RER (07-1029)77601 Los Arboles Dr
07-1029
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
/07-00001029 -
`-77601- LOS ARBOLES
658-260-021- - -
REMODEL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
52000
T d -4t 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Professionals Code, and my License is in full force and effect.
License Class: B -C10 License No.: 473996
Dater 4,07 / Contracto
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 ($500).:
1 _ I 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
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 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 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.I.
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
FLUTER
77-601 LOS ARBOLES
LA QUINTA, CA 92253
Contractor:
VANTAGE POINT CONSTRUCT
77245 INDIANA AVENUE
PALM DESERT, CA 92211
(760)200-0563
Lic. No.: 473996
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/06/07
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 STATE FUND Policy Number 0022485-2007
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
1.fr
3700 of the Labor Code, I shall forthwith co ly with those provisions.
Date. ` y o /Applicant:..i
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 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 and county ordinances and state laws relating to building construction, and hereby authorize re ntatives
of this county to enter upon the above-mentioned property for inspection pur s.
6_ e: L'O% Signature (Applicantror.Agent
sf
LQPERMIT
Application Number . . . . . 07-00001029
Permit
BUILDING PERMIT
Additional desc .
Permit Fee
423.50 Plan Check Fee
275.28
Issue Date . .
Valuation .
. 52000
Expiration Date
10/03/07
Qty Unit Charge
Per
Extension
BASE FEE
414.50
2_00-_------4_5000-THOU
--------
BLDG 50,001-100,000
---------------------------------------------
9.00
Permit
ELECT -ADD/ALT/REM
Additional desc .
Permit Fee . . . .
17.25 Plan Check Fee
4.31
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
10/03/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
3.00 .7500
PER ELEC DEVICE/FIXTURE 1ST 20
2.25
----------------------------------------------------------------------------
Special Notes and Comments
repair fire damage drywall,6 rafters
and insulation.
---------------------------------------=------------------------------------
Other Fees . . . . .
. . . ENERGY REVIEW FEE
27.53
STRONG MOTION (SMI) - RES
5.20
Fee summary' Charged Paid Credited
-----------------
Due
----------
Permit Fee Total
------------------------------
440.75 .00 .00
440.75
Plan Check Total
279.59 .00 .00
279.59
Other Fee Total
32.73 .00 .00
32.73
Grand Total
753.07 .00 .00
753.07
Bin #
City of La Quinta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # na
`O f-
Project Address: '7760k \os
Owner's Name: 15 Tc(`
A. P. Number:
Address: 2_ 6o\ L-.JA(balej
Legal Description:
City, ST, Zip:. J A,
Contractor: ^
Telephone:
Address: -- ^
Project Description:
City, ST, Zip: oc e l P C i-2 I
f , C C Tk t4
Telephone: aO0 —OZ -6
1R.,
State Lic. # : City Lic. #:
Arch., Engr., Designer: SJ e_
Address: 22 V—_(tA Qr., "I)
City, ST, Zip: `}
Telephone: 3k _Gb
State Lic. #: t`, 32) b
Name of Contact Person: (`Z
Construction Type: Occupancy:
Project type (circle one): New . Add' Repair Demo
Sq. Ft.: # s: # nits:
Telephone # of Contact Person: Ot - `6.
Estimated Value of 4jecft
APPLICANT: DO NOT WRITE BELOW THIS L NE
#
Submittal
Req'd
Rec'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, read or corrections
((q
Plan Check Deposit
Truss Calcs.
Called Contac Person
D
Plan Check Balance
Energy Calcs.
Plans picked up
V,Construction
Flood plain plan
Plans resubmitted
4/
Mechanical
Grading plan
2"d Review, ready for correctio s issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
qjda?
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
0
School Fees
Total Permit Fees
2, 1 WWA " A i io
4 Q k& /6 s9/
D/
i Ct ;tr 7JXCsP.O. BOX 1504 No. 15705
Building 78-495 CALLE TAMPICO
Address 77-591,601,611.(;2i LA OUINTA, CALIFORNIA 92253
)litre 'Rosa Coves H.O.A.
Mailing
Address 50107 C-Alle Oaxaca
City Zip • Tel.
La Qui.nta 9253
Contractor
P.ryant Universal
3462 La Campana
City Zip Tel.
palm: iprin;rs 922I'D 0 3/_0-60 2
Lic. Cit
&tCla sif. 355.57 1 Licy# 2243
Arcn., tngr.,
Designer
Address I Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)ffect. of Division 3 of the Business and Professions Code, and my license is in full force and
SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 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 or the Contractor'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 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 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, Buisness and
Professions Coda: The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon and who does such work himself or through his own employees,
provided that such improvements are rat 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
or proving that he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) iicensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of, consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a cert_ifted'copy thereof. (Sec. 3800. Labor Code.)
Policy No. 1 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 N the permit is for one hundred dollars ($100) 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 the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: 9. 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.
m
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 (5100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This Is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 160 days.
1 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.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description Install new poly urethaneii flat"
roof and. Coating over exsisting built up
.roof.
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$9,790
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
3 (i 0
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
$30.00
REMARKS
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 tine
FINAL DATE 'INSPECTOR
Issued by: ate Permit
Validated by:
Validation: