10-0111 (RER)P.O. BOX 1504
787495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT'
BUILDING PERMIT
Applicant: Architect or Engineer:
44iclead 42�: (fa&4
73
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that Iam licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busin/anofessionals Cites y License is in full force and effect.
L' enseClass: B License 792381
Date: c5 ontractor:
OWNER -BUILDER DECLAR1
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 acivil penalty of not more than five hundred dollars ($500).:
1 _ I 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 wfio 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
hiµµ, Duslneas mil f ivfwoluiu OvJ,..Tho Ovamataral C1ato Livanav Le! -j dyn nw ipply rn ori ninmar 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:
LQPERMIT
1
Owner:
MULFLUR THOMAS E
1451 -SW HIGHLAND RD
PORTLAND', OR 97221
t
Contractor:
RISEN CONSTRUCTION
82775 CHARLESTOWN AVENUE
INDIO, CA 92201
(760)347-6399
Lic. No.: 792381
VOICE (760) 777-7012.
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
D 4/14/10
MAY 2 0 2010
CITY OF LA MIKA
------------------
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 EXEMPT Policy Number EXEMPT
_ 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 ers' compensation provisions of Section
.ems
3700 of the abor Code, I II fo �'t% comply th those provisions
WARNING: FAILURE TO SECURE W K RS' COMPENSATION COVER 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
mridltinns and rPBtriction5 Set forth 011 Oig application.
1 . Each person upon whose behalf this application is made, each person at whose request a11C f6f
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 inf mation is correct. I agree to comply with all
city nd county. ordinances and state laws relating to building cc uction,. and thorize representatives
o is county to enter on the above-mentioned property for' pecti rpose .
Datea� /t� .Signature (Applicant or Agent):
V
Application Number
10-000001,11
Property Address:
48385~VISTA CALICO
APN:
649-530-008- - -
Application description:
REMODEL = RESIDENTIAL `
Property Zoning:.
LOW DENSITY RESIDENTIAL
Application valuation:
50000
BUILDING & SAFETY DEPARTMENT'
BUILDING PERMIT
Applicant: Architect or Engineer:
44iclead 42�: (fa&4
73
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that Iam licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busin/anofessionals Cites y License is in full force and effect.
L' enseClass: B License 792381
Date: c5 ontractor:
OWNER -BUILDER DECLAR1
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 acivil penalty of not more than five hundred dollars ($500).:
1 _ I 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 wfio 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
hiµµ, Duslneas mil f ivfwoluiu OvJ,..Tho Ovamataral C1ato Livanav Le! -j dyn nw ipply rn ori ninmar 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:
LQPERMIT
1
Owner:
MULFLUR THOMAS E
1451 -SW HIGHLAND RD
PORTLAND', OR 97221
t
Contractor:
RISEN CONSTRUCTION
82775 CHARLESTOWN AVENUE
INDIO, CA 92201
(760)347-6399
Lic. No.: 792381
VOICE (760) 777-7012.
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
D 4/14/10
MAY 2 0 2010
CITY OF LA MIKA
------------------
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 EXEMPT Policy Number EXEMPT
_ 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 ers' compensation provisions of Section
.ems
3700 of the abor Code, I II fo �'t% comply th those provisions
WARNING: FAILURE TO SECURE W K RS' COMPENSATION COVER 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
mridltinns and rPBtriction5 Set forth 011 Oig application.
1 . Each person upon whose behalf this application is made, each person at whose request a11C f6f
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 inf mation is correct. I agree to comply with all
city nd county. ordinances and state laws relating to building cc uction,. and thorize representatives
o is county to enter on the above-mentioned property for' pecti rpose .
Datea� /t� .Signature (Applicant or Agent):
_ Application Number,
10-00000111
-------. Structure Information
EXISTING 2924 .SF SFD
-----
Construction Type<;
TYPE V, UNPROTECTED
Occupancy Type
DWELLG/LODGING/LONG <=10
. Other'struct info .
