10-0596 (RER)4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/02/10
Application Number: 10-00000596 Owner:
Property Address: 79405 BROOKVILLE WILSON DAVID W
APN: 772-040-007- - -
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 20000 ---
A
Contractor: f
Applicant: Architect or E gineer: SANTUCCI BUILDERS I 1
v1/A 72529 BEAVERTAIL 22 E CEP Q 2010
PALM DESERT, CA 922 v
(760)578-7757
Lic. No.: 820801 Ct11!�FWQ��TA
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
Li ense CI ss:"peri
License No.: 820801
V/ Date: l �
R -BUILDER DECLARATION
I hereby affirmpt 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 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 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.).
(_ I 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:
LQPER 11T
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 EXEMPT Policy Number EXEMPT
I certify that, in the performance of the work for.which this permit is issued, I shall not employ any
person in any manner s as to become subject to the workers' compensation laws of California,
and agree that, if I sho Id become subject to th workers' compensation provisions of Section .
_ 00 of the Labor Cod , 1 shall forthwith com ly with those provisions.
/te: % l Applicant: `
WARNING: FAILURE TO SECURE W R RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI 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 1 ave read this application and state that the above information is correct. I agree to comply with all
city and cow y or 'antes and state laws relating to wilding construction, and a eby authorize representatives
of this y to ter upon the above-mentioned pro rty for inspection purp ses.
0<ate: gnature (Applicant or Agent):
w�'�
• �3
Application Number . . . . . 10-00000596
Permit . . .
BUILDING PERMIT
Additional desc
INTERIOR REMODEL
.Permit Fee . . . .
207.00
Plan Check
Fee
134.55
Issue Date . . . .
Valuation
. . . .
20000
Expiration Date
1/04/11
Qty Unit Charge
'Per
Extension
BASE FEE
45.00
18.00 9.0000
-------------------------
THOU BLDG 2,001-25,000
--------------------------------------------------
162.00
Permit
ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee . . .
35.25
Plan Check
Fee
8.81
Issue Date . . . .
Valuation
. . . .
0
Expiration Date . .
1/04/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
27.00 .7500
-----------------------------7-----------------------------------------------
PER ELEC DEVICE/FIXTURE
1ST
20
20.25
Permit . . .
MECHANICAL
Additional desc .
Permit Fee . . . .
41.50
Plan Check
Fee
10.38
Issue Date . . . .
Valuation
. . . .
0
Expiration Date
1/04/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
3.00 4.5000
EA MECH VENT
INST/ DUCT ALT
13.50
2.00 6.5000
----------------------------------------------------------------------------
EA MECH VENT
FAN
13.00
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . .
51.00
Plan Check
Fee
12.75
Issue Date . . . .
Valuation
. . . .
0
Expiration Date
1/04/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
5.00 6.0000
EA PLB FIXTURE
30.00
1.00 3.0000
EA PLB WATER
INST/ALT/REP
3.00
1.00 3.0000
EA PLB FIXTURE
DRAIN/VENT
REP/ALT
3.00
----------------------------------------------------------------------------
Special Notes and Comments
INTERIOR REMODEL TO BATHROOM
AND
LQPERN11T
Application Number . . . . . 10-00000596
----------------------------------------------------------------------------
Special Notes and Comments
LAUNDRY. 9/02/2010 REVISION TO BATH RM.
LAYOUT & ADD SINK. R-3 OCC. TYPE V -B
CONSTRUCTION. 2007 CODES / 2008 ENERGY.
----------------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
ENERGY REVIEW FEE 13.46
HOURLY PLAN CHECK' 17.50
Fee summary Charged
Permit Fee Total 334.75
Plan Check Total 166.49
Other Fee Total 31.96
Grand Total 533.20
LQPERNIIT
Paid Credited Due
.00 .00 334.75
.00 .00 166.49
.00 .00 31.96
.00 ..00 533.20
�p
Bin # ^
�h
City of La Qurnta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permlt # nn
Project Address: 7' 9 W-5 (-7
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:[
CJ Li ✓ c. t!✓�
Address:
Telephone: % ,�$?
Project Description:
City, ST, Zip:
V Z J G';
Telephone: 7 O
State Lic. # : City Lic. #,
�.
Arch., Engr., Designer: (JL4. Lyl�
I
Address: 1�?6;1 / (J
_ 14,
City., ST, Zip:
Telephone: 'L2 ^ �� U
State Lic. #: s `•<' .
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
Req'd
Recd
TRACX3NG
PERMIT FEES
ffSubmittoal
Plan Check submitted
/"
Item Amount
Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance. L
Tide 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctiofLuue
q
Electrical �
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
""Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Bin #
City of La Quinta
Building &r Safety Division
P.O. Box 1504,. 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
'D' ` `
Project Address: OS -rt"o L)"J . U- -e-
Owner's Name:QA-1/
A. P. Number: 7 74o 4 b p -7 -, `
Address: —q, o5 r O t
Legal Description (-Ael< (, S� 1-.� 1' ��
City, ST, Zip:,/` 7 avZ53
Contractor: S; i +v C . Tf—
Tele hone:?
Address: -Z2 %5--e-a v, -,+,J V':
Project Description:
City, ST, Zip: Pa v" r% (f Z 2 Z(P Q
A 1�` y►1 F7�. C
Tele hon/%"
State Lie. # : ��/L) j'jD City •Lie.`#:
Arch., Engr., Designer: (VN
Address: — b L V P
City, ST, Zip � kto--ti L%L L—S �-. a 10
Telephone: D
State Lie. #:
ii::h:r?r:•hi.i;'(i.i.i. f�:j•;�p:i*:"a'::�"::i: :{'f4�ii�:?::^:•.`^i:}
onstructionT a Occupancy: t
type ' air Demo
Project a circle one): New Addn Alter Re J ) P
i
Name of Contact Person: ��� t �---
Sq. Ft.:
# Stories:
# Units: p
Telephone # of Contact Person:-�6 v -?74 3Rq9
Estimated Value of Project: �®
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
submittal Req'd Rec'd TRACKING
PERMIT FEES
Plan Sets Plan Check submitted ?
Item Amount
77
Structural Cales. Reviewed, ready for correc '
Plan Check Deposi .
Truss Calcs. Called ntact Pers-900'rPlan
Check Bal
Title 24 Cates. Pla .,ked
Cons^h
d
Flood plain plan P miffed
technical I Aft
Grading plan 2•" Review, ready for correctio /issue
tri
subeontactor Called Contact Person
g
Grant Deed Plans picked up
H•O A. Approval lan esubmitf
VVA
IN HOUSE:- '`� epiew, rea y or rr o issueer
Impact Fee
Planning Approval Called Contac ers'
Pub. Wks. Appr Date of pC06t issue
School Fees
Total Permit Fees
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