07-1952 (SOTB)Ai.
P.O. BOX 15(4.,-,--' • ;, ..
78-495 CALLE TAMPICO
LA QUINTA,.'CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 07-00001952
" Property Address: 81781 RUSTIC CANYON DR'
APN: 764-280-999-43 -300237-
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 1000
Applicant:
Architect or Engineer:
VOICE (760) 777-7012,
FAX (760) 777-7011'
INSPECTIONS (760) 777-7153
Date: 7/05/07
Owner:
WATERMAN RESIDENCE
81-781 RUSTIC CANYON
LA QUINTA, CA 92253-
Contractor:
2253-Contractor:
TESERRA D d
P.O. BOX
i COACHELL A'92236
(760)398 92 2
Lic . No : 2 8 062887
LICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury th t I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busine s and Professionals Code, and my License is in full force and effect.
License Class: C8 C27 C29. License No.: 656128
Date: Contracto '
O NER-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).:
(_ ) 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 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
oneyear 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: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of they.
` work for which this permit is issued .(Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERA11T -
WORKER'S COMPENSATION DEC ATION
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 SEABRIGHT • Policy Number ' BB1070510
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 become subject to the workers' compensation laws. of California,
and agreethat, if I should be onfe subject to the workers' compensation provisions of Section
3700 of the Labor C9q&JAUJLLorthwith comply with those provisions. _
Date: Applicant:
WARNING: FAILURE TO SECURE RKERS' 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 abo a information is correct. I agree to comply with all
city and county ordinances and state laws relating to building nstruction, and hereby authorize representatives,
sof-this cou y to�nt2er upon the above-mentioned prop. fo i pection purposes.
Date:QJSignature (Applicant or Agent):
a
. 'Application. Number .
. . . . 07-00001952
Permit. .
BUILDING PERMIT
Additional desc
"
Permit-Fee25.00
Plan Check Fee
16.25
Issue ':Date
Valuation.
1000
Expiration Date
1/01/08
Qty Unit Charge
Per
Extension
BASE :FEE
15.00:
5.00 2:0000
-----------------------------------------------------------------------
HND BLDG
501-2,000
10-00
-Permit
ELEC-MISCELLANEOUS
Additional desc.-.,
Permit Fee . . . .
15.75
Plan Check Fee
3:94
Issue Date . . . .
Valuation . . .
0
Expiration Date
1/01/08_
Qty Unit Charge
Per
Extension
BASE
FEE
15:00
1.00 .,7500
PER ELEC
DEVICE/FIXTURE 1ST 20
.75
--------------------------------------------------------------------------
Special Notes and Comments
FIREPIT PER APPROVED
PLAN ONLY
Fee summary Charged
Paid Credited
.Due
Permit Fee Total
------------
40.75
-------- - ----------
.00 .00
40.75
Plan Check Total
20.19
.00 .00
20:19
Grand Total
60.94
.00 :00
60.94.
LQPERAIIT
.
Bin #
City ®f La Quinta
Building 8z Safety Division
Permit #
G
P.O. box 1504, 78-495 Calle Tampico
La
^� `
�2
Quinta, CA 92253 - (760) 777-7012
Dr
Building Permit Application and Tracking Sheet
Project Address:
9"1141
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
-ja Telephone:
Address:
Project Description:
City, ST, Cf z23
Telephone: -2_ 2_ 2_
State Lic. #
City Lic.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Tjpe-. Occupancy:
State Lic. #:
---
Name of Contact Person:
project type (circle 0,C) New Add'r Alter Repair Demo
C to i1V Sq. Ft.: # Stories: # Units:
Telephone 4 of Contact Person: �0 - a- -
Estimated Value of Project: /000
-------------------
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal Req'd
Rec.'d TRACKING
Plan Sets
PERM-fT FEES
Plan Check submitted
Item
Structural CaIcs.
Amount
Reviewed, ready for corrections
Plan Check Deposit
Truss CaIcs.
Called Contact Person
Energy CaIcs.
Plan Check 3alance
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2n' Review, ready for correctionsfissue Electrical
Subcontactor List
Called Contact Person
Grant Deed
Plumbing
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
rN HOUSE:-
Review, ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
A.I.P.P.
Date of permit issue ---
School Fees
0
CITY -rV r PT�T .
al Peqmi! Fees
3 �o I sQ UA Pz
IIJS�D� �IMENS�oN
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