08-0143 (RER)t t,•. r �4
��1� ��I,ICt/
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 08-00000143 Owner:
Property Address: 80580 VIA TERRACINA TIM TRAVER
APN: 772-250-999-108 -30357 - 80580 VIA TERRACINA
Application description: REMODEL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 7897
Contractor:
Applicant: Architect or Engineer: TRAVER CONSTRUCTION, Tarr,
.80580 VIA TERRACINA
LA QUINTA, CA 92253
(760)771-6683
Lic. No.: 631395
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I a licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business d ro sionals Code, and my License is in full force and effect.
License Class: C8 License No.: 631395
Date:tractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of rjury 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).:
(_ 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. , B.&P.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:
LQPERVIIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/20/08
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 229-0034422
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 t come subject to the workers' compensation laws of California,
and agree that, if I should c e sub' ct to the workers' compensation provisions of Section
37000� y�000S1ff the Labor Co , s III for th comply with those provisions.
Date : 22.1applicant:
WARNING: FAILURE TO SEC WOR S' 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 stat4hriformation is correct. I agree to comply with all
city and county ordinances and state laws relatintructio nd hereby authorize representatives
of this county entgr�on the above-mentionepec ' rposes.
Date:�Signature (Applicant or Age
Application Number . . . . . 08=00000143
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 99.00 Plan Check Fee 64.35
Issue Date Valuation . . . . 7853
Expiration Date 8/18/08
Qty Unit Charge Per Extension
BASE FEE 45.00
6.00 9.0000 THOU BLDG 2,001-25,000 54.00
----------------------------------------------------------------------------
Permit . . . ELECT - ADD/ALT/REM
Additional desc . .
Permit FPP 19.10 Plan Check Fee 4.78
Issue Date . . . . Valuation . . . . 0
Expiration Date 8/18/08
Qty Unit Charge Per Extension
BASE FEE 15.00
117.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 4.10
----------------------------------------------------------------------------
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 24.00 Plan Check Fee 6.00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 8/18/08
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
CONVERT PATIO TO LIVING SPACE 117 SQ.
FT.
----------------------------------------------------------------------------
Other Fees . . . . . . . ENERGY REVIEW FEE 6.44
STRONG MOTION (SMI) - RES .94
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 142.10 .00 .00 142.10
Plan Check Total 75.13 .00 .00 75.13
Other Fee Total 7.38 .00 .00 7.38
Grand Total 224.61 .00 .00 224.61
LQPERIIIT
i
Bin #4 A
City of La Quinta.
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.#
i , v
00
Project Address:��S-80 v/Q %rree a�z La Qt,.�l�e
A. P. Number: 7rj2_ZS-4 _QQQ�%8- ,�O 3$°7
Legal Desc4tion:
Owner's Name:
r� f 7r,;, e Tr+zver'
Address: �pSPO Y4 Tr 4G/nQ
City, ST, Zip: [, z Q w,1*" 9 Z 2S3
Contractor:I
ravel' �okS><i'�cc�ia �v l .a
Address: O e/ss4
Telephone:
Project Description:
City, ST, zip: LQ Qar•s rt¢ ., C'a. 922S 3
N.�. 4 P/40f e o e cco y
Telephone: (p � �O / _OQII
/ ,y 1,• �1. �57421�!? 00/' G/ Of/
40&14e"Ar 4141,6- 1-ek«o ,
State Lic. # :-CB-�s,3 3 S
City Lic. #: 020 $ 3
Arch., Engr., esigner:
Address: S4 ►tie
C/s7l N n►.
o
City, ST, Zip:1.
v
p
Telephone:ConstructionT
State Lic. #:
Name of Contact Person: T, M. %r4 ver
Oor �pqe Occupancy:
Project type (circle one): New Add'n Ate!` Repair Demo .
Sq. FL:l/' J
# Stories: �.
# Units:
Telephone # o f Contact Person: 74-P-4601-011) .
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submitt 1
Req'd
Recd
TRACK NG .
PERMTT FEES
Plan Sets'
!
Plan Check submitt I G
`•Rem
Amount
Structur 1 Caics.Reviewed,
ready or corrections
Ilan Check Deposit
Truss Cs les.
Called Contact, Perso
Plan Check Balance
Energy Ics..
