10-1253 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00001253
Property Address:
56405 RIVIERA
APN:
762-022-005- - -
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
5000
Applicant: Architect or Engineer:
.4
BUILDING &.SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
TOM MCDANIEL
56-405 RIVIERA
LA QUINTA, CA 92253
Contractor: '
EDWARDS CONSTRUCTION INC, B
51455 DESERT CLUB DRIVE
LA QUINTA, CA 92253
(760)777-8202
Lic. No.: 684857
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/09/10
n Cf 2010
CCiy i3F LA QUNTA
------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
--
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby. affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing. with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B i � e No.: 684857
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
✓Date: Contractor:
issued.
YI have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
7-'" Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under•penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier GRANITE STATE Policy Number WC 555-.61-55
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
' permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
- and agree that, if I should become subject to the workers' compensation provisions of Section
' License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the L o e, s a��complyh t o ions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 byAI
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
+Dater Applicant:
1 11, 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
WARNING: FAILURE TO SECURE WORKERS' COMPE E11L,_AND_SNALL
Contractors' State License Law does not apply to anowner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN
• improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
'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.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
.. property who builds or improves thgrenn, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.). "
(_) 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:
LQPERAIIT
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 aresult 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 law building construction, and hereby authorize representatives
of this county to enter upon the above -me perfy-%�ipgpection pur oses:
Date/2-�--' Signature (Applicant or Agen
LQPERMIT
Application Number . . . . . 10-00001253
Permit BUILDING PERMIT
Additional desc ENTRY ROOF STRUCTURE
Permit Fee . . 72.00 Plan Check Fee
46.80
Issue Date . . . . Valuation
5000
Expiration Date 6/07/11
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
--------------------------------------------------------------
27.00
--------------
Permit . . ELEC-MISCELLANEOUS"
Additional desc .
Permit Fee . . . . 16.50 Plan Check Fee
4.13
Issue Date Valuation . . .
. 0
Expiration Date 6/07/11
Qty Unit Charge Per
`Extension
BASE FEE
15.00
2.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
1.50
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Special Notes and Comments
ENTRY ROOF STRUCTURE 32SF W/ GATE &
LIGHTS TO EXIST. SFD. R-3 OCCUPANCY,
TYPE V -B CONSTRUCTION.•2007 CODES 2008
ENERGY.
------------------------------------------------------------7---------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
4.68
STRONG MOTION (SMI) - RES
.50
Fee summary Charged Paid Credited
----------------- ---------- ---------- ---- - ----- ----------
Due
Permit Fee Total 88.50 .00 .00
88.50
Plan Check Total 50.93 .00 .00
50.93
Other Fee Total 6.18 .00 .00
6.18
Grand Total 145.61 .00 .00
145.61
LQPERMIT
Bin #
City of.La Quint
'a
Building Safety &r Safe Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 -,(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: S
Name: C42_1 , C" _
A. P. Number: 6 2' y -O o O S
Address:
Legal Description: L" iT'�TlE77 Zf 601
City, ST, Zip:
Contractor: _
Telephone: ° '• ' �
WIN .Q�
Address:
Project Description:
City, ST, Zip:
—y 7
Telephone: 7 / �l.(
y%` E 'y
.J c . a/ :ho
State Lic. # : 5 -7 City. Lic. #.:
., Designer: -CC
` .
Address: 77 —6 T -Z (nDCJ F-(TP1K6 (-C),r>7
D •V2 I V (P ,
_
City., ST, Zip: I
/�-/
Telephone: V�4t>
>}
r • f,;; ,..NOON:x ;ms's
£>y: ,?;,>;>�.,,.
r� ;z:�• sf . :,�,.;•.��?�.
Construction Type: Occupancy:
State Lic. #:f
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: gZ>' .
-sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Selo
Z
Plan Check submitted
11t!(0
Item
Amount
Structural Calcs.
Z
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person,
?i
Plan Check Balance.
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
r' Review, ready for corrcctioissue
1 Z
Electrical
Subeontactor List
Called Contact Person
12
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
Scho61 Fees
Total Permit Fees
Note, --vf; tvmz .axe
'ro