BRES2017-0013Building
Address
Owner
Mailing
Address
City
Contrac or
Address
rr'% . "V
TwV1 4 4 " tx6zofi--O�*3
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
QUINTA, CALIFORNIA 92253
State Lic.
& Classif. �hi r� 1 �,/__ L#c.
Arch., Engr.,
Designer
Address -
City Zip Sta
%►. _vAie_ a4go � Lic.
ti LICENSED COI}TRACTOfti,S DECLARATION
I hereby affirm 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 frill force and effect.
SIGNATURE Im7r
OWNER -BUILDER DECLARATION
I herebyy afflrm that I am exempt from the Contractor's License Law Tor the. foiiowing reason:
(Sec.7031.5,Business and Prolossiv sCade:Anyoilyorcountywhichmquk05apermittoconstruct,
offer, Improve, derpollsh, or repair any structure, pnarto its issuance afso requires the applicaritfor
such ppeermlt to Me a signed afatemenf firm! he Is licensed pursuant to the provisions of fha Contrac-
!or's License Law Chaptur 9 {commencing with Section 7000) of Dwislon 3 oftite Business and
Professions Cade, or that he Is exempt f ruffom, and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicanl for it permlt sull*W the applicant 10 a clvll penally of
not more than five hundred dollars ($500).
E)1, as owner of the property, cr my employees with wages as their sale ocrnpensafion, will do
the work, and the structure is not intended or offered for sale. (Sec- 7044, Business and Proles-
sl0ns Code: The Contractor's License Law does not apply to an owner of property who builds or
improves rhomon and who does such work himself nr through his own employees, provided that
such Improvements are not intended or offered fW sale. lf, however, the building or improvement
is sold within orre your pt completion, tiro owner -builder will have fire burden of proving that he did
nor build or Improve far fha purpose of sale).
❑ I, as owner of the property, am excluslvely contracting With llcensed Ccntraolors to construct the
project. (SeC. 70+4, BUSli ASS andPrefessions Code: The Confmcfor's License Law does not apply
to an Owner of properly who builds or improvestho{$on, and who contracts for zwch pto)acts OM
a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKER'S COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to selfinsure, or a certificate of Worker's
Compensation Insurance, of 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 ($100) valuation
or Isss)_
carh`fy that in the performance of the work for which this permll is Issued, I shall not employ
any person in any manner so as to become subject to Workers' Compensation Laws of California.
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.
CONSTRUCTION LENDING AGENCY
I hereby affirm thatthere is a construction lending agency for the performance of the work for
which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled -out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I ceitify that I have read thls application and state that the above Information is Correct.
I agree to comply with all city and county erdlnaftces and state laws relating to building
construction, and hereby authorize represenlatives of this city to enter the above -mentioned
property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
WHITE = BUILDING DEPARTMENT
BUILDING: TYPE CONST. OCC. GRP.' F—
A.P. Number - 1
Legal Description "-e -
Project Descriptlon _4'2��i�-�iXi I
Sq. Ft.
Size
New El
No. No. Dw.
Stories Units
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
CONTACT INFORMATION
NAME:
PHONE:
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: _ _ Date Permit
Validated by:
Validation:
YELLOW = APPLICANT
PINK = FINANCE
Date: 8/2/2017
No.: 17-00677-1
Owner: David Gee
Address: 53 E Roanoke St
City: Seattle WA 98102
Type: Single Family Residential
Lot # Street No.
51525
Comments:
CERTIFICATE OF COMPLIANCE
��+FIFO s
Desert Sands Unified School District
IV -
47950 Dune Palms Road
gC�C'ILI, xis
ruxcnoW o
La Quinta, CA 92253
r punuAx weci.� �
t ,,n0 T V
(760)771-8515°�
Y�
Email:
Jurisdiction: La Quinta
Tract #:
Street Name Sq. Feet APN Permit No.
Avenida Rubio 2012 773-045-025
At the present time, the 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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fens imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $3.48 X 2012 S.F. or $7,001.76 have been paid for the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in the proposed project may now be issued.
Fees Paid By: _CC/6heck No.: 0784605683ank ❑f America - BobBab_Sipovac Telephone:
Bank Name/Recipient of Certificate
Funding: Residential
By Scott L. Bailey
Superintendent
Fee Collected/ Exempted by: Sharon M ilvrey Certificate Fees Due: $7,001.76
Original Paymentis) Rec'd: $0.00
New Payment Rec'd: $7,001.76
C Over/Under: $0.00
NOTICE: Pursuant to Government Code Section 66020(d)(1), this wil rve to notify you that the 90-day approv 9 i Tic Vo a ' flirt M" R fees or
other payment identified above will begin to run from the date o hich the building or installation permit f r�ii fir+ Tic
�e r t9 date on
which those amounts are paid to the District(s) or to another public nt'ity authorized to collect them on the Dis ric ( ehafi, whichever i 'r r.