Plans ' icked u 1
P P �
Plans resubmitted �1, •
Construction
Flood ph in plan
echanical
Grading. Ian,2''
Review, ready for eorrectio issue
Electrical
Subcontactor List
Called Contact Person 2b
Dumbing
Grant D d.
Plans picked up
SI14.I.
II.O.A. Approval
Plans resubmitted
Grading
IN IJOU E:-
Review, ready for corrections#wuj
Developer Impact Fee
Plannigg, pproval
Called Contact Person
A-I.P,P,
Pub. Wks. Appr
Date of permit issue
School Fees
ly
Total Permit Fees
—= �`�=s� -►awl
Ck44CIIEEDRECORDING REQU6Y
AND WHEN RECORDED MAIL TO:
Tim W. Traver
Jane A. Traver
80-580 Via Terracina
La Quinta, CA 92253
A:P:N.,-772.60o=032=5' -TRA 71: . .- .. . Order'NI
T � 0,20 -OSr�i
Doc " 20055-03338 7
04/28/2005 08:0014 Fee:7.00
Page 1 of t Doe T Tax Paid
Recorded in Official Records
County of Riverside
Larry W, Ward
Assessor, County Clerk
1
& Recorder
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GRANT DEED
THE UNDERSIGNED GRANTORIS) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $746.90
I 1 computed on full value of property conveyed, or
I ) computed on full value less value of liens or encumbrances remaining at time of sale,
corporated area; [
I 1 unincorporated Q City of La Quinta , and
FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged,
Paul F. Montgomery and Connie J. Montgomery, Husband and Wife as Joint Tenants
hereby GRANT(S) to Tim W. Traver and Jane A. Traver, Husband and Wife, as Cottttttunity
Property with Right of Survivorship
the following described property in the County of Riverside, State of California;
Lot 108 of Tract 30357, In the City of La Quinta, County of Riverside, State of California, as per snap
recorded i .. ook 324, Pagels) 8-29, Inclusive of Maps, in the Office of the County Recorder of said County.
�iK-•cam_ i / /�.�%X. _ �fi��
Pa VF. M tgo a Connie J. Mont mery^��
Document Date: April 4, 2005
STATE OF CALIFORNIA ki e f `� i d Q' )SS
COUNTY OF - _ )
On. �`r, s before me,
Personally appeared ./_l I lr.• MA 92111mel4l— —
personally known to me (or proved to me on th sis of saiAtectory evidence) to be the persons) wlwAe name(s) ' /are subscribed to the
within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacityfies) and that by
his/her/their signaturels) on the instrument the person(s) or the entity upon behalf of which the persons) acted, executed the instillment.
WITNESS my hand and official s al.
1
i
Signature
ry . ERIN Lr TIERAL
Commission 01349519 This area for official notarial seal.
Notary Public - Celifomla
Loa Angeles County
Rowwqr
My Comm. Eitpires Mar 14, 2008
al's
----- -•------- --------- -- - - - -------- - - -- --
Mail Tax Statements to: SAME AS ABOVE
Coachella Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
This Box For District Use Only
TYWRLOPRR FRFS PAM
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO WOUNT:
MITIGATION AMOUNT:
COMMAND. AMOUNT:
DATE:
RECEIPT:
CHECK #:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Tim Traver (Residence at Mt. View CC) Date: February 22, 2008
Owner's Name: Tim Traver Phone No. (760)
Project Address: _
Project Description:
80-580 Via Terracina. La Quinta, CA 92253
Room Addition
APN: 772-250-999-108 Tract #: Lot #'s:
Type of Development: Residential jel Commercial Industrial
Total Square Feet of Building Area: 117 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 authorizedW, sign on behalf of the owner/developer.
Dated: 2/22/08
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
17620
Number of Sq.Ft.
Amount per Sq.Ft.
Amount Collected
Gov. Code Project
65995 Approval
117 sq. ft.
$ 0.00
$ 0.00
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Support Services
Certificate issued by: Leticia C. Torres, Facilities Analyst
Agreement Existing Not Subject to Fee
Prior to 14/87 Requirement
Note: Pursuant to AB -181, any mobilehomes being replaced
or relocated within the same school district are exempt from
developer fees_AAny additions of 500 sq. ft. or less is also
exempt from developer fees. (Unless additions are on a�
structure that is under construction.
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 says 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 inydocs de% fees, certificate ofcompliance firm tablesTO IISF.doc 1/16/03 T