11-0968 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-00000968
Property Address: 78174 PINNACLE POINT
APN: 770 -370 -035 -
Application description: REMODEL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 250
Applicant:
Ij�./IILAtiL
T4t�l 4 4k, Q-"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
POPMA GREGORY L & PENNY A
23400 SW STAFFORD HILL CT
WEST LINN, OR 97068
Contractor:
Architect or Engineer: , GU&,TAFSON , CONSTRUCTION
P O. BOX 6237
LA QUINTA, .CA 9.2248
��.
(760)2007a462
Lic. No.: 677600
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: . 9/07/11
2011
rrrV of LA QUINTA : .
_ LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury .that I am licensed, under provisions of ChapteP9 (commencing with
I hereby affirm under penalty of perjury.one of the following declarations:
. Section 7006) of Division 3 df;the:Business and.P7ofessionals Code, and my Lice rise is in full force' and effect.
- I -have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
_ License Class: B. a ,1�;�-. -' r License Nor 677600.. ,
- for,,by Section 3700 of Labor Code,. for the performance of the which this. permit is -
. f
-lam
It
,issued.. _ .. .. a. ..
- Dater / ' Contractor. _ -
_ I have and will maintain workers' compensation insurance,'as required by Section 3700 of the Labor
-Code,,forthe performance of the,work for which this permit is issued. My workers' compensation
OWNER -BUILDER. DECLARATION
inwrance,carrier and policy number are: '. ,
I hereby affirm under penalty of perjury that I amexempt;from t_he;Contractor's.State License Law*for the
Carrier STATE° FUND - Policy Number. .179566972011
following reason (Sec. 7031-.5; Business and Professions. Code: Any city oricounty that. requires a permit to
_'I certify that, in the `performance of the work for which'.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 manner so as'to become subject to the workers'compensation laws of California,
permit to file. a signed statement that.he or she is.licensed pursuant to the provisions ofthe Contractor's State
and agree that, 'if I should �becar6e subject to the workers' compensation:provisions of Section
License Law`IChapter 9�(commencing with'Section 70001.of Division 3 of the Business and Professions Code) or
3700 of the Labor Co ,1 shall fortt♦ ith comply with those provisions:
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).:
Date: —/'% fl Applicant: `IVa
(_ )..I,as"ownerpfahe-property, or my employees with wages as their sole compensation, will do the work, and
10
-
• 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,
SUBJECTAN EMPLOYER TO CRIMINAL -PENALTIES ANDCIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
IN ADDITION,TOHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
DOLLARS ($100,000). �T
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:). •:'.
APPLICANT ACKNOWLEDGEMENT -
(_ 1 I, as owner "of"the property,, am ectxclusively. contracting. with licensed contractors to construthe project (Sec.
IMPORTANT .Application is hereby. made to the Director of Building and Safety for a permit subject to the -
- 7044, Business ands Professions Code: The.Contractors' State License Law does not apply'to an owner of
conditions and restrictions set forth on this application. -
property who builds or improves thereon, -and who contracts for the projects with a contractor(sl licensed
1.. Each person upon,whose.behalf this application is made each person at whose request and .for -
pursuant.toahe Contractors' state-0cense Law.):
whose benefit'work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 .I am exemptunder Seo. - ', B.&P.C. for, this reason -
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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:
LQPERMIT
•'of La Quint' a; 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
withiri'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 buiclding _ struction, and hereby authorize representatives
of this county to enter upon the above-mentioned property f inspection oses.
pate: Q-7-11 Signature (Applicant or Agent): i
Application Number . . . . . 11-00000968
------ Structure Information FIRE PIT GAS/LANDSCAPE ELECTRICAL -----
Other struct info . . . . . CODE EDITION
----------------------------------------------------------------------------
2010
Permit . . . ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . . 15.75 Plan Check Fee
3.94
Issue Date . . Valuation . . .
(. 0
Expiration Date 3/05/12
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 : . =1.8-.00 Plan Check Fee'
4.50
Issuer .,Date :- Valuation ' .. -..
0
..
Expiration Date.. 3/05/12
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"
FIRE PIT GAS PIPING -FOR FUTURE LISTED.
APPLIANCE"AND':'ELECTRICAL CIRCUIT FOR
FUTURE•LANDSCAPE•LIGHTING TRANSFORMER'.
2 010. • CAL I FORNIA ` CODES,:
September' 7:; `;201.1 -5,:18.:04 -`PM AORTEGA .
---------------------------------------.-------_------------------------------
Other Fees . . . BLDG.STDS ADMIN ("SB1473')
1.00
Fee summary Charged Paid Credited
Due,
Permit Fee Total. 33.75 .00.. .00
33:75.
Plan Check Total 8.44 :'.00 .00
8.44
Other',Fee, Total 1.00 A0 .00
Y:. 00
Grand 'Total• . 43.19 0"0' .00
43,.19
LQPERMIT _
4
Bin+#
CityVof U, Que to •
4
Building a Safety Divirlon
P.O: Box 1504, 78495 Ca11e Tampico
La:Qtnnta, CA 92253.- (760) 777-7012 .
Building Perm►t Application. and Tracking Sheet
Perrriit.#
li- IA
Project Address: " 7, , `
Owner's Name: G Y
A. P. Number:
Address:. '7 VPVlY1ci
Legal Description:
..
Contractor. vg - <~ . 5 �`
City, STllzip: a � a,K 9 zZr�
telephone ,< v:'V - 3 `j 6 i- HIN
Address: U 2 -3 ?
Pro�ectDescnption:
City, ST, Zip: L _
F a(• r
Telephone: U 3:
, 'IMM'Vsa>b •f
State Lic. # :
City Lie .-.,#:
.
't'✓D O[-:
Arch., Engr., Designer,ry
✓fti:t. v
Address:
City, ST. Zip: i
Telephone: k .4_
'State Lic. #: . ; _.� . ' ,.
;,„•”
�7Constuction Type: Occupancy:
`Project :type (circle one): New Add'n Alter Repair Demo
'Name of Contact Person:
Sq. Ft.: # Stories:#Units:
Telephone # of Contaa Person:
Estimated Value ofProject: (� , U-0 1 "
APPLICANT
# Submittal RM'd Rcc'd -:
-.DO NOT WRfTE BELOW THIS UNE
r' TRACKING PERMIT FEES
Plan Sets
Plan Cheirk submitted Item Amount
Structural Gala •r
Reviewed; ready for corrections Plan Check Deposit
Tres; Catea.MCalled
Contact Person Plan Check Balance
Title 24 Cale' ''
Places picked cep 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�pickcd up S M [.
H.O.A. Approval
Plans, resubmitted Grading
IN HOUSE:-
ReOcw; ready for comectionshutic Developer Impact Fee
Planning Approval
Called Contact Person A.LP.P.
Pub. Wks. APpr
`Date 4G crmlt issue •' 'b��
School Fees .
Total Permit Fees