Notice to Building Department: THIS DOCUMENT VALID ONLY IF IMPRINTED WITH EMBOSSED SEAL.
AUG 0 3 2017
CITY O?i LA QUINTA
COMMUNITY DEVELOPMENT'
Building Permit Number: BRES2017-0013
Project Description: SFR
Exempt:
(Materials may contain hazardous wastes and o-
are not subject to recycling provisions) ,a
QQ
Construction Debris Management Plan dd
Plan Submittal Date 2/13/17
Job Site Address
Owner's Name
Number, Street, or PO Box
City, State, Postal Code
Owner's Phone Number
Owners E-Mail Address
51525 Avenida Rubio
David and Christopher Gee
Project Managers Name Bob Sipovac
Project Managers Phone Number 760-567-2347
Project Managers E-mail AddressbQb&sippyn�; coin
Builder / Contractor
Sipovac Construction, Inc.
Number, Street or PO Box
72651 Theodora Ln.
City, State, Postal Code
Palm Desert, CA 92260
Project Square Footage
2012 sq. ft.
City Approval By
Date of City Approval
Materials To Be Discarded:
Product
Tons
Trash
0.50
Not recyclable
Product
Asphalt
0.00
Recyclable
Masonry (broken)
Brick/Block
0.10
Recyclable
Plaster
Cardboard
0.10
Recyclable
Scrap Metal
Commingled
0.00
Recyclable
Tile (floor)
Concrete
0.50
Recyclable
Tile (root)
Drywall
0.25
Recyclable
Wood
Donated / Reuse*
0.00
Recyclable
Landscape Debris
*Describe Items
CU
AUG 0 3 2017
C M OF LNG QUINTA
COMMUNITY DEVELOPMENT
Tons
0.00 Recyclable
0.25 Recyclable
0.10 Recyclable
0.10 Recyclable
0.00 Recyclable
Q. 1 5J Recyclable
0.10 Recyclable
Totals: Recycle Trash Projected Diversion:
1.7 1
I understand it is the property owner's responsibility to submit copies of weight tickets or receipts to the District
Environmental Coordinator as these hauls occur. I hereby certify that completion, implementation and adherence of the Debris
Management Plan (DMP) for the above named project shall guarantee that at least 50% of the jobsite waste is diverted from
landfilling. The remaining material will be recycled or reused. I will divert, for recycling or re -use, remaining materials generated from
the first day of the project through the completion of the project In accordance with this plan. This DMP is issued in the name of the
property owners) and shall remain their property throughout the construction andlor demo iifion project. A contractor serving as agent
of the owner may obtain a DMP for the owner. However, the DMP is still issued in the name of the property owners) and the owner
retains legal responsibility for ensuring that the provisions of the DMP are adhered to. The property owner(s) and general contractor
shall be kept informed of the diversion progress through bi-monthly reports. If self -hauling, all refuse material from this project site
IIIUSI Ue Cdr Ull LU dll dppl UVCU ICGyUIUI UI Lf '[U1 SLd L1U11.
Owner / Developer / Project Manager 1
P Of
// z
ate
Construction Debris Management Plan
Summary of Requirements
As of January 1, 2011, The Green Building Standards Code (CALGreen) requires that the construction of most
new structures in the State of California comply with sections 4.408 and 5.408 of the code in accordance with
Assembly Bill 939 requiring that no more than 50% of jobsite waste be disposed of as trash at local land fill sites
and transfer stations. Exceptions may be made for certain projects under certain conditions.
The City of La Quinta is committed to the highest level of environmental respect, to conserving our precious
natural resources and setting an example to provide for a better world for generations to come. Recycling helps
keep reusable resources out of landfills and will also reduce disposal costs.
IMPORTANT: Burrtec Waste & Recycling Services is the City's franchise
hauler. If you choose to self -haul any recyclables or trash, you must provide
copies of all weight tickets and/or receipts from the transfer station, landfill, or
recycler as the job progresses. Clean-up companies and other haulers are not
permitted to haul waste or recyclables from the City of La Quinta. Self -haul
weight tickets should be submitted to: Renado Gouldlock, District
Environmental Coordinator - rgouldlock@burrtecdesert.com, or faxed to (760)
340-0417, or mailed to: 41575 Eclectic Street, Palm Desert, CA. 92260.
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