10-1134 (SOTB)TiAt 4
P.O. BOX 1504 ^'
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 10-00001134 Owner:
Property Address: 58325 MIJAS GATES PATRICK
APN: 764-620-010-- - - 58325 MIJAS
Application description: STRUCTURES OTHER THAN BUILDINGS LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (
Application valuation: 600
Contractor:
Applicant: Architecl or Engineer: HEARTH & STONE HOME RE
/J e4 67984 CLUB HOUSE ROAD
DESERT HOT SPRINGS, CA
(760)333-7677
LIC. No.: 921441
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:
13 License o.: 921441
Date: -�y /L� 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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 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, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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 contractors) 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 ISec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERN11T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/28/10
u XT 2,-q 20110
92241
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 EXEMPT Policy Number EXEMPT
_ 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
gree that, if I should become subject to the workers' compensation provisions of Section
/
3709
of the Labor Code, I shall forth.th c�o(m�plyith those provisions.
//
Dale: L `7ipplicant: /�r`✓ &Z.
WARNING:
\ "�-
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.
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 count to en a/r upon
Date: W — the above-mentioned pro(/gerty/for inspection p poses
`Signature (Applicant or Agent):
Application Number . . . . . 10-00001134
Permit
BUILDING PERMIT
Additional desc . .
Permit Fee . . . .
15.00 Plan Check Fee
9.75
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
4/26/11
Qty Unit Charge
Per
Extension
----------------------------------------------------------------------------
BASE FEE
15.00
Permit
ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee
15.75 Plan Check Fee
3.94
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
4/26/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 .7500
PER ELEC DEVICE/FIXTURE 1ST 20
.75
----------------------------------------------------------------------------
Special Notes and Comments
18" HIGH FIRE PIT 48"
ID WITH QUARTZ,
STONE VENEER GAS LINE
(1) ELECTRICAL
OUTLET PER APPROVED PLANS
-------------------------
& S.T.
----------
Other Fees . . . . .
------------------------------------------
. . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
.98
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total
30.75 .00 .00
30.75
Plan Check Total
13.69 .00 .00
13.69
Other Fee Total
1.98 .00 .00
1.98
Grand Total
46.42 .00 .00
46.42
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APPENDIX II: ARCHITECTURAL / LANDSCAPING IMPROVEMENT REQUEST AND AGREEMENT
Date of Request: _ / — /3=z. t
Lot +� Tract No.
• Owner/Applicant: P,4. T k I. e It- �� S
Andalusia at Coral Mountain Address: 3 s I/''j _SA
s
Local Telephone: "? Other Telephone: !
• Architect(s), if applicable:
Architect(s)'s Address:
Architect(s)'s Telephone Number:
• Contractor(s), if applicable: C 4&L ,>
Contractor(s)'s Address:
Contractor'(s)'s Telephone: _7G O- 3 3 7 -7 G 7 i
(Attach additional sheets with name(s) of Contractors/Subcontractors, if necessary)
• Description of Improvement: (Please provide a complete narrative description of the proposed modification and include
drawings as appropriate):
• Attachments (3 sets):
❑ Full construction drawings . ❑ Specifications/Dimensioris
❑ 'Site Plan ❑ Drainage Plan
Landscape Plans ❑ Elevations
0 Other (describe/list or attach additional pages as required):
Starting Date: Estimated Completion Date: ( 0
This Architectural / Landscape. Improvement Request shall be accompanied by:
�A anon -refundable fee of X400 as a processing and review fee to check the plans for conformance with the Design Review
Guidelines. The check for this fee shall be paid to the order of Andalusia at Coral Mountain Association.
❑ A security deposit to be drawn against by Master Association for any and all direct costs to the Master Association including, but
not limited to, the following: (1) legal expenses; (2) consulting fees; (3) filing fees; (4) recordation costs; (5) nonrefundable
administrative costs (application fee); (6) costs to repair any damage to the common area and/or streets maintained by the Master
Association caused by the construction of the Architectural Improvement; (7) any other costs directly related to and/or necessary for the
supervision of the Architectural Improvement, as well as to bring the costs necessary for the Master Association to bring the
Architectural Improvement into compliance with the Master Declaration and/or these Guidelines; and (8) payment for any Enforcement
Assessment levied in accordance with the Master Association's Enforcement Procedure. The check for this fee shall be paid to the
order of Andalusia At Coral Mountain Association. This security deposit, minus Master Association's direct costs, shall be returned upon
receipt u: ML' Notice of Completion trom Owner and final sign -off by Design Review Committee.
