12-1236 (SOTB) 1111111 VIII III VIII IIII 63 1
P.O. BOX 1504 IE ,J VOICE(760)
4
78-495 CALLE TAMPICO FAX(760) W- O
LA QUINTA, CALIFORNIA 92253 BUILDING&SAFETY DEPARTMENT INSPECTIONS(760)777-7153
BUILDING PERMIT
Date: 10/31/12
Application Number: 12-00001236 Owner:
Property Address: 79410 AZAHAR ANDERSON,ALAN G & MARILYN K
APN: 772-340-008- - - 1875 58TH ST NE
Application description: STRUCTURES OTHER THAN BUILDINGS TACOMA, WA 98422
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 9000
Contractor: D 3120'1
Applicant: Architect or Engineer: MONARCH HOMES DESERT DI NC oC
49950 JEFFERSON ST, #130 \AQV\�►SA
INDIO, CA 92201 Ci\r°NCEo�p�
(760) 63
No. : 4F1taA
Lic. No. : 457228
---- -----------_----------------------------------------- ----- ------ -----------------
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 License No.: 457228 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued.
/ate)Q ontractor: $-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
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 STATE FUND Policy Number 719000322
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,I 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 Labor Cod)11hall forthwith comply_i
h those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 11
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).: Date:!U I Applicant:
(_1 1,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'COMPENSATION C VERAGE IS UNLAWFUL,AND SHALL
Contractors'State License Law does not apply to an owner 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.). APPLICANT ACKNOWLEDGEMENT
(_1 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project.(Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044,Business and Professions Code: The Contractors'State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon,and who contracts for the projects with a contractor(s)licensed 1. Each person upon whose behalf this application is made,each person at whose request and for
pursuant to the Contractors'State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_1 I am exempt under Sec. ,BAP.C.for this reason 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.
Date: Owner: 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued(Sec.3097,Civ.C.). city and county ordinances and state laws relating to building construction,and hereby authorize representatives
of this county o enter upon the above-mentioned property folins•ection purposes. 't
Lender's Name: 11t l•�,V•lit�.
a ate: SKa<ure(Applicant or Agent): wo,��U.
�7
Lender's Address: (`
LQPER.MIT
r
Application Number . . . . . 12-00001236
Permit . . . BUILDING PERMIT
Additional desc' .
Permit Fee . . 108.00 Plan Check Fee 70.20
Issue' Date Valuation . . . . 9000
Expiration Date 4/29/13
Qty Unit Charge Per Extension
BASE FEE 45.00
7.00 9.0000 THOU BLDG 2,001-25,000 63.00
----------------------------------------------------------------------------
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 21.00 Plan Check Fee 5.25
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/29/13 .
Qty Unit Charge Per Extension
BASE FEE 15.00
2.00 3.0000 EA ELEC PWR APP <=1 6.00
------------------------ -----------------------------------------------
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 18.00 Plan Check Fee 4.50
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/29/13
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00
----------------------------------------------------------------------------
Special Notes and Comments
DETACHED FREESTANDING FIREPLACE AT
COURTYARD [ENGINEERED] THIS PERMIT DOES
NOT PERMIT THE INSTALLATION OF A WOOD
BURNING FIREPLACE - VENTLESS GAS
APPLIANCE ONLY. 2010 CALIFORNIA BUILDING
CODES.
October 30, 2012 2:23:43 PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
ENERGY REVIEW FEE 7.02
STRONG MOTION (SMI) - RES .90
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
LQPERMIT
Application Number, . . . . . 12-00001236
Permit Fee Total 147.00 .00 .00 147.00
Plan Check Total 79.95 .00 .00 79.95
Other Fee Total 8.92 .00 .00 8.92
Grand Total 235.87 .00 .00 235.87
LQPEPMIT
I' RUR
' COURSE HOMEOVGNERS ASSOCLArtOV
NOTICE OF APPROVAL
September 18,2012
Alan&Marilyn Anderson
1875 58th Street NE
Tacoma,WA 98422
RE: 79410 Azahar
Dear Alan&Marilyn Anderson:
Your Request for an architectural change has been approved. Specifically,you have approval to proceed with the following:
Install courtyard pavers,fountain and fireplace
We reserve the right to make a final inspection of the change to make sure it matches the Request you submitted for Approval. Please
follow the plan you submitted or submit an additional Request form if you cannot follow the original plan.
Your approval is conditional with the stipulation of the following:Must obtain all necessary permits
You must follow all local building codes and setback requirements when making this change. A Building Permit may be needed. This
can be applied for at the City offices.
Our approval here is only based on the aesthetics of your proposed change. This approval should not be taken as any certification as to
the construction worthiness or structural integrity of the change you propose. If applicable, please be aware that you are responsible
for contacting the appropriate utility companies before digging.
Thank you for submitting your application and we look forward to receiving your notice of completion upon commencement of
completed work.For your convenience a"notice of completion" document has been attached.
We appreciate your cooperation in submitting this Request for Approval. An attractive Community helps all of us get the full value
from our homes when we decide to sell.
Sincerely,
Ann Miller
Assistant Association Manager
Citrus Course HOA
Encl. l
P.O Box 12920 Palm Desert, CA 92255 ' 41-865 Boardwalk, Suite 101, Palm Desert, CA 9225.5
760:346.9000 " FAX 760.346.9997 * vvwtiv.cilruscoursehoa.cont
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Building a Safety Division
Permit# P.O.Box 1504,78-495 Calle Tampico
La.Quinta,CA 92253-(760) 777-7012
t2•�z31P Willing Permit Application and Tracking Sheet
Project Address: Owner's Name:.
A P.Number. /L ® Address:
Legal Description: City,ST,Zip:
Pit
Contractor. Telephone: i +tx:
st: :
Address: Project Description:
City,ST,Zip: 0
i Telephone:
State Lic.#: City Lic.M. rl
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Arch.,F.ngr.,Designer. T�AIAOY�
i Address:
!J62 J2 At ism 45;�Ze4
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Tele hone: ' -�.�'�'w•
p Q. 7. Construction Type: Occupancy:
State Lic.#: A!5 It
Project type(circle one): a Add n. Alter Repair Demo
Name of Contact Person: S9•Ft.: es:
Telephone#/ f Contact Person: Aw 2. Estimated V ueo�ect: cat.r
bei'. '->'-�r v �LrG�j 2>�. 7 APPLICANT: DO NOT WR 8EL0 S LINE
# Submittal Req'd Rec'd TRACVMG pERMiT FEES
Plan Sets Plan Check submitted ,0 Item Amoutt
Structural Cafes. Reviewed,ready for tort tions Plan Check Deposit. .
Truss Calcs. Called Contact Person Pian Check Balance
Title 24 Calci. Pians picked up Construction'
-- Flood plain ptaa_ �Plans.resubmitted ------ -Mechanical --
— Grading plan 2`i Review,ready for correctioastissue — - Electrical _ ---
-- -- Subcoataetor List - — _ Ca114 Contact Person Plumbing
Grant Deed Plans picked up S.M.L
1LO.A.Approval Plans resubmitted Grading
IN IIOIISE:- ''"Review;ready for corrections/issue Developer Impact Fee
Planning Approval. Called Contact Person LP.P.
Pub.Wks.Appr ' Date of permit issue
School Fees
Total Permit Fees
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