11-1326 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
T-fbt 4 4 Q"
Application Number: 11-00001326
Property Address: 81960_ _D_ANIEL DR
APN: 764-270-999-11 -300232-
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 17500
Applicant:
Architect or Engineer:
p'I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CHIP FURNISS
81960 DANIEL DRIVE
LA QUINTA, CA 92253
I
Contractor:
DESERT OUTDOORS INC f
79405 HIGHWAY 111, PMBh42
LA QUINTA, CA 92253
(760)399-9600 L
Lic. No.: 964474
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12./19/11
r�
-----------------7--------------------------------------------------------------------------------
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.
Licen a Class: 'C27-053 License No.: 964474
/�
_ 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.
G,
Date: % Z! �� tractor: ��.f/t�t /�/�/ IV
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 NOAGUARD INS Policy Number DEWC229889 -
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
that or she exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
cant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$5001•:
any applicant
3700 of the Labor /Code,III shall forthwith 'Comply cwith those provisions.
e: � Applicant: �
(_ 1 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sac.
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 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: 11 /�
Lender's Address: U A
LQPERMIT
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 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 ancJ.,county ordinances 90 state laws relating to building construction, and hereby authorize representatives
of tW county to enter up9K the above-mentioned property for inspection purposes.
ate: LZ l ignature (Applicant or Agent): / ��(im'►
on Number . . . .'. 11-00001326
Permit . . BUILDING PERMIT
Additional desc .
Permit Fee . . . .
189.00 Plan Check Fee
122.85
Issue Date
Valuation . . .
. 17500
Expiration Date ..
6/16/12
Qty Unit Charge
Per
Extension
BASE FEE
45.00
16.00 9.0000•THOU
-----------------------------------------------------------------------------
BLDG 2,001-25,000
144.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee.". .
15.75 Plan Check Fee
3.94
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
6/16/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 .7500
----------------------------------------------------------------------------
PER ELEC DEVICE/FIXTURE 1ST 20
.75
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
18.00 Plan Check Fee
4.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
6/16/12
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
BBQ, 43-L.F. 2' RETAINING WALL, GAS &
ELECTRIC RUN TO FUTURE EQUIPMENT AREA.
--------------------------
Other Fees . . . . .
--------------------------------------------------
. . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE-
12.29
Fee summary Charged Paid Credited
------------------------a-----------------------
Due
Permit Fee Total
----------
222.75 .00 .00
222.75
Plan Check Total
131.29 .00 .00
131.29
Other Fee Total
13.29 .00 .00
13.29
Grand Total
367.33 .00. :00
.367.33
LQPERMIT
A
BIR #
City of La Quil;ta
Building ar Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Qulnta, CA 92253 -=(760) 777-7012
Building Permit Application and Tracking Sheet
Permit # p
Project Addles: g, 1�11UFD -No4t9 U 1
wner's Name:.
A. P. Number .Legal
FAddress:
ity, ST, Zip:(� V
s.�
Telephone:
Project Description:
Description:
Contractor. -
Desert Outdoors
Address: 78-065 Main St. Ste. 205
City, ST, zip: La Quinta, Ca. 92253
Telephone: 760-399-9600:
State Lia # : --c-53 964474
Arch, Engr.,Designer Flying Buttress
t
Address: - 77725"Enfield Ln. Ste. 136
city.sT,zip: Palm Desert, CA. 92211
Telephone: 760-772-4411
-�?r
ConstructionType, . Occupancy:
State Lic. #: 33446
Project type (circle one): New. Add'n Alter Repair Demo '
Name of Contact. Person: pJ1AQ
Sq. Ft.:
# Stories:
.# Unita:
Telephone # of Contact Person:r%(Q� • •,�r%'S : ?j
Estimated Value.of Project 1� .~j V
APPLICANT: DO NOT WRITE BELOW THISIINE
#
Submittal
Req'd
'Reed
TRACMG
PERMIT FEES-
PianSets
Plan d cksubmitted
Item Amount ,
Structural Calces
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Calci.
Plans picked up
Construction
Flood plain plan
Plans resubmitted.'.
Mechanical
Grading plan
2`' Review, ready for correctionslissae
Electrical
Snbeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
1LO.A- Approval
Plans resubmitted
Grading
IN HOUSE.,
Review; ready for correcdonsAssae
Developer Impact Fee
Planning Approval.
Called Contact Person
A.M.P.
Pub. Wks. Appr
Date of permli Issue
School Fees
Total Permit Fees