06-2103 (AR)Q
P.O. BOX -1504
78-495 CALLE TAMPICO.
LA QUINTA, CALIFORNIA 92253
Application Number: 06-00002103
Property Address:. 51205 CALLE QUITO
APN: 770-143-009-109 -000000-
Application description: ADDITION - RESIDENTIAL
Prnne?rty Zoning: LOW DENSITY RESIDENTI.A.L
Application valuation: 372
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT',
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 Profession m is in full force and effect.
License/Cla, B 1834Date:.Z/tractor:,
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 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 185001.:
1 _ 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, thebuilding 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 contractorls) 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: 5/19/06
Owner:
BRAUCKMANN INC
50-855 WASHINGTON ST #227
LA QUINTA, CA 92253
Contractor:
BRAUCKMANN INC
50855 WASHINGTON ST
LA QUINTA, CA 92253
(760)485-9269
Lic. No.: 781834
r,F#zz"MY 2 2 200
CITY OF LA QUINTA
V1h1ArdPG nC®T ..
WORKER'S COMPENSATION DECLARATION
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
Y 1 certify that, in the. performance of the w 'ch this permit -is issued, I shall not employ any
person in any manner so a come subject r cers' compensation laws of California,
and gree that, if I d become s' compensation provisions of Section
37 ofo/f the. or/Code, I co ith those provisions.
Date: `R(S licant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. 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 noYcommenced
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 th above informationcor g er a to comply with all
city and 4countyordices and state laws relati o building constru y authorize representatives
of this cpon the above-ment ed propert s.
Date nature (Applican -
Application Number- 06-00002103
Permit BUILDING PERMIT
Additional desc '.
Permit Fee . . . . 15.00 Plan Check Fee
9.75
Issue Date . . . . Valuation
372
Expiration Date 11/15/06
.
Qty Unit Charge Per
Extension
BASE FEE
15.00
Permit . . . ELECT- ADD/ALT/REM
Additional desc .
Permit Fee . . . . 16.50 Plan Check Fee
4.13
Issue Date` Valuation . . .
. 0
Expiration Date 11/15/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
1.50
Special Notes and Comments
ADDITION OF MECHANICAL ROOM 19 SF..
Other Fees ... . . . . . . ENERGY REVIEW FEE
98
HOURLY PLAN CHECK
35.00
STRONG MOTION (SMI) - RES
.50
Fee summary Charged Paid Credited
-------------------------=-----------------------------
Due
--
Permit Fee Total 31.50 00 .00
31.50
Plan Check Total 13.88 .00 .00
13.88
Other Fee Total 36.48 .00 ..00
36.48
Grand Total 81.86. .00 .00
81.86
r '
LQPE%MIT
..
.
Bin #
City of La .Quinta
Building 8t Safety Division
P-O: Box 1504, 78-495 'Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
p g ,
Permit #
_
Project Address: J %jsC
Owner's Name:
A. P. Number:
Address:�� ec-,SSTZ
Legal Description:
Contractor:
City, ST, Zip:
Telephone:
Address:
Project Description: �,q O Q o
City, ST, Zip:
Telephone:
'
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
a e'
Telephone:
State Lic. #;
Name of Contact Person:
Construction Type: C•ccupancy:
Project type (circle one): New . Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:7/. 6.M-'7,i6
Estimated Value of Proje �26"-) .:-0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd Recd
TRACMG
PERMTT FEES
Plan Sets FRS
ZL4A AX/an
Check submitted
�/ p
Item
Amount
Structural Calcs,
R iewed, ready for corrections
Plan Check Deposit
Truss Calcs.
aped Contact, Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan
2nd 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 corre'onsrssue
Developer Impact Fee
Planning ApprovalCalled
Contact Person
-�
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees