BRES2015-041578-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tihr4 4Qabtrw
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BRES2015-0415
Property Address:
81930 MOUNTAIN VIEW LN
APN:
767480012
Application Description:
THE ESTATES /OWENS RESIDENCE /SFD
Property Zoning:
Application Valuation:
$414,520.40
Applicant:
LARRY OWENS
81960 MOUNTAIN VIEW
LN
LA QUINTA, CA 92253
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 Professions Code,
and my License is in full force and effect.
License Class: License No.:
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
yISS ).:
I, as owner of the property, or my employees with wages as their sole
ompensation, wilr 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
joheAr she did not build or improve for the purpose of sale.).
I, as owner of the property, am exclusively contracting with licensed contractors
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
th ontractors' State LicenseLa )
am exempt under Sec. B.&P.C. for this reason
Date:Z Z / Own
CONST CTION 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
Lender's Address:
Owner:
LARRY OWENS
P O BOX 6416
LA QU I NTA, CA 0
61
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/29/2016
AX
a
Contra
r EB 29 2016
CfTYOFLAQUIWA
CO'MMUNI.TYDEVELQDitiEk?TDFPARTkiEPJT
Llc. No.:
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: _ Policy Number: _
_ 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 the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: 2 Z / Applica
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 Building Official 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.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Age
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT' QTY AMOUNT
PAID PAID DATE
ART IN PUBLIC PLACES - RESIDENTIAL 270-0000-43201 0 $536.30
•$536.30 2/29/16
PAID BY METHOD RECEIPT #
CHECK # CLTD BY
LARRY OWENS CHECK R13374
1062 RSE
Total Paid for ART IN PUBLIC PLACES - AIPP: $536.30 $536.30
DESCRIPTION
ACCOUNT
QTY*
AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$17.00
$17.00
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $17.00 $17.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DIF - CIVIC CENTER
2S2-0000-43200
0
$796.00
$796.00
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT,
QTY
AMOUNT
PAID
PAID DATE
DIF - COMMUNITY CENTER
254-0000-43200
0
$129.00
$129.00
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT.
QTY'
AMOUNT
PAID
PAID DATE
DIF - FIRE PROTECTION
257-0000-43200
0
$366.00
$366.00
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD. BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DIF - LIBRARIES
253-0000-43200
0
$344.00
$344.00
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DIF - PARK MAINTENANCE
256-0000-43200
0
$40.00
$40.00
2/29/16
PAID BY'
METHOD
RECEIPT #.
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DIF - PARKS/REC
251-0000-43200
0
$2,048.00
$2,048.00
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DIF - STREET MAINTENANCE
25S-0000-43200
0
$116.00
$116.00
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DIF - TRANSPORTATION
250-0000-43200
0
$2,842.00
$2,842.00
2/29/16
PAID BY
METHOD
RECEIPT #"
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
Total Paid for DIF - SINGLE FAMILY ATTACHED: $6,681.00 $6,681.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT:
PAID
PAID DATE
TEMP POWER SERVICE
101-0000-42403
0
$24.17
$24.17
2/29/16
PAID BY
:METHOD.
RECEIPT #.. ,
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
TEMP POWER SERVICE PC
101-0000-42600
0
$16.92
$16.92
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
Total Paid for ELECTRICAL: $41.09 $41.09
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RESIDENTIAL, EA ADDITION 1,000SF
101-0000-42403
0
$98.64
$98.64
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
1113374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RESIDENTIAL, EA ADDITION 1,000SF, PC
101-0000-42600
0
$40.64
$40.64
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$145.03
$145.03
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT:
PAID
PAID DATE
RESIDENTIAL, FIRST 1,000SF, PC
101-0000-42600
0
$47.86
$47.86
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD*BY
LARRY OWENS
CHECK
R13374
1062
RSE
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $332.17 $332.17
DESCRIPTION
ACCOUNT.
QTY
AMOUNT
PAID
PAID DATE
RESIDENTIAL PRECISE GRADING - CUSTOM
HOME LOT>7KSF
101-0000-42408
0
$36.26
$36.26
2/29/16
PAID BY
`METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY.,
AMOUNT
PAID
PAID DATE
RESIDENTIAL PRECISE GRADING - CUSTOM
HOME LOT >7KSF PC
101-0000-42600
0
$181.29
$181.29
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
1113374
1062
RSE
Total Paid for GRADING: $217.55 $217.55
DESCRIPTION
ACCOUNT
QTY •
AMOUNT
PAID
PAID DATE
CONDENSER/COMPRESSOR
101-0000-42402
0
$181.30
$181.30
2/29/16
PAID BY
METHOD
RECEIPT#.
CHECK # "
CLTD BY "
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION -
ACCOUNT.