' CODE EDITION
2007/o8 energy
# BEDROOMS
1.00
Permit . . . . ., :
BUILDING PERMIT
Additional desc
.Permit Fee
414..50 Plan Check Fee
269.43
Issue Date" . . . .
Valuation
50000
Expiration.Date.
10/11/10
Qty Unit Charge
Per.
Extension
BASE FEE
252.00 -
25.00 6.5000
THOU BLDG 25;.001-50;000
162.50
Permit . . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee
32;70 Plan Check Fee
8.18
Issue Date . .
Valuation . .
. . 0
Expiration Date
10/11/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
20.00" 7500
PER ELEC DEVICE/FIXTURE 1ST 20
15.00
6.00 .4500
EA ELEC'DEVICE/FIXTURE >20
2.70.
Permit ".
MECHANICAL
Additional desc .
Permit Fee.
48.50 Plan Check Fee'.
12.13
Issue Date
Valuation
0
Expiration Date
10/11/10
Qty Unit Charge
Per ".
Extension
BASE FEE
15'.00
2.'00 4:5000
EA MECH VENT INST/ DUCT ALT
9.00
2.00 9.0000
EA MECH APPL REP/ALT/ADD
18.00
1.00 6.5000
EA MECH VENT FAN
6.50
Permit
PLUMBING
Additional desc .
Permit Fee
36.00 Plan Check Fee
9.00
Issue Date
Valuation
0
' LQPERAIIT -
...
.
Application•Number . . 10-00000111
Permit PLUMBING
Expiration Date 10/11/10
Qty Unit •Charge Per
Extension
BASE FEE
15.00
3.00 6.0000 EA PLB FIXTURE
18.00
1.00 3.0.000 EA 'PLB WATER INST/ALT/REP
3.0,0
-----------------------------------------------.---------- ------------.------
Special Notes and Comments
'ALTERATION OF EXISTING WINDOWS TO -FRENCH
DOORS. GARAGE CONVERSION TO
BEDROOM/OFFICE - 276 SF, ADDITION TO
GUESTHOUSE - 10 SF; GARAGE ADDITION -
430 SF. R3 OCCUPANCY, TYPE VB
CONSTRUCTION. 2007 CODES / 2008 ENERGY. .
Other Fees . . BLDG STDS ADMIN (SB1473)
2.00
ENERGY REVIEW FEE
26.94•
STRONG MOTION (SMI) - RES
5.00
Fee summary Charged Paid Credited
Due
Permit Fee Total .531.70 .00 .00
531.70
Plan Check Total 298.74 .00 .00
298.74
Other Fee Total 33.94 .00 .00
33.94
Grand Total '864.38 .00 .00
864.38
LQPER1w1T ...
CERTIFICATE OF COMPLIANCE �'�IED8
t, Desert Sands Unified School District4�o
47950 Dune Palms Road , ¢ BERMUDADUNES r
rn RANCHO MIRAGE
Date 3/24/10 La Quinta, CA 92253 INDIAN WELLS'
PALM DESERT.
No. 30637 (760).771-8515 v> LA OUINTA ��
QINDIO L�
O
Owner M/M Thomas Mulflur APN # 602-190-008
Address 48-835 Vista Calico Jurisdiction La Quinta
City La Quinta ''Zip 92253 Permit # t
Tract # No. of Units 1
Type Residential Addition
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 48835 'Vista Calico 286 Unit 6
Unit 2 Unit 7
Unit 3' Unit 8 -
Unit 4 Unit 9
Unit 5 Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, 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 -
LALM , i
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 286 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 - Siji Fernandez Check No.
Name on the check Telephone 760-347-6399
Funding Exempt
By Dr. Sharon P. McGehee -,I. �: �' c ry,y;J
Superintendent
Fee collected /exem ed by S a on M ilvrey Payment Recd �c $0.00=
`- 9ver/Under � �•
Signature
NOTICE: Pursuant to Government Code Section 66020((1), th 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 th 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 Districtft) behalf, whichever is earlier.
i
NOTICE: This Document NOT VALID without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting ,