RER (04-4244)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLS TAMPICO FAX (760) 777 -7011' -
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number 04-00004244 Date 5/2_7/_04
Property Address . . . . . . 79524 MISSION DR E
APN:' 649-640-009-9 -29457 -
Application description REMODEL - RESIDENTIAL
Property Zoning . . . . . . LOW DENSITY RESIDENT A ►�-t
Application valuation 8000
Owner Contractor
------------------------------ -,------
TD DESERT DEV LTD PARTNERSHIP EDWARD$ CONSTRUC ION, BOB
79285 RANCHO LA QUINTA DR 79920 FIESTA DR
LA_QUINTA CA 92253 LA.QUINTA CA 92253
WCC: PREF INS
WC: WKN10'90403 01/01/05
CSLB: 684857 03/31/06
CCC: B
---_-- Structure Information CONVERT LIVING AREA. TO GOLF CART GARAGE -----
Construction Type TYKE V -.NON RATED
Occupancy Type . . . . . GAR, CARPORT, SHED, AG
Flood Zone . . . . . . . NON -AO FLOOD ZONE
Other struct info . . . CODE EDITION 2001 CBC
----------------------------------------------------------------------------
Permit . . . BUILDING PERMIT
Additional desc
Permit Fee 99. 00 Y , Plan Check .Fee. 64.35
Issue Date . . Valuations 8000
Qty' Unit Charge Per. k Extension
BASE FEE., 45.00
6.00 9.0000 THOU BLDG 2,001-25,000 54.00
----------------------------------------------------------------------------
Permit . ... ELECT -ADD/ALT/REM
Additional desc
Permit Fee 19.50 Plan Check Fee 4.88
Issue Date Valuation . . . . 0
Qty Unit Charge Per Extension
BASE - FEE 15.00
6.00 .7500 PER. 'ELEC DEVICE/FIXTURE 1ST 20. 4.50
-----------------------
Special Notes and Comments
CONVERT LIVING AREA TO A GOLF ART GARAGE
Other Fees ••ENERGY REVIEW FEE 6.44
,J
r.. i
P.O. BOX 1504 • VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Date: J - Z - O
Architect or En eer:
/V/
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirmand 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 Lic€ �e is irnI�ce and effect.
Claps License
No. fb
Q
Date sky I 'J -q �L. AC44-a ( A c, "2F,d`i/JA,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).):
U 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 or 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.).
U 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' 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.
__N hqQ 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
ed. erg co pe tion insurance carrier �p�gw1 um6nare
Carrier a'u itis Policy Number__ Wil +0'}-CC3-�
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 Calif ia, nd agree tha if I ould become subject o the workers' compensation provisions of Section 3700 of the Labor Code, I shall
fort comply with tho provi ions.
'� Date 5 ""` Applicant
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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury at 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
Lenders Address
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
constructs n, an hereby authorize representatives of this county o ter u on th ov entioned pr erty for inspection purposes.
Date Signature (Applicant or Agent):.•`-=�
-
M 5:-� Fi^
Page 2
Application Number
. . . . .
04-00004244
Date 5/27/04
Other Fees . . . .
. . . . .
STRONG MOTION
(SMI) -
RES .80
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
118.50
.00
.00
118.50
Plan Check Total
69.23
.00
.00
69.23
Other.Fee Total
7.24
.0.0
.00
7.24
Grand Total
194.97
.00
.00
194.97
if
X
X
M
X
Bin 1
3
City of La uinta
Q
Building at 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: 7 l --5Z 041,11 btaIll,
A. P. Number /4-YO .V0
Owner's Name: � %Lj-(-E4,
��
Address: '7q —52-4 &ss(okl' vK
Leal Description:
City. ST. Zip: u
Contractor.
FTele phone. �!
Address: .��y .Irproject
City, ST, Zip: �. Lz$3
Description: I a
O
Telephone:
State Lic. # : !'-PI [( '
City Lic. #: 3 fi
, 9AAc,/ l
-c—
Arch., Engr., Designer. L.
Address: b2S
) l 1 6 i2r ls-� l hti yip,
< ��.
City, ST, Zip: � /
Telephone: 3'C� �% `T •.:: , ":�•• ..:. -:
F,..
State Lic. #: _
Construction Type: —culcr
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL: # Stories: # Units:
Name of Contact Person: �`�
Telephone # of Contact Person: Q
stirnated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
3
Submittal
Plan Sets
Req'd
Ree'd
TRACKING
Plan Check submitted Vv
PERMIT FEES
Item
Plan Check Deposit
Amount
Structural Cala.
Reviewed, ready for corrections
Truss Calrs.
Called Contact Person)r
Plan Check Balance
Construction
Mechanical
Energy Cales.
Plans picked up S
Flood plain plan
Plans resubmitted
Grading plan
Y' Review, ready for correction ue d17
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
Developer Impact Fee
IN HOUSE:-
''' Review, ready for corrections woe
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit'
School Fees
4 )
OC
TotA Permit Fees
i