09-0986 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tit!t44Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/11/09
Application Number: 09-00000986
Owner:
Property Address: 51740 AVENIDA CARRANZA
INDYMAC
APN: 773-125-012-13 -000000-
Property Zoning: COVE RESIDENTIAL
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G
Application valuation: 0
Contractor: Sri
Applicant: Architect or Engineer:
SUPERIOR ASSET SOLUTION I j
22421 BARTON ROA #354 /�, �D69
)TERRACE, CA 92313Nc� Q�/Nr
(909)890-0460
rl
p�pT q
Lic. No.: 920391
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LICENSED CONTRAC OR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed nd provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business d P fessi ode, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License C ss: B e No.: 920391
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ate: ntractor:
issued.
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
' OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 562-0002309
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the work for ich this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any mje a workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, it t orkers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
, $700 of the Labh o ply ith those provisions.
A4.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by��
L
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
ate: 0 icant:
JL/ pl
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
_7
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
Lender's Name:
Lender's Address:
LQPERAIIT
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 i work is not commenced
within 180 days from date of issuance of such permit, or cess tion o rk for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that thea ve i form is r t. I agree to comply with all
city and county ordinances and state laws relating to buil ' cc ruc ' a by authorize representatives
oft 's county to nter upon t above-mentioned prope or i pec '
Date: nature (Applicant or. Agent):
Application Number . . . . . 09-00000986
Permit SPECIAL INSPECTION
Additional desc .
Permit Fee . . . . 100.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 3/10/10
Qty Unit Charge Per
Extension
BASE FEE
=
100.00
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Special Notes and Comments
SPECIAL INSPECTION TO VERIFY PATIO HAS
BEEN REMOVED RESOLVING CODE CASE #09-444
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
a
LQPERMIT
Bin #
City Of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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`Project Address: (_% ` o 1Jw/ ��
Owner's Name: i�J D
A.T. Number:
A d s:
Legal Description:
• Contractor:ele
'City; ST, Zip:
'T one: �>#"•`<':<� <><`>`��<
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Address: ? 2i ,3 3s--4
Prof tce Description:
City, ST, Zip: Cl 2,3 L3
c q- 4q L
=Telt hone:
P -
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'Stat&lic. #: p
`City I; c
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Ltc. #:
c :
Construction Type: Occupancy:an
ProJect hP (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
y Estimated Vilue of Project:; gyp, 0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" 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:-
''" 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