SOTB (13-0711)P:O. BOX 1504
787495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T-4:ty� 4 4v Qum&
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 13-00000711
Property Address: 52125 MERIWETHER WY
APN: 767-200-998-84 -330761-
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5000
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I a licensed under provisions of Chapter 9 (commencing with _
Section 7000) of Division 3 of the Business d Professionals Code, a y -License is in full force and effect.
License Clas : C7 -CIO -D28 F Li a No.: 660756
Date:,�'C� 'Contractor.
WNER-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 contractorls) 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.). I
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/20/13
Contractor:
INTERACCESS SYSTEMS
79521 COUNTRY CLUB DRIVE
BERMUDA DUNES, 201
(760)345-0478 D
LiC. No.: 66075
JUIN n2013
-
--ER-COMPENS�'� . --- - - - --
- -
---------------- - WORK
I hereby affirm under penalty of perjury one of th ons:
_ 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 TWIN -CITY FIRE Policy Number 72WEC8552MH
_f 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 become subject to the workers' compensation laws of California,
and agree that, if I shout ecome subject to the workers' compensation provisions of Section
37 0 of the Labor C , Z I shall forthwith cor those provisions.
2,
,'Date: -- Y /i pplicant: /1
WARNING: FAILURE TO S RE W S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER O CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 co my ordinances and state laws relating to building onstruction, and hereby authorize representatives
of this cgu ty enter upon the above-mentioned property r inspection purposes.
Date:- '� Signature -(Applicant or Agen /
t
LQPERAI[T
Application Number . . . . . 13-00000711
Permit . . . . . . BUILDING PERMIT
Additional desc
Permit Fee . . . . 72.00 Plan Check•Fee'.
46.80
Issue Date . . . . Valuation . . .
. 5000 -
Expiration Date 12/17/13
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 . . . . 18.00 Plan Check Fee
4.50
Issue Date Valuation . . . .
0,
Expiration Date 12/17/13
Qty- Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.0000 EA ELEC PWR APP <=1
3.00
-------------- 7 ------------------------------------------------------------
Special Notes and Comments
ENTRY GATES W/ FOUNDATION SUPPORT PER
ENGINEERED DESIGN. INCL.ELECTRICAL
CONTROLLERS. ENGINEER: REZA ASGHAPOUR
C67613. 2010 CODES.
----------------------------------------------------------
-------------------------- 7-------7-----------------Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
Other
1.00
HOURLY PLAN CHECK
70.00
STRONG MOTION (SMI) - COM
1.05
Fee summary Charged Paid Credited
---------- ---------- ----------- ----------
Due
-----------------
Permit Fee Total 90.00 .00 .00
90.00
Plan Check Total 51.30 .00 .00
51.30
Other Fee Total 72.05 .00 .00
Other
72.05
Grand Total 213.35 .00 .00
213.35
I Sin. #. � r .
y � 7, 6P ty of La, Qurnta
57j? 1� ttirl Building a Safety Division
" Permit # P.O. Box 1504,.7#-495 Calle Tampico
i La..Quinta, CA 92253 - (760) 777-7012
.i Building Pelrmit'Applicadon and Tracking Sheets:
✓� D3
A%;mwzez cif/ Owner's Name:. xox. � 4J 6-Avwo.
r=n
Address: P Otion: City, ST, Zip:. LAZA�p7�(
Telephone:
V 77
Project Description: Q
City, sT. Zip: Di Gf>i c1.?�oJ . p �% AIAILI
'j Telephone �� 87�
�f.�'r -•
Lie. _#.: 7 9111-151,5 r
Designer
FAddreFss:-
City Lie- #;
�`(
City.,ST, Zip:
Telephone: , /
Construction Type... Occupancy: A"
State Lic. #:
Project type (circle on :. ew Add'a Alter Repair Demo
Name of Contact Person: ;:771l 0
ta>rOT.-W Sq. Ft-: # Stories: /V # Units: i✓�
Telephone # of Contact Person: (a0
3Cf EstimaW Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
M Submittal Req'd
Recd TRACKING PERMIT FEES'
j
Plan sets
Plan Cheek submitted 1 Item Amount
Structural Calcs.
Reviewed, ready for corrections (: P% Plan Check Deposit. .
Tram Cake.
CaUed Contact Person '. Plan Check Balance"
Mile 24 Cales.
Pians picked up Coastractlon '
Flood plain plan
Plans resubmitted.. Mechaiiteal
Grading plan
V Review, ready for correcti-4ue Electrical
Subeontactor List
Called Contact Person j►1 6 Plumbing
Grant Deed
Plans picked up S.M.I-
H.O.A: Approval
Plaits resubmitted Grading
IN ROUSE:-
Review; ready for eorreetions/issae Developer Impact Fee
Planning Approval
Caked Contact Person AXP-P-
Pub. Wks. Appr '
Date of permit Issue
! Sc4061 Fees
.. 0 - •'1l 2l3.3'� .
Total Permit Fees