SPIN (08-0438)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08 -00000438 -
Property Address:
52600 AVENIDA MENDOZA
APN:
773-303-004-20 -000000-
Application description:
SPECIAL INSPECTION
Property Zoning:
COVE RESIDENTIAL
Application valuation:
100
T-iht- 4 4 Q" -
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
---------------------------7----------------------
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: License No.:
Date: Contractor:
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
a y pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( ) .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
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 _ 1 1, 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 /l—
ate: 3 12 caner >�v2 SMR
CONSTRUCTION LENDING AGENCY
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: pIr
LQPERDIIT
Owner:
CHARLES COLEMAN
52600 AVENIDA MENS
LA-QUINTA, CA 922E
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/12/08
------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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 Policy Number
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 a come subject to the workers' compensation laws of California,
and agree that, if I sh be' a subject to the workers' compensation provisions of Section
37000 of the La ode h forthwith comply with those provisions. �f !/
ate*3-12-00 A is F� C. COrLFi A4411
WARNING: FAIL E 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 a e inform ion is correct. I agree to comply with all
city and county ordinances and st a laws relating to buildi truct* n, and hereby authorize representatives
of thi2 u/nty to enter upon th ove-mentioned grope ns on purposes.
ate:J—f 2— 0O Si ature (Applicant or Agent -
Application Number
Permit .
Additional desc
Permit Fee . . . .
Issue Date
Expiration Date .
. . . . 08-00000438
SPECIAL INSPECTION
100.00
9/08/08
Plan Check Fee . .00
Valuation . . . . 100
Qty Unit Charge Per Extension
BASE FEE 100.00
----------------------------------------------------------------------------
Special Notes and Comments
SPECIAL INSPECTION TO ALLOW IID TO
REPLACE ELECTRIC METER, PREVIOUSLY
REMOVED, POSSIBLE TAMPERING
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 100.00 .00 00 100.00
Plan Check Total .00 .00 .00 .00
Grand Total 100.00 .00 .00 100.00
LQPE%NlIT
G
Bin #
City of LaQ uinta
Building 8i Safety 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: 2 &00 4YE• MEW
Owner's Name: G —F -MA
A. P. Number: ---"
Address: S 2 �20 AVE d EN 26
Legal Description:
Contractor:
City, ST, Zip: LA" Qll1N 2Z�3
Telephone:
Address:
Project Description: N l..! i Ni3 i2 'OPGA1ZE 2 ,
City, ST, Zip:
Covep- LiZ Fug -E-0 SiEunc, J C�
Telephone:
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: i �
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2nd Review, ready for corrections/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:-:
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
YrT %100.7 7 �71 l �--