10-1079 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
"`&t�v 4 - XP Q"
Application Number: r* 10-000_01079
Property Address: 81373 RUSTIC CANYON DR
APN- 764-280.-999-41, -300236-
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 7000
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACYQR'SIDECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of erj y that I a Iicen d ffrovins of Chapter 9 (commencing with
Section 7000) of Division 3 of a usiness an rofss'namy License is in full force and effect.
Lich^se lass: C27 379421
D�r�Y on ,
/ 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, 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 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , BAP.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: lk
LQPERMIT
Owner:
ANDREW ZALESKI
81-373 RUSTIC CANYON DRIVE
LA QUINTA, CA 92253 _
VOICE (760) 777-70i2
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/20/10
Contractor: S OCT 2 2 26-113,
f.'3 '
ARTISTIC LANDSCAPE INC. L U
78206 VARNER RD, #D PMD2�4 !�
PALM DESERT, CA 92211 1 Ci�'f�FLA(id11N%`i ""t
(760) 360-1395 I iMt!"'r. ;') t
Lic. NO.: 379421
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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 DELOS INS CO Policy Number 03DKRM12 5 4
I certify that, in the perform a of the wor for which is permi iss d, I shall not employ any
person in any manners to become bject to t w rker m nsation laws of California,
and agree that, if I sh I become le t to the or rs' an tion provisions of Section
/3700 of e Labor" , I shall f ith comp th t s pro v ions.
/0 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.
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 ork being
performed under or following issuance of this p it.
2. Any permit issued as a result of this applicati b omes null and void if work is not o menced
within 180 days from date of issuance of uch ermit, or cessation of w rk for. 1 ys will subject
permit to cancellation. '
I certify that I have read this application and state t at th bove ihfor tion is cor t'ag e t comply with all
city and county ordinances and state laws relatin to b 'ding con tru 'on, and h y out rize representatives
oft c my tenter upo a above -mention rty for in e n s.
gnature (Applicant or A
Application Number . . . . 10-00001079
Permit . . . ELEC-MISCELLANEOUS
Additional desc ..
Permit Fee . . . . 19.50 Plan Check Fee
4.88
Issue Date . . . . Valuation
0
Expiration Date 4/18/11 '
Qty Unit Charge Per
Extension
BASE FEE
15.00
6.00 .7500 -PER ELEC DEVICE/FIXTURE 1ST 20
4.50
Permit PLUMBING
Additional desc .
Permit Fee . . . . 18.00 Plan Check Fee..
4.50
Issue Date . . Valuation
.0.
Expiration Date 4/18/11
Qty' Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
------------------.------------------------------------------
3.00
Permit . . . WALL/FENCE PERMIT
Additional desc ..
Permit Fee . . . 15.00 Plan Check Fee
.0.0
Issue Date . . . . Valuation .
. 306
Expiration Date 4/18/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
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Special Notes and Comments
PRE -FAB BBQ (25 L.F. GAS LINE), PRE -FAB
FIREPLACE (20 L.F..GAS LINE)16 L.F 41.
EQUIPMENT WALL, CITY STANDARD,•WALL
FOUNTAIN WITH 2 COLUMNS, ELECTRICAL
CONDUIT AND 6 OUTLETS, PER ST.'2007/2008
CODES.
------------------------------------ -------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
STRONG MOTION (SMI) - RES
.70
Fee summary Charged Paid Credited
---------- ----
Due.
----------------- ----------
Permit Fee Total 52.50 .00. .00
52.50
Plan Check Total 9.38 .00 .00
9.38
Other Fee Total 1.70. .00 .00
1.70,
LQPERMIT
Bin#
City Of'.a Quinta
Building at Safety-Mis)on
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # (,�
1� 1
(�
Project Address: 1 L IA
Owner's Name: `
A P. Number.
Address: jC �
-73 �� L V1 O'Y�
Legal Description:
City, ST, Zip: �� Q U_ L v\, x l 7
I
�-
Contractor: 1 I) C_
Address: 7_6Z_ U,b kY)O fes( yN
Telephone.
Project Description: a
City, ST, Zip:? U T eA � -J '
U l YL--- 1,1,z-e_ :4-6A.5 U
Telephone: Z&
h
� l %LIYI
State Lic. #
City Lic.
3j d
Arch., Engr., Designee
e CvN w"� Birt LeC�j
Address:
Pi i �• C. C
City., ST, Zip:
SL (,
Telephone:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
H.
Name of Contact Person: \ e
Sq. Ft :
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Projp
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACIMG
PERMIT FEES
Plan Selo
Plan Check submitted
�% D
Item
Amount
Straetural Calm
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Pian Check Balance
Title 24 Cake.
Plans picked up
Construction
Floodplain plan
Pians resubmitted
Mechanical
Grading plan
2' Review, ready for correction.%/Issue
ElecMeal'
Qp Lrs
Subcontactor List
Called Contact Person
Plu-bing4t 6^5
I t% •�FY
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Revlew, ready for correctlonsressue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fecs
?o
0
7-4t-- -i.
.�
_ __ - - �-.
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_. __._._ .. ._ .. _.. ...... _ _ _._ __�____.,_. I
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