QTY
AMOUNT.
PAID,
PAID DATE
CONDENSER/COMPRESSOR PC
101-0000-42600
0
$120.85
$120.85
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
1111374
1062
RSE
DESCRIPTION
ACCOUNT '
QTY
AMOUNT
PAID
PAID DATE
EVAPORATIVE COOLER
101-0000-42402
0
$36.27
$36.27
2/29/16
PAID BY
METHOD
RECEIPT'#
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION.
ACCOUNT :
QTY
AMOUNT.
PAID
PAID, DATE.
EVAPORATIVE COOLER PC
101-0000-42600
0
$36.27
$36.27
2/29/16
PAID BY
METHOD
RECEIPT,#
CHECK #
CLTD BY.
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
EXHAUST HOOD
101-0000-42402
0
$24.18
$24.18
2/29/16
PAID BY
METHOD
- RECEIPT#"
CHECK # `
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
EXHAUST HOOD PC
101-0000-42600
0
$9.66
$9.66
2/29/16
PAID BY
METHOD,-
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374.
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
FURNACE
101-0000=42402
0
$181.30
$181.30
2/29/16
PAID BY
METHOD .'
RECEIPT # " "
: CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT:
QTY
.AMOUNT
PAID
PAID DATE
FURNACE PC
101-0000-42600
0
$120.85
$120.85
2/29/16
PAID BY
METHODRECEIPT
#
CHECK #
• CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY.
AMOUNT
PAID
PAID:DATE
VENTFAN
101-0000-42402
0
$132.99
$132.99
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
-CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT -
QTY
:' AMOUNT
PAID
PAID DATE
VENT FAN PC
101-0000-42600
0
$53.13
$53.13
2/29/16
PAID BY
METHOD " . -
RECEIPT4,
CHECK #
CLTD.BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WALL HEATER
101-0000-42402
0
$49.42
$49.42
2/29/16
PAID BY
METHOD
RECEIPT*
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT •-
PAID
PAID DATE
WALL HEATER PC
101-0000-42600
0
$24.18
$24.18
2/29/16
PAID BYMETHOD
RECEIPT #
CHECK #.
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
Total Paid for MECHANICAL: $970.40 $970.40
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
MULTI -SPECIES RESIDENTIAL 0-8 UNITS -
2015 UPDATE
101-0000-20310
0
$1,301.00
$1,301.00
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
Total Paid for MULTI -SPECIES RESIDENTIAL: $1,301.00 $1,301.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
NEW CONSTRUCTION PERMIT
101-0000-42400
0
$701.97
$701.97
2/29/16
PAID BY
METHOD..
RECEIPT #
CHECK #
CLTD BY.
LARRY OWENS
CHECK
R13374
1062
RSE
Total Paid for NEW CONSTRUCTION PERMIT:. $701.97 $701.97
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
NEW CONSTRUCTION PLAN CHECK
101-0000-42600
0
$1,400.00
$1,400.00
10/28/15
PAID BY
METHOD
RECEIPT #
CHECK #'
CLTD BY
LARRY OWENS
CHECK
R10343
1042
SGU
DESCRIPTION
ACCOUNT
QTY
AMOUNT
'PAID
PAID DATE
NEW CONSTRUCTION PLAN CHECK
101-0000-42600
0
$82.36
$82.36
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,482.36 $1,482.36
DESCRIPTION
ACCOUNT-..
QTY
AMOUNT
PAID
PAID DATE
BACKFLOW DEVICE.
101-0000-42401
0
$12,09
$12.09
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
BACKFLOW DEVICE PC
101-0000-42600
0
$4.83
$4.83
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT ,
QTY
AMOUNT
PAID
PAID DATE
FIXTURE/TRAP
101-0000-42401
0
$398.97
$398.97
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
FIXTURE/TRAP PC
101-0000-42606
0
$398.97
$398.97
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY ,
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
GAS SYSTEM, 5+ OUTLETS
101-0000-42401
0
$36.26
$36.26
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
GAS SYSTEM, S+ OUTLETS PC
101-0000-42600
0
$24.17
$24.17
2/29/16
PAID BY
METHOD
RECEIPT'#
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SEPTIC SYSTEM
101-0000-42401
0
$12.09
$12.09
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SEPTIC SYSTEM PC
101-0000-42600 •
0
$4.83
$4.83
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT.
QTY
AMOUNT .
PAID
PAID DATE
WATER HEATER/VENT
101-0000-42401
0
$36.27
$36.27
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WATER HEATER/VENT PC
101-0000-42600
0
$21.75
$21.75
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
'ACCOUNT
QTY
AMOUNT
PAID'
PAID DATE
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12.09
$12.09
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
DESCRIPTION
ACCOUNT
QTY .
