06-3791 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t!t 4 4
0".
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 06-00003791
Property Address: 56485 VILLAGE DR
APN: 764-040-013- - -
Application description: ADDITION - RESIDENTIAL
Property Zoninq: LOW DENSITY RESIDENTIAL
Application valuation: 1778
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 the Business and Professionals Code, and my License is in full force and effect.
License Class: B License No.: 344189
Date: 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).:
(_ 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.).
1 1 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 c radts for proje with a contractor(s) licensed
pursuant to the Contractors' State. License Law.l.
(_) I am exempt under Sec. , B.&P.C.1pythi as
ate: V� �/ �V� ner:
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: WIA
LQPERMIT
Owner:
POOK
347 BLUE CAVERN POINT
LONG BEACH, CA 90803
Contractor:
REYNOSO ENTERPRISES INC
3066 NORTH GREENBRIERR
LONG BEACH, CA 90808
(564)421-1979
Lic. No.: 344189
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/27/06
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 1830327
_ 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 subjpct t9A4e workers' co ensation laws of California,
and agree that, if I should be a subje o e s' comp anon provisions of Section
3700 of the Labor Code II fort o those isions.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERA E 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 ' ct. ree to co ly with all
city and county ordinances and state laws relating to building co uctio d e horize re sentatives
of this co my to enter upon the abo -mentioned property f spe n as
tJ6i e:l 0-3�-0 Si re (Applicant or Agent):
tet`, � •
LQPERn1IT
Application Number . . . . . 06-00003791
Permit BUILDING PERMIT
Additional desc .
Permit Fee . . . . 41.00
Plan Check
Fee
26.65."
Issue Date . . . .
Valuation
1778
Expiration Date . . 4/25/07
Qty Unit Charge Per
Extension
BASE FEE
15.00,
13.00 2.0000 HND BLDG 501-2,000
-------------------------------------'---------------------------------------
-26.00
Permit ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee . . . . 15.77
Plan Check
Fee
3.94
Issue Date
Valuation
. . .
. 0
Expiration Date 4/25/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
22.00 .0350 ELEC NEW
-------------------------------------------------------------------7--------
RES - 1 OR 2
FAMILY
.77
Permit . . MECHANICAL
Additional desc .
Permit Fee . . . . 24.00
Plan Check
Fee
6.00
Issue Date
Valuation
. . .
. 0
Expiration Date .4/25/07
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
REMOVE WALL AND REPLACE WITH STEEL
I -BEAM, REVISE TITLE-24.October 24,
2006 2:02:30 PM jjohnson
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ENERGY
REVIEW FEE
2.67
HOURLY
PLAN CHECK
70.00
STRONG
MOTION (SMI)
- RES
.50
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 80.77
.00
.00
80.77
Plan Check Total 36.59
.00
.00
36.59
Other Fee Total 73.17
.00
.00
73.17
Grand Total 190.53
.00
.00
190.53
Coachella Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
Project Name:
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMMAND. AMOUNT:
DATE:
RECEIPT:
CHECK #:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Date: October 31, 2007
Owner's Name: Christopher Pook Phone No.
Project Address: 56-485 Village Drive La Quinta, CA
Project Description: Addition to new home
APN: 764-040-013 Tract #: Lot #'s:
Type of Development: Residential XX Commercial Industrial
Total Square Feet of Building Area: 22 sq. ft.
Certification of Applicant/Owners: The person signing certifies that the above info on is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized t9ggn o half ofAg6el/developer.
Dated: October 31, 2007 Signature: �i/� L //'/1h/A'
***********************************************************************
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
17620 65995 Approval
Note
Number of Sq.Ft. 22
Amount per Sq.Ft. 3.48
Amount Collected 76.56
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Support Services
Agreement Existing Not Subject to Fee
Prior to 1/1/87 Requirement
Certificate issued by: Elvira Mattson, Secretary III Signature:
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 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 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.
MV:c/mydocs/devfees/certificate of compliance form updated 3-2007 3/9/07