07-0386 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
41
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant: NZA
0�
V
T4'yl 4 4 Q"
07-00000386
79375 BROOKVILLE
772-040-006- - -
STRUCTURES OTHER THAN BUILDI
LOW DENSITY RESIDENTIAL
18000 1
Architect or
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
qX
U CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury th I T.I cert d under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busin s afessi als Codeand my License is iri full force and effect.
Licens5,Class: C8 C27 C29 License No.: 656128
DaW4 J'v T Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I a exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and P ofessions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair a structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she s licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Sec on 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefromandthe bas i 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 _ 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
1 _ 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:
LQPERMrT
Owner:
ESTANCIAS
79-375 BROOKVILLE
LA QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236-
(760)398-9222
2236(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/02/07
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 performan a of the work for which this permit is issued, I shall 'not employ any
person in any manner so as me subject to the workers' compensation laws of California,
and agree that, if I shoul come s bject to the workers' compensation provisions of Section
/n- 37he Labor I hal forth ith comply with those provisions.
Date Applicant:
14
WARNING: FAILURE TO SECURE RK RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO HE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, I EREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made o 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 em yees for any act or omission related to the work being
performed under or following issuance of his permit.
2. Any permit issued as a result of this appli ecomes null and void if work is not commenced
within 180 days from date of issuance such rmit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state a the abov information is correct. I agree to comply with all
city and county ordinances and state laws relat to u ding co truction, and hereby authorize representatives
ofthis county to er1�LT7t upon the above-mentione ro er y for in ection purposes.
Da: , , Signature (Applicant or Ag nt
Application Number . . . . . 07-00000386
Permit . . .
BUILDING PERMIT
Additional desc . .
Permit Fee
189.00
Plan Check Fee
122.85
Issue Date.
Valuation . . .
. 18000
Expiration Date
8/01/07
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
16.00 9.0000
----------------------------------------------------------------------------
THOU BLDG
2,001-25,000
144.00
Permit
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee
17.25
Plan Check Fee
4.31
Issue Date . . . .
Valuation
0
Expiration Date*.
8/01/07
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
8/01/07
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
-----------------------------
FIREPIT/AGAL 496-BBQ/Z21-58-1995
PER
APPROVED PLAN.
Fee summary Charged
---------------------------
Paid
Credited
Due
Permit Fee Total
----------
224.25
--------------------
.00 .00
224.25
Plan Check Total
131.66
.00 .00
131.66
Grand Total
355.91
.00 .00
355.91
LQPERMIT
� L Cln"-N
Bin # City of. La Quinta
Building U Safety Division
Permit # („ P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
1� J"
Building Permit Application and Tracking Sheet
Project Address: �Ci �F'L L� Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: 5� Z -Z
Telephone:
Address: l2
Project Description:
City, ST, Zip:(f CA
CjZZ3 `P
��Z C L'pp��'J-- C
Telephone: V9 ZZ Z
{�
State Lic. # : t'p S(p ,2
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair
Demo
Name of Contact Person: N�G ��
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: cZ 5j C)—
Z, s
Estimated Value of Project: 3l Le cr,0!)
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING. PERMIT FEES
Plan Sets
Plan.Check submitted Item
Amount
Structural Calcs.
Reviewed; ready for corrections Plan Check Deposit
Truss Calcs.
Called Contact Person Plan Check Balance
Energy Cales.
Plans picked up Construction
713
Flood plain plan
Plans resubmitted Mechanical
Grading. plan"
2" Review, ready for corrections/issue Electrical
,.0
Subcontactor List
Called Contact Person Plumbing
ibZ.j
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''" Review, ready for corrections/issue eveloper Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
4fr-
Pub. Wks. Appr
School Fees
Date of per i issue
—.....�..... n n w r- T
Permit Fees
DATE---BY—.�4--