AMOUNT
PAID
PAID DATE
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$12.09
$12.09
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY '
LARRY OWENS
CHECK
R13374
1062
RSE
Total Paid for PLUMBING FEES: $974.41 $974.41
DESCRIPTION
ACCOUNT
QTY
AMOUNT.
PAID
PAID DATE
SMI - RESIDENTIAL
101-0000-20308
0
$53.89
$53.89
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $53.89 $53.89
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SINGLE FAMILY DETACHED
224-0000-20320
0
$1,837.44
$1,837.44
2/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
LARRY OWENS
CHECK
R13374
1062
RSE
Total Paid for TUMF - RESIDENTIAL: $1,837.44 $1,837.44
TOTALS: $15,146.58 $15,146.58
Description: THE ESTATES / OWENS RESIDENCE / SFD
Type: BUILDING, RESIDENTIAL Subtype: DWELLING - SINGLE Status: APPROVED
Applied: 10/28/2015 SGU
FAMILY ATTACHED
Approved: 2/10/2016 JJO
Parcel No: 767480012 Site Address: 81930 MOUNTAIN VIEW LN LA QUINTA,CA 92253
Subdivision: TR 26769 Block: Lot: 12
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $414,520.40 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: NEW 5896 SQ. FT. SFD. THIS PERMIT DOES NOT INCLUDE POOL SPA, BLOCK WALLS, DRIVEWAY APPROACH, FIRE PIT, BBQ OR WATER
FEATURE. HOME IS FIRE SPRINKLED PER 2013 CRC CODES
Printed: Monday, February 29, 2016 3:57:41 PM 1 of 9 O
LYEWr sysTEms
ADDITIONAL
CHRONOLOGY
CHRONOLOGY.TYPE
STAFF NAME
ACTION DATE, COMPLETION DATE
NOTES
EMAILED TERRIE OWWENS TO PICK UP GREEN SHEET
E-MAIL
AMY YU
12/10/2015
12/10/2015
REDLINES ON PRECISE GRADING AND HYDROLOGY. REDLINES
PLACED IN STEPHANIE'S INBOX
NOTE
JIM JOHNSON
2/8/2016
2/10/2016
NOTE
STEPHANIE GUMPERT
12/11/2015
12/11/2015
OWENS PICKED UP GREEN SHEET AND PRECISE GRADING
PLAN FOR CORRECTIONS.
NOTE
STEPHANIE GUMPERT
12/28/2015
12/28/2015
TERRI OWENS BROUGHT IN GREEN SHEET AND I PUT IT IN
THE FILE.
NOTE
STEPHANIE KHATAMI
2/8/2016
2/8/2016
1 WAS ADVISED BY GABRIEL THAT THEY STILL HAVE A COUPLE
OF OUTSTANDING ITEMS THAT WILL BE SUBMITTED LATER.
MR. OWENS PROUGHT IN REVISED SHEET S71 AND REVISED '
OFFICE MEETING
JIM JOHNSON
2/9/2016
2/9/2016
FTG PAD CALCS FOR LAST CORRECTION. CALLED JOHN
THOMPSON TO VARIFY CORRECTION RESPONSES.
Printed: Monday, February 29, 2016 3:57:41 PM 1 of 9 O
LYEWr sysTEms
PLAN CHECK COMMENTS
FROM CONSULTANT
KAY HENSEL
1/13/2016
1/13/2016
STRUC READY FOR CORRECTIONS 1/12/2016
RECEIVED
PLAN CHECK COMMENTS
FROM CONSULTANT
KAY HENSEL
2/5/2016
2/5/2016
STRUC RFC ON 2/4/2016 - BACK TO OFFICE ON 2/5/2016
RECEIVED
PLAN CHECK PICKED UP
STEPHANIE GUMPERT
11/20/2015
11/20/2015
PLAN CHECK PICKED UP
STEPHANIE KHATAMI
1/14/2016
.1/14/2016
LARRY OWENS
PLAN CHECK SENT TO
RAMSES SEVILLA
1/25/2016
1/25/2016
SEND_TO YOUNG DUE BACK 2/8/16
OUTSIDE PC
PLAN CHECK SENT TO
STEPHANIE GUMPERT
10/28/2015
10/28/2015
SENT TO YOUNG. DUE BACK 11-19-15
OUTSIDE PC
PLAN CHECK SUBMITTAL
STEPHANIE GUMPERT
10/28/2015
10/28/2015
RECEIVED
PLAN CHECK SUBMITTAL
STEPHANIE GUMPERT
12/30/2015
12/30/2015
RECEIVED
GREEN SHEET ITEMS ONLY
1. GEOTECHNICAL REPORT
RESUBMITTAL
ANGELICA ZARCO
12/23/2015
12/23/2015
2. REVISED PRECISE GRADING PLAN
3. HYDROLOGU REPORT
4. PC COMMENTS WITH RESPONSES
TELEPHONE CALL
JIM JOHNSON
11/20/2015
11/20/2015
CALLED LARRY OWENS TO INFORM HIM THE PLANS ARE
READY FOR CORRECTIONS
CONDITIONS
CONDITION
DATE
DATE
DATE
CONTACT
STATUS
REMARKS
NOTES
TYPE
ADDED
REQUIRED
SATISFIED
,
HEALTH DEPT APPROVED SEPTIC SYSTEM 2500
READY TO ISSUE
GAL UNIT. FIRE DEPT APPROVED FIRE SPRINKLER
JIM JOHNSON
1/13/2016
2/12/2016
COMPLETE
SYSTEM, HOA AND SCHOOL FEE LETTER IN
CHECKLIST
FOLDER, SEE NOTES AMY YU PW GREEN SHEETS.
GRADING PLAN NOT SIGNED
Printed: Monday, February 29, 2016 3:57:41 PM 2 of 9
SYSTEMS
READY TO ISSUE I JIM JOHNSON I
1/13/2016 I I
2/12/2016 I COMPLETE I I
APPLICANT BROUGHT 5 UEIPER GNED
GRADING PLAN;
CHECKLIST IN
Printed: Monday, February 29, 2016 3:57:41 PM 3 of 9'
c7SYSTEti1S
FINANCIAL
INFORMATION
DESCRIPTION ACCOUNT CITY AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD
BY
ART IN PUBLIC PLACES -
RESIDENTIAL 270-0000-43201 0 $536.30
$536.30
2/29/16 R13374 1062 CHECK LARRY OWENS RSE
Total Paid for ART IN PUBLIC PLACES - AIPP: $536.30 $536.30
BSAS SB1473 FEE
101-0000-20306 77FTT
$17.00
$17.00
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION $17.00 $17.00
BSA:
DIF -.CIVIC CENTER
252-0000-43200
0
$796.00
$796.00
2/29/16.
R13374
1062
CHECK
LARRY OWENS
RSE
DIF -COMMUNITY
CENTER
254-0000-43200
0
$129.00
$129.00
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
DIF - FIRE PROTECTION
257-0000-43200
0
$366.00
$366.00
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
DIF - LIBRARIES
253-0000-43200
0
$344.00
$344.00
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
DIF - PARK
MAINTENANCE
256-0000-43200
0
$40.00
$40.00
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
DIF - PARKS/REC
251-0000-43200
0
$2,048.00
$2,048.00
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
DIF - STREET
MAINTENANCE
255-0000-43200
0
$116.00
$116.00
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
DIF - TRANSPORTATION
250-0000-43200
0
$2,842.00
$2,842.00
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
Total Paid for DIF - SINGLE FAMILY ATTACHED: $6,681.00 $6,681.00
TEMP POWER SERVICE
101-0000-42403
0
$24.17
$24.17
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
Printed: Monday, February 29, 2016 3:57:41 PM 3 of 9'
c7SYSTEti1S
Printed: Monday, February 29, 2016 3:57:41 PM 4 of 9 i _
sysrrnis
CLTD
DESCRIPTION
ACCOUNT.
CITY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
TEMP POWER SERVICE
101-0000-42600
0
$16.92
$16.92
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
PC
Total Paid for ELECTRICAL: $41.09 $41.09
RESIDENTIAL, EA
101-0000-42403
0
$98.64
$98.64
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
ADDITION 1,000SF
RESIDENTIAL, EA
101-0000-42600
0
$40.64
$40.64
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
ADDITION 1,000SF, PC
,
RESIDENTIAL, FIRST
101-0000-42403
0
$145.03
$145.03
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
1,000SF
RESIDENTIAL, FIRST
101-0000-42600
0
$47.86
$47.86
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
1,000SF, PC
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $332.17 $332.17
RESIDENTIAL PRECISE
GRADING - CUSTOM
101-0000-42408
0
$36.26
$36.26
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
HOME LOT >7KSF
RESIDENTIAL PRECISE
GRADING - CUSTOM .
101-0000-42600
0
$181.29
$181.29
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
HOME LOT >7KSF PC
Total Paid for GRADING: $217.55 $217.55
CONDENSER/COMPRES
101-0000-42402
0
$181.30
$181.30
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
SOR
CONDENSER/COMPRES
101-0000-42600
0
$120.85
$120.85
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
SOR PC
EVAPORATIVE COOLER
101-0000-42402
0
$36.27
$36.27
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
EVAPORATIVE COOLER
101-0000-42600
0
$36.27
$36.27
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
PC
EXHAUST HOOD
101-0000-42402
0
$24.18
$24.18
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
EXHAUST HOOD PC
101-0000-42600
0
$9.66
$9.66
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
Printed: Monday, February 29, 2016 3:57:41 PM 4 of 9 i _
sysrrnis
Printed: Monday, February 29, 2016 3:57:41 PM 5 of 9 C
SYSTf: tits
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID GATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
FURNACE
101-0000-42402
0
•$181.30
$181.30
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
FURNACE PC
101-0000-42600
0
$120.85
$120.85
2/29/16
R13374
1062
CHECK
LARRY OWENS .
RSE
VENT FAN
101-0000-42402
0
$132.99
$132.99
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
VENT FAN PC
101-0000-42600
0
$53.13
$53.13
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
WALL HEATER
101-0000-42402
0
$49.42
$49.42
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE'
WALL HEATER PC
101-0000-42600
0
$24.18
$24.18
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
Total Paid for MECHANICAL: $970.40 $970.40
MULTI -SPECIES
RESIDENTIAL 0-8 UNITS
101-0000-20310
0
$1,301.00
$1,301.00
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
-2015 UPDATE
Total Paid for MULTI -SPECIES RESIDENTIAL: $1,301.00 $1,301.00
NEW CONSTRUCTION
101-0000-42400
0
$701.97
$701.97
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
PERMIT
Total Paid for NEW CONSTRUCTION PERMIT: $701.97 $701.97
NEW CONSTRUCTION
101-0000-42600
0
$1,400.00
$1,400.00
10/28/15
R10343
1042
CHECK
LARRY OWENS
SGU
PLAN CHECK
NEW CONSTRUCTION
101-0000-42600
0
$82.36
$82.36
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE '
PLAN CHECK
Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,482.36 $1,482.36
BACKFLOW DEVICE
101-0000-42401
0
$12.09
$12.09
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
BACKFLOW DEVICE PC
101-0000-42600
0
$4.83
$4.83
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
FIXTURE/TRAP
101-0000-42401
0
$398.97
$398.97
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
FIXTURE/TRAP PC
101-0000-42600
0
$398.97
$398.97
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
GAS SYSTEM, 5+
101-0000-42401
0
$36.26
$36.26
2/29/16.
R13374
1062
CHECK
LARRY OWENS
RSE
OUTLETS
GAS SYSTEM, 5+
101-0000-42600
0
$24.17
$24.17
2/29/16
1113374
1062
CHECK
LARRY OWENS .
RSE
OUTLETS PC
Printed: Monday, February 29, 2016 3:57:41 PM 5 of 9 C
SYSTf: tits
INSPECTIONS
REVIEWS
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
DATE
1ST BLDG NS (3 WK)
JIM JOHNSON 10/28/2015
11/19/2015
11/20/2015
BY
SEPTIC SYSTEM
101-0000-42401
0
$12.09
$12.09
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
SEPTIC SYSTEM PC _
101-0000-42600
0
$4.83
$4.83
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
WATER HEATER/VENT
101-0000-42401
0
$36.27
$36.27
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
WATER HEATER/VENT
101-0000-42600
0
$21.75
$21.75
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE'
PC
WATER SYSTEM
101-0000-42401
0
$12.09
$12.09
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
INST/ALT/REP
WATER SYSTEM
101-0000-42600
0
$12.09
$12.09
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
INST/ALT/REP PC
Total Paid for PLUMBING FEES: $974.41 $974.41
SMI - RESIDENTIAL
101-0000-20308
0
$53.89
$53.89
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
Total Paid for STRONG MOTION INSTRUMENTATION SMI:' $53.89 $53.89
SINGLE FAMILY
224-0000-20320
0
$1,837.44
$1,837.44
2/29/16
R13374
1062
CHECK
LARRY OWENS
RSE
DETACHED
Total Paid for TUMF - RESIDENTIAL: $1,837.44 $1,837.44
TOTALS:
INSPECTIONS
Printed: Monday, February 29, 2016 3:57:41 PM 6 of 9 i�fA`�■ Imo- 7'
. �Ll U V LJ SYSTEiMS
REVIEWS
RETURNED
REVIEW TYPE
REVIEWER SENT DATE
DUE DATE
STATUS
REMARKS
NOTES
DATE
1ST BLDG NS (3 WK)
JIM JOHNSON 10/28/2015
11/19/2015
11/20/2015
REVISIONS REQUIRED
1ST BLDG STR (3
JOHN 10/28/2015
11/19/2015
11/17/2015
REVISIONS REQUIRED
WK)
THOMPSON
FIRE
JACQUELINE 12/2/2015
12/16/2015
12/7/2015
APPROVED-
GARCIA
CONDITIONS
Printed: Monday, February 29, 2016 3:57:41 PM 6 of 9 i�fA`�■ Imo- 7'
. �Ll U V LJ SYSTEiMS
1ST PW GREEN
SHEET
2ND PW GREEN
SHEET•
Permit Details PERMIT NUMBER
City of La Quinta BRESw20115t041=5
AMY YU 12/10/2015 12/17/2015 12/10/2015
REVISIONS REQUIRED
AMY YU 112/23/20151 1/5/2016 1 1/5/2016 1 PENDING DOCUMENTS
2ND BLDG NS (2 I
JIM JOHNSON 112/30/2015 I 1/15/2016 I 1/14/2016 I REVISIONS REQUIRED
WK)
2ND BLDG STR (2 I JOHN 112/30/2015 I 1/15/2016 I 1/8/2016 I REVISIONS REQUIRED
WK) THOMPSON
1. Please have engineer sign and stamp the
hydrology report.
2. Please revise the Tract No. on top of the plan.
3. Please show bearing and distances on the
property lines.
4. Please revise to show City Standard 221 on
construction note #1.
S. Please label the retention basin on the south
side.
6. Please install drywell. in basins for nuisance
water per COA.
7. Please show stoop for door leading outside.
8. Please provide Soils Report and fill in the Soils
Report information in grading note #1.
9. Please show earthwork quantities and if there
are any over excavation recommended by the
Soils Report.
10. Please show lot size and disturbed area:
WDID number is required if disturbed area is over
1 acre.
CALLED LARRY OWENS TO SUBMIT SIGNED
PRECISE GRADING PLANS
•CALLED LARRY OWENS TO HAVE SOILS ENGINEER
SIGN THE PRECISE GRADING PLAN ALSO. PRECISE
GRADING PLAN ON AMY'S DESK
REVISIONS TO TRUSS CALCULATIONS REQUIRED
WITH RESUBMITTAL.
JT 1-8-16
3RD BLDG NS (2 WK) JIM JOHNSON 1/25/2016 2/8/2016 1/26/2016 APPROVED
3RD BLDG STR (2 JOHN 1/25/2Q16 2/8/2016 2/4/2016 APPROVED
WK) THOMPSON
3RD PW GREEN AMY YU 2/11/2016 2/18/2016 2/11/2016 READY FOR APPROVAL PAD CERT, COMPACTION REPORT, AND GREEN
SHEET SHEET ATTACHED.
Printed: Monday, February 29, 2016 3:57:41 PM 7 of 9
SYSTEiviS
Printed: Monday, February 29, 2016 3:57:41 PM 8 of 9
SYSTEMS
Attachment Type
CREATED
OWNER
DESCRIPTION
PATHNAME
SUBDIR
ETRAKIT ENABLED
DOC
2/11/2016
AMY YU
SLADDEN ENGINEERING
1766_001.pdf
0
COMPACTION REPORT
DOC
11/20/2015
JIM JOHNSON
81-930 MOUNTAIN
PAD CERT 2-3-16.docx
0
VIEW.docx
DOC
11/20/2015
JIM JOHNSON
SCHOOL FEES BRES2015-
SCHOOL FEES BRES201S-
0
0415.pdf
041S.pdf
1ST REVIEW.-
1ST REVIEW -
DOC
11/17/2015
JOHN THOMPSON
STRUCTURAL
STRUCTURAL
0
COMMENTS.doc
COMMENTS.doc
1ST REVIEW -
1ST REVIEW -
DOC
11/17/2015
JOHN THOMPSON
STRUCTURAL SOIL
STRUCTURAL SOIL
0
REQUIRMENTS.pdf
REQUIRMENTS.pdf
1ST REVIEW -
1ST REVIEW -
DOC
11/17/2015
JOHN THOMPSON
STRUCTURAL
STRUCTURAL
0
TRANSMITTAL.pdf
TRANSMITTAL.pdf
2ND REVIEW -
2ND REVIEW -
DOC
1/8/2016
JOHN THOMPSON
STRUCTURAL
STRUCTURAL
0
TRANSMITTAL.pdf
TRANSMITTAL.pdf
2ND REVIEW -
2ND REVIEW -
DOC
1/8/2016
JOHN THOMPSON
STRUCTURAL
STRUCTURAL
0
COMMENTS.doc
COMMENTS.doc
3RD REVIEW -
3RD REVIEW -
DOC
2/4/2016
JOHN THOMPSON
STRUCTURAL
STRUCTURAL
0
TRANSMITTAL.pdf
TRANSMITTAL.pdf
3RD REVIEW -
3RD REVIEW - '
DOC
2/4/2016
JOHN THOMPSON
STRUCTURAL
STRUCTURAL
0
COMMENTS.pdf
COMMENTS.pdf .