❑ All copies of plans and specifications, as enumerated in the Application Procedure, Section 4, (page 30).
THE OWNER(S) UNDERSTANDS AND AGREES TO THE. FOLLOWING:
1 • By submission of this application, Uwe have followed the Architectural / Landscape Request Procedure as specified in the
Master Association's Architectural / Landscape Guidelines, beginning on page 29, including the attachment of three sets of any
applicable plans, specifications, drawings, manufacturer's brochures, city building permits, signed construction regulations, and/or other
descriptions as may be required by the Checklists, beginning on page 32.
Master Design Guidelines - 35 -
�r
8/1 /07
2• The architectural modifications will be made in strict compliance with the approved plans and specifications submitted with
this application. Should any changes be required at any time during the project, those changes must be approved by the Design
Review Committee Architectural & Landscaping Approval Request Form and Agreement and noted on this application.
3. Owner shall hold the Master Association harmless from all liability .related to any damage to existing residences,
improvements thereon, any common area property and/or golf course, wherever located within the Andalusia at Coral Mountain
subdivision, resulting from the installation/construction of this improvement or modification. Applicant shall advise Master Association
office promptly upon completion of the work.
4. • Any application shall be deemed 'incomplete, and the Design Review Committee shall disapprove, any and all plans and/or
specifications submitted to it for approval if the Owner fails to deliver the required fees and security deposit referenced herein.
5. Owner shall comply with the Design Guidelines of the Andalusia at Coral Mountain Master Association, and fumish copies of
these provisions to the contractor(s) engaged by Owner for the improvement. Applicant further understands that it is Owners
responsibility to ensure that his/her contractor(s) also complies with these provisions.
6• . Owner shall secure proper building permits, if required by the local governmental entity. Applicant understands that the City
of La Quinta may not approve any plans which have not yet been approved by the Master Association's Design Review Committee.
7• Owner shall pay the fees and deposits, as set forth in Section 5.3 of the Design Guidelines to process this Architectural
Request Form, the terms of which are incorporated herein by this reference.
8. Applicant agrees to complete the Properties within ninety (90) days of the Properties Approval date, unless otherwise stated.
"Properties Approval Date" is defined as the date of the letter granting
Applicant approval to
is defined as the date when the City of La Quinta has conducted its final inspection and approved the mprovement(s), or, if o building
permit is required, the date the Design Review Committee gives final approval.
9• Owner(s) agrees that he/shelthey will be solely responsible for the maintenance of the improvement
Signatures: Owner: �
Date:
Owner:
Date:
Neighbor Comments: (The comments of any owners of any home adjacent to the property lines of the applicant's
Improvement shall be required, except for landscape plans and items on the pre -approved list.)
I/We, the undersigned, have reviewed the plans,and specifications for the above requested improvement. We understand that Neighbor
Comments do not in themselves cause approval or disapproval, however the Design Review Committee may contact the neighbors to
determine more detail regarding their comments. As neighbors, we indicate below that either: (1) we -do not object to this improvement;
or (2) object with the following comments -
(For Master Association use only)
The attached request has been reviewed by the Design Review Committee and its action is:
Xchedcomments
Approved as Submitted ❑ Approved as Amended 0 Rejected Rejected, Pending Further Information 11Refer to
Date: 10 La;)
(� Signature:
4orqtheTia4tine Review -Committee.
Final Irisoection• ❑Approved as submitted
❑ Disapproved (refer to the attached comments)
Date: Signature:
For the Association Design Review Committee
Master Design Guidelines - 36 -
8/1 /07
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 2-5— J
Owner's Name:
A. P. Number:
Address: S-63 Z 5—
Legal Description:
City, ST, Zip:
Contractor• A/p ryje J?
Telephone: � ., `• � . M1
Address: C14,& •
Project Description:
City, ST, Z*&g!G A�Yi 7 t 2-Z
)-7 Cc.
Telephone: -X77G' 33 `�7
' r `y %s ^
y z
/� cf— /J• i1i ) �( st�Z
State Lic. # : 2 I 4 City Lie. C.
Arch., Engr., Designer:y
�LoC� j Wr G
Address:
City., ST, Zip:
Telephone:
:^'> ;� � . ;'�`�l'
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
ii
Submittal
Req'd
Recd
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
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrcctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
34 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