08-1247 (ELEC)ft\
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
X08=00001247
x61276''CACTUS'SPRING DR
764-280-999-17 -300235-
ELECTRICAL
MEDIUM HIGH DENSITY RES
200
T a-vl �4 4 Q"
Architect or Engineer:
W14
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perj t I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the usine and Professionals Code, and my License is in full force and effect.
License Class: B C53 License No.: 552140
�2�, ,actor:
/ OWNER -B ILDER DEC ATION
I hereby affirm under penalty of perjury that I am exempt fr the tractor'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, 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.).
(_ 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:
LQPERMIT
Owner:
BILL & JILL GROTH
61276 CACTUS SPRING
LA QUINTA, CA 92253
Contractor:
BRYAN INVESTMENTS
P.O. BOX 1804
PALM SPRINGS, CA
(760)345-8483
Lic. No.: 552140
GROU
92263
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/23/08
--------------- - - -
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.
Ot, I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
TTT"' Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier NORTHERN INS NY Policy Number WCO281765000
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 to become subject to the workers' compensation laws of California,
and agree that, if I d become subject to the workers' compensation provisions of Section
31100 of the La r Cod , I shall forthwith comply with those provisions.
a "4✓ plicant:
WARNING: FAILURE TO SECURE WORKERS' COMPE ATION c1RAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN 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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to b construction, and hereby authorize representatives
of this cou • o enter upon the above-mentioned pr, erty or inspection purposes.
r
a[ure (Applicant or Agentl:
Application Number . . . . . 08-00001247
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 33.50
Plan Check
Fee.00'
Issue Date . .
Valuation
. . .
.. 0
Expiration Date . 1/19/09
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 18.5000 EA ELEC
SVC <=600V/<=200A
18.50
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Special Notes and Comments
RUN 75 L.F. OF 3/4" CONDUIT FOR
220
POWER TO ABOVE GROUND SPA
Fee summary Charged
Paid Credited
--------------------
Due
----------------=--------------------
Permit Fee Fee Total 33.50
.00
.00
33.50
Plan Check Total .00
.00
.00
.00
Grand Total 33.50
.00
.00
33.50
LQPERMIT
WE
1
VERIFY ALL CONCRETE
LAYOUT, FINISH, AND COLOR
WITH OWNER
GONG. STEPS
WALK
110 ELECT.
PLUG
K LOCATE 12" FROM
GONG. SLAB AND
ADJACENT TO WALL
22'
u u 9 A
EX PATIO -cr-
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GONGRETE LAYOUT Revised: 7-18-08
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EX PATIO
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # n
Project Address: W), 76 Ca
0_-t4 -S,o r I t12
Owner's Name: 2111 G ro' 7-h
A. P. Number:
Address: � X7 C-tj,s s r
D r.
Legal Description:
City, ST, Zip: �Ll Q a 1'nta
Contracfor :Tele
phone:
.......................
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Address: -P to
Project Description:
City, ST, Zip: LPa Im Sari mci
�4 3
rd
Telephone: '766-3,a-7-
M...
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UJ i r t 7For a 6 aw- G? oa Yid
State Lic. # 5 d0
city Lic. #: 0 6619
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
..... .... ..... .... .....
..... ..... .... .... .
. ... .. ... . . ...... .......
C onstruction Type: -Occupancy:
State Lic. #:
Froject type (circle one): New Add'n Alter Repair
Demo
Name of Contact Person- le rlfi
0 f- J"QaArle t3)- L, 0. ti
Sq. Ft:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec1d
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
Title 24 Calc&
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for corrections/issue
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