DOC
2/3/2016
MARY FASANO
PAD CERT 2-3-16.pdf
81930 MTN VIEW
0
BRES2015-041S.pdf
Printed: Monday, February 29, 2016 3:57:41 PM 8 of 9
SYSTEMS
Printed: Monday, February 29, 2016 3:57:41 PM 9 of 9 C
SYSTFti1S
ATTACHMENTS
Attachment Type
CREATED
OWNER
DESCRIPTION
PATHNAME
SUBDIR
ETRAKIT ENABLED
DOC
12/30/2015
STEPHANIE GUMPERT
GRANT DEED.pdf
GRANT DEED.pdf
0
DOC
12/30/2015
STEPHANIE GUMPERT
SUB LIST.pdf
SUB LIST.pdf
0
DOC
12/30/2015
STEPHANIE GUMPERT
DEBRIS MANAGEMENT
DEBRIS MANAGEMENT
0
PLAN.pdf
PLAN.pdf
DOC
2/18/2016
STEPHANIE KHATAMI
PM10 APPROVAL 2-11-
PM10 APPROVAL 2-11-
0
16
16.pdf
Printed: Monday, February 29, 2016 3:57:41 PM 9 of 9 C
SYSTFti1S
r.
Tdf 4 4auhrw
P:O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760)777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building et has bee subr4i}ted in yo}y�r name listing yourself as the builder of the property
improvements•specified'at�� O /%%40,=1 V lelu Li16�,T
We are providing you with anOwner-Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signer you understand or verify this information.
.fJ 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
/building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
2. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
A. I understand Contractors are required by law to' be licensed and bonded in California and to list their license numbers on
ts and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
6. I understand if"I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to.serious financial
risk.
mkn
7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or .all of the work is performed
under contract with a licensed general building Contractor.
Z8Z8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
.
or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
9. I understand I may obtain more information regarding my -obligations as an "employer" from the Internal Revenue
Service, the United States Small.Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-32 1 -CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party 'legally, and financially responsible for proposed construction activity at the following address:
11. I agree that, as the party legally and fmancially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as.well as employers.
12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and. wish to hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owne Date:
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act as my agent(s) to apply for, sign; and file. the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy_ Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature.
Property Owner's Signature: Date:
�5 2o�s-0 yes Cv
PO. BOX 1504 APPLICATION ONLY
Buildingc� Low 78-495 CALLE TAMPICO
Address.. iS 1"q � n in Qlua C in Vi LA QUINTA, CALIFORNIA 92253
(
BUILDING: TYPE CONST.c 301-A Fr CC. GRR
A.P. Number :Z (a -7 - y g ` - Q ) 2L — L
Legal Description Lof I al L ,%+q+mss at Li . uin+e.
Project Description
Mailing
Address
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City
+6
Zip
84.�.S
Tel.
Conti ctor
Address
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CityTel
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State Lit.
& Classif.
City
Lic. #
Arch., Engr.,
Designer 63 ; S
New f7/ Add ❑ Alter ❑ Repair ❑ !Demolition ❑
Address Tel.
CityZip
se
ip as 1,0
State
Lic. #C _14 q IR
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)
of Divisi 3 the BuCness ofessions Code, and my license is in f II force and effect.
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
(Sec. 7031.5, Business and Professions Code: Any city, or county which requires a permit to construct,
after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions o/ the Contrac-
tor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professions Code, or that he is exempt therefrom, and the basis for the alleged exemption. Any
violation of Section 7037.5 by any applicant for a permit subjects the applicant to a civil penalty o/
not more than five hundred dollars ($500).
Estimated Valuation
Q (� e) a
PERMIT AMOUNT
Plan Chk. Dep.
- Plan Chk. Bal.
111, 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 Profes-
sions Code: The Contractor's License Law does not apply to an owner o/ property who builds or
improves thereon and who does such work himself or through his own employees, provided that
such improvements are not intended or offered for sale. If, however, the building or improvement
is sold within one year o/ completion, the owner -builder will have the burden of proving that he 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 Contractor's License Law does not apply
to an owner o/ property who builds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B. & P.C. for this reason
Const.
Mech.
Electrical
Plumbing
S. M. 1.
Grading
Driveway Enc.
Date owner
Infrastructure
WORKER'S COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's
Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑Copy is filed with the city. ❑Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($700) valuation
or less).
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 Workers' Compensation Laws of California.
TOTAL Q
CONTACT INFORMATION 1 riTP'
NAME: �1 C)J- un � le �Q
PHONE: 1 s
tINI
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
CONSTRUCTION LENDING AGENCY
Front Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued. (Sec. 3097, Civil Code.)
