05-3234 (AR)P.O. BOX 1504 rrlr 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA.92253
Application Number:
05--00003234
t
v Property Address:
56222 VILLAGE DR �••��
APN:
764-040-017- - -
Application description:
ADDITION - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
15255
40"
BUILDINZ f8 SAFETY DEPARTMENT
SEP 08 X005 B IEDING PERMIT
Applicant: Architect or Engineer:
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 theBusinessand P ofess' nals Code, and my L' ense is in full force and effect.
License Clasp, 5 910
(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.).
( 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:
T !\D�9�IiT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/08/05
Owner:
JERRY WILLIAMS
56222 VILLAGE DR
LA QUINTA, CA 92253
Contractor:
J W DESIGN & CONSTRUCTION, INC
P.O. BOX 1154
SAN LUIS OBISPO, CA 93406
(805)544-3130
Lic. No.: 554910
-----------------------------------------------
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 173035405
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 bec a sub' t to the workers' co a ion provisions of Section
(� 3700 of the Labor Co I fort i
Date: %,W Applicant: 7%;ivr
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. 1 agree to omply with all
city and county ordinances and state laws relating to buildin structi ,and reb h pies ntatives
of this coupt enter upon the above-mentioned pr r nspact, urp
001,
Date: L" Signature (Applicant or Agehtl'
Application Number .
. . . . 05-00003234
Permit . .
BUILDING PERMIT
Additional desc .
Permit Fee `..
171.00 Plan Check Fee
111.15
Issue Date
Valuation . . .
. 15255
Expiration Date
3/07/06
Qty Unit Charge
Per
Extension
BASE FEE
45.00
14.00 9.0000.THOU
----------------------------------------------------------
BLDG 2,001-25,000
126.00
Permit
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
22.91 Plan Check Fee
5.73
Issue Date.
Valuation . . .
. 0
Expiration Date
3/07/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
226.00 .0350
-------------------------------------------------
ELEC NEW RES - 1 OR 2 FAMILY
-----------------------------
7.91
Permit . . . MECHANICAL
Additional desc..
Permit Fee . . . .
24.00 Plan Check Fee
6.00
Issue Date
Valuation
0
Expiration Date
3/07/06
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
226 sq: ft. patio conversion to living
space -September 8, 2005 8:15:58 AM
jjohnson
------------------------------
Other Fees .
-----------------------------------
. . . ENERGY REVIEW FEE
11.12
STRONG MOTION (SMI) .- RES
1.52
Fee summary Charged Paid CreditedDue
--------------
Permit Fee Total
----------- --------------------
217.91 .00 .00
217.91
Plan Check Total
122.88 .00 .00
122.88
Other Fee Total
12.64. .00 .00
12.64
Grand Total
353.43 .00 .00
353.43
LQPERNUT.
1�
Coat k1la Valley Unified School District
8-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
Project Name: Jerry Williams
�qOL� cS� On L1�QQ
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Date: August 12, 2005
Owner's Name: Jerry Williams Pho:le No. (805) 748-2698
Project Address: 56222 Village Dr., La Quinta, CA 92253
Project Description: Addition while under Consrtuction
APN: 764-040-017
Tract #:
Lot #'s:
Type of Development: Residential XX Commercial Industrial
Total Square Feet of Building Area: 226 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 authorized to sign on behalf of the owner/de-eloper.
Dated: 08/12//05 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 Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Number of Sq.Ft. 226
Amount per Sq.Ft. $ 2.88
Amount Collected $ 650.88
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Business Services
Certificate issued by: Leticia C. Torres, Facilities Clerk Signatur,
a' aJaJ�
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires this District provide (1) a written notice to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions (i°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 othe- 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 paymeat 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 start! 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 Jetermined 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.
1/16/03 T
TW�p
"
Building & Safety Department
78-495 Calle Tampico
PO Box 1504
La Quinta, CA 92253
(760) 777-7012 voice — (760) 777-7011 fax
CERTIFICATION OF BUILDING AREA
STREET ADDRESS OF JOB: 56222 VILLAGE DRIVE
APN: 764 040 017
DESCRIPTION OF WORK: ADDITION WHILE UNDER CONSTRUCTION
SQUARE FOOTAGE: 226 SF
OWNER'S NAME: JERRY WILLIAMS
CITY OF LA OUNTA
BUILDING & SAFETY DEPT.
APPRIOVED
DATEfl' OJ BY !�=
Coachella Valley Unified School District
83-733 Avenue 55
P0Box 847
Thermal, CA 92274
(760) 398 5909
SCHOOL FACILITY FEES COLLECTION HOURS:
8.00 A. M. - 4.00 P. M. Monday - Friday
PLEASE NOTE:
FEES MUST BE PAID IN CHECK OR CASHIERS CHECK. NO CASH.
For questions regarding this letter, please calla
Ed Randall, Counter Technician
(7 60) 777-7012