05-2481 (SOTB)4'
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00002481
Property Address: 81683 CHARISMATIC WY
APN: 767-200-999-5.3 -3,12021-
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5000
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DESERT CHEYENNE, INC.
78401 HIGHWAY 111:, SUITE G
LA QUINTA, CA 92253
(760)777-9920
_ _ — — — _ _ —.— _ _ --
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 thecBusiness and Professionals ;Code; and my License•is in full force,and effect:
License;Cl s: C53- Lifense= : 614611
t)ate: E 0 �mractor. f
OWNER -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 Contracfor's•Stste
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 thealleged 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 i$500).:
(_) J, as owneuef'the property, or my employees with wages as.their sole Compensation, will da the work, and
the structure is notintended or offered for sale (Sec. 7044, Business and Professions; Code: The
Contractors' State License Law does notapply to an owner of property who builds or improves thereon,
and..who does the work himself or herself through his or her own_emptoyees,, 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 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 wthe Contractors' State License Law.). -
(_) I am exemptunderSm. B.&P.C� for this reason
Date: S 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:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
.Date: 6/21/05
----------------------------------------------
WORKER'S COMPENSATION,DECL_A_ RATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certif(cateof,consentto seltinsurs 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 theperformance of the,work-for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number
_ I certify that, inthe 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, it I should become subje to the workers' compensation provisions of Section
3700 -of the Labor Code, I shall forth Nj corn 1 'ittAbage provisions.
'Date: licant:
WARNING_: 'FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDREOTHOUSAND
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'bensfit work'ia,performed under or pursuant to any permit, issued asaa result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold.harmless the City
of Le Quinfa, its officers, agents and employees for any act or omission related to the work being
performed under orfollowing 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,certlfy 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 construe ' n, and hereby authorize representatives
ofnterupo
thiscou -to above-mentioned property for' ape n
bate: gnature (Applicant or Agent) -
r y �
Application Number . . . . 0.5-0000248.1
.Permit . . . BUILDING PERMIT
Additional desc :
Permit Fee . . . . 72.00 Plan Check Fee 46.80
Issue Date . . . Valuation . . 5000
Expiration Date 12./18/05
Qty Unit Charge Per Extension
BASE FEE 45.00
3.00 9.0.000 THOU BLDG 2,001-25,000 27,,00
Permit . . .
Additional desc.. :
Permit_ Fee . . . .
Issue Date . . . .
Expiration Date
ELEC-MISCELLANEOUS
15.75 Plan Check Fee 3.:94
Valuation . . . . 0
12/18/05,
Qty `Unit Charge Pe_r
Extension
BASE
FEE
15:.00
1.00 .7,500 -PER ELEC
DEVICE/FIXTURE 1ST 20
.75
Permit . . PLUMBING
Additional desc .
Permit Fee 16.50
Plan Check Fee
4.13
Issue Date . . .
Valuation . .
. . 0
Expiration Date .. 12/18/05
Qty Unit Charge Per
Extension
BASE
FEE
15..00
2:00 .7500 EA PLB
GAS PIPE >=5
1.50
Special Notes and Comments
-------------------------------------
BBQ (ANSI# Z21-58-19.9.5)& FIREPIT
(ANSI
#ZZ23:1)PER APPROVED PLANS
-----------------------------------------------------------------------------------
Other Fees . . . ENERGY REVIEW FEE
4.68
Fee summary Charged
-------
Paid Credited
Due
-----------------
Permit Fee Total 104.25
.00 .00
104.25
Plan .Check Total 54..87
.00 .00
54.87
Other Fee Total 4.6.8
.00 .00
4.
Grand Total 163.8.0
.00 .00
163.80,,)
LQPERMIT
!:
Bin # _ City -of [a.. Quin ta
Building 8t Safety Division .
'. Pty P.O. Box. 1,504, 78-49S• Calle Tampico .
i • b Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: /
Owner's Name:
A. P. Number:
'Address: "
- "
Legal Description:
Contractor.
L'
City,'ST, Zip; -
Te! hone: —
Addres§: IVl
Project Description:
City. ST, Zip: U %3q.b.
Telephone:
Lic. # : l !
City Lic. #:
A0,
- -
., Engr., Designer •-
ress:
. ST,; Zip:
�r/llTria
[:rch
phone:
Y 4 J +f¢'' k':`
� m s '^ >'_ s
�v.o
Constiuction'Type: Occupancy:
Pro ect- circle one a Add n Alter Re air Demo
j tYPe E )' Pe
Sq. Ft.: it Stories: #Unitsphone:
-ucc. #.:
of'Contact Person:
it of Contact Person: G �s�f
Estimated Value of Project: * . O�
Ir PPLICANT: DO NOT WRITE BELOW THIS LINE
p
ubmittal
Rcq'd
Recd
TRACI:INC (;p l3/a.
PERMIT FEES-
Plan Sets
Plan. Check submitted
:1
item Amount
Structural Glu.
Rtviewed, ready for•corrcetions
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Tide 24 Cales.
Pianrpict:ed up
Construction
Flood plain-plan
Plans resubmitted,
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
SubconUctor List
Called Contact PersonPlumbing
Grant Deed
Plans picked up
S M.L
H.O.A. Approval
Plans. resubmitted
Grading
INROUSE:-
Review, eeady[or eorrectionsrssue
Developer lmpac1Tee
Planning Approval
Called Contact Person
A.I:P.P.
Pub. NA'ks. Appr
Date of permit issue
School Fees
Total Permit Fees
G-reS�e P;k �l Z�23 ,
:..:: _..�_.... � � Q (�� S� .•�d- . � 2 � �-ss�- tars
' [444
I
Sl!�e 15 DET
N fl�uns3�. �w.a.
dVi4a sru 8 �? f
u � X12' i r • � " ,:
:;Wlhu wrrFk
(TYP. 2)
I l,� ae
.arc
V-ArNJcAn- 54,qWO4
tbT -53
l.A- QU W -r*
40.0,4 Jim
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
Dfl E Byog�:4
�8'�Ti/Qg� dray ��'xBZ.
Ip ew`rwtL vorL &
W1 Ej Ff -pBorrt V a4J
LrNA �'TUGcn �Nrs�(
sB"T✓moo das RFS tt
7-ILE
A4 AL \1£�
-to coo
.AAAfh0 :�r77 -41,4 HorDcre-
/,VL .
arf S m�� cvul kiticho SanJarrrf �, o
f
7-1
�LL
------- ----------- 7
L-------------------- i
y5000M,5
eeeE)e e
al M?MCTEP ou I
—AaW" ted"
W VdL%p)