COMPLIANCE N o Desert Sands Unified School District 47950 Dune Palms Road Q BERMUDA DUNES 0 rn RANCHO MIRAGE 0 Date 12/12/07 La Quanta, CA 92253 INDIAN WELLS 1 ALM DESERT No. 29815 X760) 771-8515 �% PLAQUINTA �QINDIO O JJ Owner Wentworth APN # 846-200-006 Address 78144 Lago Dr Jurisdiction La Quinta City LaQuinta Zip -92253 Permit # Tract # Study Area Type Residential Addition No. of Units 1 Lot # No. Street Unit 1 78144 ' Lago Dr Unit 2 Unit 3 Unit 4 Unit 5 Comments S.F. Lot # No. 60 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 Street S.F. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 60 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 Exempt - Ken Orgega Check No. Name on the check Telephone Funding Exempt By Dr. Sharon P. McGehee , •°�,`- Superintendent 1 .. fir; Fee collected /exe ted har cGilvrey Payment Recd 0.00 -' Signature NOTICE: Pursuant to Government Code Section 66020(!)(), this Will serve to notify you that the 90 -day approval period in which you may protest the fees o r other payment identified above Will begin to run from thi ate 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 if Duplicated Embossed Original- Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting