07-2085 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:_
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
. CPU
n
07-00002085 /
45150 BIRCHCREST CIR
604-412-012-21 -23995 -
STRUCTURES OTHER THAN BUILDINGS
LOW DENSITY RESIDENTIAL
4500 f!
I hereby affirm under penalty of pe
Section 7000) tof Division 3 of the
License ass: I C53
Date: V1 I'1 I V I Contractor
Architect or Engineer:
Nlk
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
GONZALEZ DANIEL
45-150 BIRCHCREST CIR
LA QUINTA, CA 92253
Contractor:
INTERNATIONAL GUNITE INC
75153 MERLE DRIVE, SUITE
PALM DESERT, CA 92211
(760)779-1503
Lic- No.: 875547
B
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/17/07
--- ---------------------------------------------------------------------------—
LICENS D CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
tat I am I censed under provisions of Chapter 9 (commencing with 1 hereby affirm under penalty of perjury one of the following declarations:
and P ofessionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License No.: 875547 for by Section 3700 of the Labor de, for the performance of the work for which this permit is
issued.
_ I have and will maintain wor ers' com ensation insurance, as required by Section 3700 of the Labor
I . - I Q - Code, for the performanc of the w rk for which this permit is issued. My workers' compensation
V OWNER -BUILDER DECLARATION insurance carrier and poli y number re:
I hereby affirm under penalty of pes,. I tha 1 am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Busin ss d Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, o re air any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that kVor 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 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.).
(_ 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 a contractor(s) licensed
pursuant to the Contractors' State License Law.).
I _ 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 the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPEPN11T
Carrier
person in any manner so
nd agree that, if 1 shouli
700 of the Labor Code,
It Date: - Q Applicant:
WARNING: FAILURE TO SECURE Woj,,
SUBJECT AN EMPLOYER TO CRIMIN 1111
DOLLARS ($100,0001 IN ADDITION tI
SECTION 3706 OF THE LABOR CODE I
_ Poli yNumber 229-0033730
:e of the ork for which this permit is issued, I shall not employ any
to beco a subject to the workers' compensation laws of California,
tome s act to the workers' compensation provisions of Section
all fort ith comply with those provisions.
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL -
LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
ST, 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 de, each person at whose request and for
whose benefit work is performed under or pursuant t any permit issued as a result of this application,
the owner, and the applicant, each agrees f<o, and sha defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for an 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 become null and void if work is not commenced
within 180 days from date of issuance of Ouch permit, cessation of work for 180 days will subject
permit to cancellation.
I certify t I ha a read this application and state tht.*nspettio
r ation is orrect. I agree to comply with all
city and co my dinances and state laws relating toc on, a hereby, authorise representatives
of this cputt y1tp nteltupon the above-mentioned grp poses.
Date: pl1 jV►�Siignature (Applicant or-Agent):t
r.4 .
Application Number . . . . . 07-00002085
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
72.00
Plan Check Fee
46.80
Issue Date
Valuation . . .
. 4500
Expiration Date-.
1/13/08
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
3.00 9.0000
-------------L--------------------------------------------------------------
THOU BLDG
2,001-25,000
27.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . . .
17.25
Plan Check.Fee
4.31
Issue Date . . . .
Valuation . . .
. 0 -
Expiration Date
1/13/08
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
3.00 .7500
PER ELEC
DEVICE/FIXTURE 1ST 20
2.25
----------------------------------------------------------------------------
Special Notes and Comments
BBQ & FIREPIT PER APPROVED
PLAN ONLY
Fee summary Charged
----------------- ----------
----------
Paid Credited
Due
------
Permit Fee Total
89.25
---------- ---
.00 .00
-
89.25 r
Plan Check Total
51.11
.00 .00
51.11
Grand Total
140.36
.00 .00
140.36
LQPERMIT
Bin #
Permit �# �(
1/�
Project Address:
A: P. Number:
Legal Description:
Contractor: 17 O—VIW
Address:
City, ST, Zip: - E
Telephone:P607-7 9 1 K-0-5,
State Lic. #
r Arch., Erii Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person: e kvct
Teleahone # of Contact Person: h o
# I Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Cafes.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
c, bre&-7— Owner's Name: & a ?J Z
Address:,1�(/.�L .
City, ST, Zip:
yJ / Te C .. Telephone:
e 2 , —�JJ// 1'3 Project Description:
� 1 .
City Lic. #:
SAFETY DEOT. I I A.I.P.P.
of
Total Permit Fees
�✓
Fee.
V
Construction Type: Occupancy:
Project type'(circle one): New Add'n Alter Repair Demo
t'le Q
Sq. Ft.:
# Stories:.
# Units:
Estimated Value of Project:. -5 tp'�7�.
APPLICANT: DO NOT WRITE BELOW THIS LINE L"T 4"(
Wd
TRACKING
Plan Check submitted 1
1
Item
Amount
Reviewed, ready for corrections
.Plan Check Deposit
Called Contact Person
Planec a ance
Plans picked up
Co truction
50711�
Plans resubmitted
Me hanical
2°" Review, ready for corrections/issue
Ele trical
Called Contact Person
PI tubing
Plans picked up
S.411.
SAFETY DEOT. I I A.I.P.P.
of
Total Permit Fees
�✓
Fee.
V