• Rear Setback from Rear Prop. Line
p
Lender's Name
Side Street Setback from Center Line
Lender's Address
This is a buildingSide
permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
Property
Setback from Pro Line
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-mentioned
property for inspection purposes.
FINAL DATE INSPECTOR
Issued by: Date Permit
Signature of applicant Date
Mailing Address
Validated by:
Validation:
City, State, Zip
WHITE = BUILDING DEPARTMENT YELLOW
= APPLICANT PINK = FINANCE
,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
DFVF.i.nPF.R FF.F.S PAID
AREA: AMOUNT ... - . .
LEVEL ONE AMOUNT: - LEVEL TWO AMOUNT: MITIGATION AMOUNT: COMMAND. AMOUNT:
DATE: - - RECEIPT: CHECK #: - -LS
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: ffhe_Estates_at La uinta Date:January 20, 2016
Owner's Name: Larry Owens Phone No.
Project Address: 81-930 Mountain View, LaQuinta
Project Description: New Single Family Dwelling with Casita
APN: 767-480-012 Tract #: Lot #'s:
Type of Development: Residential XX Commercial Industrial
Total Square Feet of Building Area: 5,896
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/developer:
Dated: January 20, 2016 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. 5896
Amount per Sq.Ft. $3.36
Amount Collected $19810.56
Building Permit Application Completed: Yes/No
By: Elsa F. Esqueda, Director of: Facilities and Maintenance
Note:
Pursuant to AB 181 any room additions or enclosures of 500
sq. ft. or less are exempt'from developer fees. Any mobile
homes being relocated within the same school district's
jurisdiction are exempt from developer fees..
Certificate issued by: ' Laurie Howard, Secretary Signature: AJ,1_41 k_1a&Wa'A'
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..
A4V:chnydocs!devi'ees/certificate of compliance Farm upckued 3-2007 11/2010
:. M DOC . # 2012=0264829
RECORDED AT THE REQUEST OF 06/08/2012 08:00 AM Fees: $15.00
�►- CHICAGO TITLE COMPANY _ Page 1 of 1 Doc T Tax Paid
. Recorded in Official Records
RECORDING REQUESTED BY County of Riverside
_ Larry W. Ward ,
' Assessor, County Clerk & Recorder
AND WHEN RECORDED MAIL TO:
The Owens Family Trust dated Dec. 11, 1998 '
P. (i.. BOX 6416 "This document was electronically submitted
La Qu i nta , CA 92248 n to the County of Riverside for recording—
Receipted by:,TVERBA
Space Above This Line for Recorder's Use Only -
A.P.N.: 767,480-0112-9 TRA #: p _ (2 �J'- Order No:: 126031086-H55 • Escrow No.: 16492 -FIS w "^
- GRANT DEED"
THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $*plllSuant to Section 11932 R &
T Code t
Tcomputed on full value of property conveyed, ormputed on full value less value of liens or encumbrances remaining at time of sale,incorporated area; ( X ] City of La Ouinta , and
.
FOR'A' VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged,
Wells Fargo Bank, N. A. `
hereby GRANT(S) to The Owens Family Trust dated Dec. 11, 1995 ; LARRY =S OWENS
AND TERRI L o OWENS : r TRUSTEES
the following described property, in the City of La Quinta; County of Riverside State of California; '
Lot 12 of Tract 26769, in the City of La Quinta, County of Riverside, State of California, asper map recorded in
• Book 235, Page(s) 40 and 41 inclusive of Maps, in the office of the County Recorder of said County.
. .:. ells Fargo B - ank.N. � . , - . - . • = ���®. .-- .
,. B ' 0 2015
y' DEC 3 ,
Matthew Norment, Ass't Vice President ' QUINTA
CITY OF VEIApMENT
Document Date: _May 22, 2012 -� COMMUNIT/ DE " --
STATE OF.TBXAS )SS
COUNTY OF, BEXAR . )
on Junto 1;201 e . .. off 0.. ,
before , a notary public in and
tate
for said s, personally appeared iii who proved to me' on
the basis of satisfactory evidence to be the person(s) whose name(s) Ware subscribed to . the • within instrument and acknowledged to me that he/she/they
executed the same in his/her/their authorized capacity(res), and that by his/her/their signature(s) on the instruntent the person(s), or the entity upon' behalf of .
which the person(s) acted, executed the instrument. ,
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my d and official se ,
Signa ture40k;E1 k6-
00ROTHY BONONCMU _
. NOTARY PUBLIC eap
STATE OF TEXAS '
MY COMM. EMP 03131113
Mail Tax Statements to: SAME AS ABOVE or Address Noted Below