07-2758 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
t4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
A15p1ication-Numb6r:- — 07-00002758__
Property Address:. _81853 RUSTIC CANYON DR
APN: 764-280-999-49 -300237
Application description: STRUCTURES OTHER THAN BUILDINGS '
Property Zoning: - MEDIUM HIGH DENSITY RES
ihppljc utior, 'daluotion: 1000
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
(•hereby affirm under penalty of perjury that I m licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business.1d Professionals Code, and my License is in full force and effect.
License Clas: C8 C27 C29 License No.: 656128
Date: l Contractor:
ER -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 f
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 1 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
'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.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors toconstructthe 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 _ 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/15/07
Owner:
VAN BUSSEL RESIDENCE -
81-853 RUSTIC CANYON DR.
LA QUINTA, CA -22253
Contractor: p
TESERRA q®AP.O. BOX 10 6
COACHELLA, CA-.9='*0��'
(7 6 0) 3 9 8 -
Lic. No.:'656128
------------------
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 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 ma*RKER
'come subject to the workers' compensation laws of California;
and agree that, isubject to the workers' compensation provisions of Section
/(app/>-�J��37700'of the Labrf rthwith comply with those provisions.
_Dae:��*J� _icant:WARNING: FAILURE TO SECUROMPENSATION COVERAGE IS UNLAWFUL, AND SHALLSUBJECT AN EMPLOYER TO CTIES AND CIVIL FINES UP TO ONE HUNDRED No
DOLLARS 1$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.
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 building const uction, and hereby authorize representatives
of this county toe er upon the above-mentioned gr
op
e
r insp coon purposes.
(Date: d_511rnature (Applicant or_Agent):
LQPERMIT
Application Number
07-00002758
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee. ..
25.00 Plan Check Fee •.
16.25
Issue Date . . . .
Valuation . . .
. 1000
Expiration Date
4/12/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
5.00 3.0000
HND BLDG 501-2,000
10,00
Permit
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee
17.25 Plan Check Fee
4.31
Issue Date
Valuation
0
Expiration Date
4/12/08
Qty Unit Charge
Per
Extension '
BASE FEE
15.00
3.00 .7500
----------------------------------------------------------------------------
PER ELEC DEVICE/FIXTURE 1ST 20
2.25
Permit
PLUMBING
Additional desc .
Permit Fee . . . .
18:00 Plan Check Fee
4.50
Issue Date . .
Valuation . . .
. 0
Expiration Date
4/12/08.
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
.BBQ & FIREPIT PER APPROVED
PLAN ONLY
Fee summary Charged
Paid Credited
Due
Permit Fee Total
60.25 .00 .00
60.25
Plan Check Total
25.06 .00 .00
25.06
Grand Total
85.31 .00 .00
85.31
LQPERMIT
GRILL STEEL STAINLESS I
LIGHT �' •SINK .
"' PROVIDE VENT, WASTE, AND
FT.
I ENE OR PLUMBING FOR SINK ON SEPARATECONSTRUCTION DOCUMENT. OUNTER
i OO 0O !
GFI
aOUTLETPRE-HUNG O O F
> S.S. DOORS STUCCO OR LIGHT
e STONE SWITCH
} \ VENEER (WATERPROOF)
VARIES B61.�1t'
� FREE-STANDING OUTDOOR KITCHEN -FRONTVATION BSI #
ELE/yry
U.L. APPROVED.
-------------
LIGHT
w
- GRILL
Fh
I i
IA LAN FREE-STANDING OUTDOOR KITCHEN' PADAPT DIMENSIONS I
I/2"=LAN # TO FIT APPLIANCES
6X8X16 CMU- GROUT•.CELLS WITH STEEL
r _#4 BARS VERT. AT 24 O.C. (Typ.
_ I
I BBR LAYOUTS MAY VARY.
FOOTING SIZE 8, REINF. ARE TYPICAL. I
Ic
• •LENGTH VARIES .
FREE-STANDING OUTDbOR KITCHEN FOUNDATION PLAN
•
STONE CAP, TILE
OR POURED CONC.
#4 BAR HORIZ. AT '
3" 32" O.C. (TYP.) j
6X8XI6 CMU
M GROUT CELLS WITH STEEL
VERTA T
F.S. 24' O.C. (TYP.).
r A I
244 BARS HORIZ. CONT.
6' C VARIES 6"I
C FREE-STANDING BBQ WALL SECTION D BBQ ISLAND -SIDE ELEV
J( I„I� Ai -- -
11
#4'TIE
STEEL AT
36" DIAM.
TOP COURSE
-- WATERPROOF
INSIDE DIMENSION
GAS FIRE RING:
(MEMBRANE
IOR
TE
I.C.B.O. —
SURFACES)
ANSI #
#4 BAR
BTU —.
VERT AT
U.L. APPROVED.
3ZI O.C.
{TYP.)
7A
7B
LENGTH -OF -GAS PIPE-
XSXB C U
a----
DIAM. OF GAS PIPE
SOLID GROUT
OUTDOOR FIRE RING
GAS LINES SHALL BE INSTALLED
GAS -SHUTOFF
PER CPC FOR DEPTH,
VALVE GRAVEL
LOCATED COURSE COVERAGE, AND PLACEMENT.
WATER PROOF
1,
WITHIN 36 GAS LOG SAND
LIGHTER MEMBRANE
OF UNIT
(TYP.)
STONE CAP
3-1/2
#4 TIE STEEL
• #4 BAR VERT. AT 32" O.C.
_
8X8X8.CMU; SOLID GROUT
F.S. d
+ F S.
ZII
CLR
METAL GAS RISER
GRAVEL SUMP
Z' DRAIN OR PROVIDE 12" DIAM. .<
3�CU. FT.
CRUSHED ROCK
T IN G
NIN . IN FOOTING
OPE G
OUTDOOR FIRE RING STONE CAP
7A
}
i
I
T
T
,
T -7T -T
TV
r s
i
I`
1 r
Bin #
Permit #
,lx Q��%
Project Address: �5�2
A. P. Number:
Legal Description:
Contractor:
Address:
City, ST, Zip:
Telephone:
State Lic. # : 6-S
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic• #:
Name of Contact Person:
Telephone # of Contact Person:.
# Submittal Req'd
Plan Sets
Structural Calcs,
Truss Cafes,
Energy Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
INUOUSE:-
Planning Approval
Pub. Wks, Appr
School Fees
City of La Quints
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
aN Owner's Name:
Address:
City, ST, Zip:
Telephone:
:N
Project Description:
1 uL `r
Lic. #:
Construction Type:
Occupancy:
p: { Project type (circle one): New Add'n Alter
Repair Demo
�— S9 Pt•
# Stories:
# Units:
Estimated Value of Project:®�
APPLICANT: DO NOT WRITE BELOW THIS LINE
-'d TRACKING .
PERA TT FEES
Plan Check submitted1
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans kicked up .
Construction
S
Plans resubmitted
MechanicaA
2"d Review, ready for correctionsfissue
Electrical
Called Contact Person
Plumbing
'
�4S •
Plans picked up
S.M.i.
Plans resubmitted
Grading
Review, ready for correctio is tJ
Developer Impact Fee
Called Contact Person
A.I.P•P.
Date of permit issue
Total Pernik Fees
FOR CONSTRUCTION