08-1284 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
08-00001284.
49200 COACHELLA DR
646-030-004-1 -000000-
ADDITION - RESIDENTIAL
GOLF COURSE
16000
Tiht 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT'
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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 Professional Code, and my License is in full force and effect.
License Class: B icense No.: 803175
ate: I tractor:
OWNER -BUILDER DECLARATION
1 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 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 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/11/08
Owner:
BRZOZOW SKI FRED
Contractor:
JET PROPERT
44489 TOWN
PALM DESERT
(760)341-8757
Lic. No.: 803175
W
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 f r which this permit is issued, I shall not employ any
person in any mann4asomes ect to the workers' compensation laws of California,
and agree thatif I sub t to the workers' compensation provisions of Section
W/.pplcant:
abor rt i comply with those provisions.
te: "
WARNING: FAILURE TO SECURE WORKE S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL 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 I have read this application and state that the a ve ' _ atio c rect. I agree to comply with all
city and my ordinances an tate laws relating to bu' in o cti , an ereby authorize representatives
of thi �(o/u/P/,ty Vhe above-mentioned grope for' s e pu oses.
ate: t!' r� -e (Applicant or Agent):
Application Number . . . . . 08-00001284
Permit . . . BUILDING PERMIT INV FEE
Additional desc .
Permit Fee . . . . 342.00 Plan Check
Fee
111.15
Issue Date . . . . Valuation
. . .
. 16000
Expiration Date . • 2/07/09
Qty Unit Charge Per
Extension
BASE FEE
90.00
14.00 18.0000 THOU BLDG 2,001-25,000
252.00
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Special Notes and Comments
----------------
ADDITION OF PARAPET AROUND PERIMETER OF
HOUSE, GUEST HOUSE AND GARAGE..
INVESTIGATION FEE ASSESSED PER 1997
UNIFORM ADMINISTRATIVE CODE §304.5 FOR
WORK BEGUN WITHOUT BUILDING PERMIT.
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Other Fees . . . . . . . . . ENERGY REVIEW FEE
11.12 .
,-STRONG MOTION (SMI)
- RES
1.60
Fee summary Charged Paid Credited
Due
'
-----------------------------------------------
Permit Fee Total 342.00 .00
----------
.00
342.00
Plan Check Total 111.15 .00
.00
111.15
Other Fee Total 12.72 .00
.00
12.72
.Grand Total 465.87 .00
.00
465.87
LQPERMIT
CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS �I—�� �I PERMIT NUMBER OWNERBUILDER Jr K -S7
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
sifica i
Trade / Clas tion
;. .:
Contractor'
:..,
State.Contractor's License :
W:oikersCom ensation:Irisurani:e ' :` ` ':.
City. Business License::..:
Company Name
Classification
(e.g. A. B, C-81
License Number
(xxxxxxl
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xxl
License Number
(xxxxi
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
CONCRETE (C-8)
FRAMING (C-5)
STRUCT: STEEL (C•51)
MASONRY (C-29)
PLUMBING (C-36)
LATH PLASTER (C-35)
.
1
S
��
1p l
DRYWALL (C-9)..
HVAC (C-20)
ELECTRICAL (C-101
ROOFINGIC-391:: ' `::;
(�1Z1K�i�CE; I�awfisl t�FC�:b�
i✓ 3
13(P y
��o
,,G2e
�
/
2cl 1
D O
SHEET METAL (C-43)
FLOORING (C-15):
GLAZING (C-17):
INSULATION' (C-2) .
SEWAGE DISP. (6-42)
PAINTING (C=33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27)
POOL (C-53)
Bin #
City of La Quinta5z"'
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and ?racking Sheet
Permit # Zv
0a
Project Address: Ci _ 2-M
Owner's Name: ,
A. P. Number:
Address: G
Legal Description:
City, ST, Zip:
Contractor: ,
Telephone:
Address:
Project Description:
City, ST, Zip:
2-7-&C
Telephone:
g
State Lie. # : ?j i ��
Arch., Engr., Designer:
City Lic. #:
Address:
City, ST, Zip:
GA, q2,21.0
Telephone: 60—� 6�
Construction Type: Occupancy:
State Lie. #:
Project type (circle one): New Add'n ter Repair Demo
Name of Contact Person:
IVA
Sq. Ft.:
# Stories
Units:
Telephone # of Contact Person: S
— W 5
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd�
. G� 'i n.n PERMTT FEES
Plan Sets
Plan Check submtt�8 1
Item
Amount
Structural Calcs.
Reviewed, ready orj jorrel�i�ns 2 9 Z00 1U)
Plan Check Deposit
Truss Calcs.
Called Contact P rson
Plan Check Balance
Energy Calcs.
Plans picked up y Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2°d Review, ready for correctionTissue 8 1 AfElectrical
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/iss Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue V, (OrivIZ
School FeesA
IN�'A � �O^/
85
• �OKKv1 rJ (3
Total PerFeesAql
g�lr ��rcwvcNS 61rR�c M1PPRo�-