06-0091 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Titit 4 4 IZ"
BUILDING & SAFETY DEPARTMENT
VOICE (760) 777-7012 a1
FAX (760) 777-7011.
INSPECTIONS (760) 777-7153
--------------------------------------------------
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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 _ 1. 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
/Date:
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:
LQPERDIIT
WORKER'S COMPENSATION DECLARATION
Date: 1/10/06
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 Policy Number
1 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 that, if I should become subject to the workers' compensation provisions of Section
370/0 of the Labor Code, I sha forthwith/c�o/mply with t se rovisions.
®"ate:411 b ` APPlica K - l
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. -
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 construction, and hereby authorize representatives
of this co ty to nter upon the above-mentioned property for inspection pure es. Iq
.date. % C Signature (Applicant or Agent): Z /1
BUILDING PERMIT
Application Number: 106=00000091'
Owner:
Property Address: 79450 CETRINO
CROCKETT STEPHEN GARY
APN: 772-120-044- - -
79-450 CETRINO
Application description: STRUCTURES OTHER THAN BUILDINGS
LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
0
-------------------------------
Application valuation: 1300
D
JAN
® 200fi
ntractor:
Applicant: Architect or Engineer:
ner
0)
TA
--------------------------------
--------------------------------------------------
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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 _ 1. 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
/Date:
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:
LQPERDIIT
WORKER'S COMPENSATION DECLARATION
Date: 1/10/06
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 Policy Number
1 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 that, if I should become subject to the workers' compensation provisions of Section
370/0 of the Labor Code, I sha forthwith/c�o/mply with t se rovisions.
®"ate:411 b ` APPlica K - l
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. -
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 construction, and hereby authorize representatives
of this co ty to nter upon the above-mentioned property for inspection pure es. Iq
.date. % C Signature (Applicant or Agent): Z /1
Application Number . . . . . 06-00000091
Permit . . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . .
31.00'.
Plan Check Fee
20.15
Issue Date . . . .
Valuation . . .
. 1300
Expiration Date . .
7/09/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
8.00 2.0000
----------------------------------------
HND BLDG
501-2,000
------------------------------------
16.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . .
15.75
Plan Check Fee
3.94
Issue Date
Valuation . . .
. 0
Expiration Date
7/09/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 .7500
----------------------------------------------------------------------------
PER ELEC
DEVICE/FIXTURE 1ST 20
..75
Permit
PLUMBING
Additional desc .
Permit Fee
18.00
Plan Check Fee
4.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
7/09/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
FIREPIT & ELECTRIC ONLY.
----------------------------------------------------------------------------
Other Fees . . . . .
. . . ENERGY REVIEW FEE
2.02
Fee summary Charged
-------------------------------------
Paid Credited
--------------------
Due
Permit Fee Total
64.75
.00 .00
64.75
Plan Check Total
28.59
.00 .00
28.59
Other Fee Total
2.02
.00 .00
2.02
Grand Total
95.36
.00 .00
95.36
LQPERMIT
l
City of La Quinta
Building 8E Safety Division
- P.O. Box. 1504, 78-495 Calle Tampico
La Quinta, .CA 92253 -.(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Proj� ect d ress��
Owner's Name:
A. P. Number:
Address: /V&
Legal Description:
City, ST, Zip:
Co�or: al�n_e _ _�u i del
r.r. -
Telephone:
J
Address:
Project Description:
City, ST, Zip:
Telephone:*
Ace ~ L se
State Lic. # : City Lic. #:
Arch., Engr., Designer:
he
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n ` Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value_ofP_roject: 6 Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
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
Energy Cales.
Plans picked up
Construction
Se-t R
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for corrections/issue
1Electricaliko
J
Subcontactor List
Called Contact PersonPlumbin
ie
0,37N25
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
Rev' d or r_ iiTsAee
'"
Developer Impact Fee
Planning Approval
DEPT•
A.I.P.P.
Pub. Wks. Appr
t o a iVY ED
School Fees
FOR CONSTRUC
DA
Total Permit Fees