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13-0815 (RER)P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMRICO FAX (760) 7774011 7. LA-QUINTA,-CALIFORNIA 92253' BUILDING & SAFETY DEPARTMENT l 1---I ! INSPECTIONS (760).777-7153 BUILDING PERMIT - Date: 10/14/13 - Application-Number: :,13-00000815 - Owner: - Property'Address: 79a05° VICTORIA•.DR „ VONDA KUMIYAMA APN: 604-373-004-36 27899, 79-105 VICTORA-- Application description: -.REMODEL - RESIDENTIAL LA, QUINTA, CA 92253' a Property Zoning:LOW DENSITY RESIDENTIAL Application Valuation: 14000 OCT 14 2013 actor. li Applicant: -Architect or Engineer , - AR-GEE CONSTRUCTION CO INC BOX 580487 P M"SPRINGS, CA'92258 FIPIARiCEDEPT. (76 ) 318-2490 ..No.: 826297 _ 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 of perjury one of the following declarations: - - . Section 7000) of Division 3 of the Business a ofess' nals Code, and my License is in full force and effect.- - , I have and will maintain'a certificate of consent to self-insure for workers' compensation, as provided License Class: B i License No.:*' • 826297 - - _ - .for by :Section 3700 of the Labor Code, for.the,performance of the workfor which this permit is issued. Date - .Contractor:' - - _ rhave 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 - WNER-BUILDER RATION _ - insurance carrier and policy numberarer I hereby affirm under penalty of perjury that I am exempt.from the Contractor's State.License Law for the Carrier PRESERVER INS Policy Number WCC701849600 following reason (Sec. 7031.5, Business and Professions Code: Any, city or county that requires permit to_ I certify that, in the performance of the work for which 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 become subject to the workers' compensation laws of California, - permit to file a signed statement that-he or she is licensed pursuant to the provisions of the Contractor's State- - and agree that, if 1 should become- subject to the workers' compensation provisions of Section - License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code)or3700 ,of the Labor Code, all rthwith comply with those provisions. 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).: Date: 1 r` Applicant: (_ 1 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 WARNING: FAILURE TO SECURE WOR S'-COMPENSATIO -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 PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself orherself through his or her own employees, provided. that the DOLLARS ($100,000) IN ADDITION TO THECOST 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 the burden of proving that he or she did not build or - - - improve for the purpose of sale.). ,' - APPLICANT ACKNOWLEDGEMENT - - 11, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made-to.the Director of Building and Safety for a permit subject to the - - 7044, Business and Professions Code: The Contractors' State License Law does not apply to an: owner of conditions and restrictionsset forth on this application: - - property who builds or improves thereon, and who contracts 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 License Law.). " - - : whose benefit,work is performed under or pursuant to any'permit.issued as a result of this application, I am exempt-under Sec. B.&P:C. for this reason the owner, and the applicant, each agrees to, and shall:defend, indemnify and hold haimless the City of La Quinta,.its -officers, agentsand employees for any act or omission related to the work being performed underor following issuance of this permit. - - - Date: Owner:' - - — 2. Any permit issued as a result of this application be null and void if work is. not commenced ' - - - " within. 180 days from date of issuance of such, perm_ it, or cessation of work for 180 days will subject _ CONSTRUCTION LENDING AGENCY - permit to cancellation.. I hereby affirm under penalty of. perjury that there is a construction lending agency for the performance of the : - I certify that I have read this application and state that the above information is correct. I agree to comply. with all work for which this permit is: issued :Sec. 3097, Civ. C.1: - - city. and county ordinances and state laws relating to bu'Id' nstru on, and' herebyauthorize representatives- Lender's Name: f t o t o this to enter upon the above-mentionedproperty or' pe ion Date: e -1y Signature (Applicantr Agen " Lender's Address: Application Number _ 13-00000815 ,Permit BUILDING PERMIT.. Additional desc •. ; _ Permit Fee _153.00 Plan Check Fee 99.45 Issue Date .,Valuation 14000.--' Expiration Date `. 4/12/14 -Unit Charge.. Per Extension: BASE°.FEE 45.00. 12..00. 9.0.000 THOU BLDG 2,001-.25,000 108.00 7-- Permit ELECTRICAL,2013 _ -Additional desc .. Permit Fee. 23.83'. Plan Cdeck.`Fee :00.. Issue Date Valuation 0 'Expiration Date. 4/12/14 '.' Qty Unit Charge Per Extension': 1..00 23`.8300 LS ELEC,FIXTURES, FIRST 20 23.83 PermitMECHANICAL 2'013 Additional desc . Permit Fee 11.92. Plan ,Check Fee .. .00 _ Issue Date"- Valuation 0 -Expiration,Date 4/12/14 Qty Unit ;Charge ,Per Extension' 1.00 '11.9200 EA MECH APPL REP/ALT 11.92 Permit, .. . . ,. PLUMBING 2013' Additional 'desc Permit Fee . . . ., 23.84 Plan'Check Fee .00 Issue Date Valuation Expiration Date 4/12/14: "0_ Qty'. Unit Charge Per Extension` 1.00 11.9200'EA PLBG FIXTURE/TRAP 11.92 1..00 11.9200 EA PLBG WATER INST/ALT/REP -11.92_ -Special Notes, and Comments. EXTEND KITCHEN 27' SQ... FT`. AND INT REMODEL , WINDOW CHANGE OUT October 10, 2013 3:10;.40 PM J.Jo11 hnson. ------------------- ----------------------•---- --- -------------- Qther Fees BLDG•STDS ADMIN•-(SB1473) 1.00 :Application Number 13-00000815 -7- _ -7 _ _ _ _ _ _- _ _ _ _ _ _ --------- _ _ _ _ _ _-_ _ _ _ _ _ _ _,_ _ _ _ _ _ _-_ _ _ _ _ _ _ _ _ .. ., -. .. `Other•Fees.',. .' ENERGY-REVIEW FEE 9.:95 HOURLY PLAN CHECK 2.62 ..50 PLAN.CHECK, ELECTRICAL 23.83; -PLAN CHECK,-MECHANICAL 4..77 PLAN CHECK,; PLUMBING - 23 .$4- ` STRONG MOTION (SMI)'='RES: 1.40 = Fee summary Charged Paid Credited Due �:. Permit Fee,'Total 212.59 -.00 00 212.59 - 'Plan.Check-Total ='. 99.45. .00 00° 99.:45 °.. °Other Fee Total. 327.29..,.0b A0,­327.29 Grand Total.: : 639.33 ..00 00 639,.33. Bin # City of La Quinta Building &r 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 v Owner's Name: v2� —/� A. P. Number: G O 3 Address: 7 ! Q VIG' Legal Description: City, ST, Zip: Z Contractor• . O e � T elePh• one.'Q Address:)0 0 e Ox � 0 �DZ% Project Description: �� s2 ( C City,`ST, Zip: /Ii A64 501 n- wl Telephone: �� �jiQx3 State Lic. #: Ll? 7, City Lic. #.: A I)D01Z Arch., Engr., Designer: sG(/ l 0 . Address: City., ST, Zip: Telephone:........:........ Construction Type: Occupancy: Ste a Lic. #: Project n'Pe (circle e 'n Alter Repair Demo J one): New Add -r me of Contact Person: Sq. Ft.: 2 #-Stories: ( # Units: --7 Telephone # of Contact Person: Q / Estimated Value of Project: APPLICANT: DO NOT[WRITEBELOW THIS LINE # Submittal Req 'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted l Item Amount Structural Calcs. Reviewed, ready f r corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up eovj!.+t� Construction Flood plain plan Plans resubmitted ilig Mechanical Grading plan god Review, readyr corrections e Electrical Subcontactor List Called Contact Per Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted 9 eQ,P rt1 IN HOUSE:- '"' Review, ready for correctio issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 7- RWM 18�zl��3 Sm ftft4z 'V b-sc- tlub(14s(C) Wt � r R�� CERTIFICATE OF COMPLIANCE Desert Sands Unified School District : _ Zq °o 47950 Dune Palms Road ¢ BERMUDADUNES 7- C/] RANCHO MIRAGE b Date 10/14/13 La Quinta, CA 92253' INDIANWELLS P UINNo: 31834 (760) 771-85115 QTA �blti'-. � INDIO Owner Vonda Kumiyama APN # 604-3737004 Address 79-105 Victoria Jurisdiction La Quintal. City La Quinta Zip Permit.# ' Tract # .. No. of Units " 1 t Type 'Residential Addition Lot # No, Street S.F. Lot # No. n Street S.F. Unit 1, 79105 Victoria 27 Unit 6 ` Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 : Unit 9 : Unit 5, , Unit 10 Comments At the present time, tFe•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:' 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,a,mount of $0.00 X 27 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 -.George Gutierrez check No. Bank Name/Recipient of Certificate . • ,Telephone 760-578-2922. • Funding. Exempt By Dr: Gary Rutherford Superintendent �� f Fee collected lex d y Sh o CG r y Payment Recd -- $o-oo 7;� ^.J. �Qver/Griner' b Signature NOTICE: Pursuant to Government Code Section 66 (d)(1), this 'I se to notify you that the 90Aay approval period in which you may protest the fees or other payment identified above will begin to run from the date on wh 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