07-0917 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
' LA QUINTA, CALIFORNIA 92253
T4ht 4 4 Q"
Application Number:
07 -00000917 -
Property Address:
57370 PENINSULA LN
APN:
762-150-002- - -
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3000
Appljcant:
Architect or Engineer:
Intik
BUILDING & SAFETY DEPARTMENT
. BUILDING PERMIT
LICE SED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busine ar rQfessionals Code, and my License is in full force and effect.
License Class: /C8 C27 C29 \ License No.: 656128
Datei ]/�( ; Contractor
- \OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 aexempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Pr fessions 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 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.). '
(_ 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 tfie performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
FULLER RESIDENCE
57-370 PENINSULA LANE
LA QUINTA,.CA 92253 r
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(76.0)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/28/07
D°
MAR 29 2307
CITY OF LA QUINTA
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 SEABRIGHT Policy Number BB1070510
I certify that, in the perfo of the work for which this permit is issued, I shall not employ any
person in any mann so as o become subject to the workers' compensation laws of California,
and agree that, if I hould b -omeubject to the workers' compensation provisions of Section
37 f the Lab de, I II for with comply with those provisions.
D e: Applicant:
WARNING: FAILURE TO SECURE VVSKEF ' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO T E 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 restrictionsset forth on this application.
1. Eachpersonupon 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 dQfend,
indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any t or omission related td the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes ull and void if work is not commenced
within 180 days from date of issuance of such permi ssation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the ove info ation i correct. I agree to comply with all
city and count rdinances a state laws relating to buil ng constr 'on, and ereby authorize representatives
of this c unt JAn
mentioned prope for inspe n purpo as.
D te: Si ur t or Agent):
Application Number . . . . 07-00000917
Permit . . ..
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
54.00
Plan Check
Fee
35.10
Issue Date
Valuation
. . .
. 3000
Expiration Date
9/24/07
Qty Unit•Charge
Per
Extension
BASE
FEE
45.00
1.00 9.0000
----------------------------------------------------------------------------
THOU BLDG
2,001-25,000
9.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . .
16.50
Plan Check
Fee
4.13
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
9/24/07
Qty Unit Charge
..Per
Extension
BASE
FEE
15.00
2.00 .7500
PER ELEC
DEVICE/FIXTURE 1ST 20
1.50
-----------------------------------------
Special Notes and Comments
----------------------------------
GUNITE WATERFEATURE BASIN WITH 4
UPLIGHTS
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . ENERGY REVIEW FEE
3.51
Fee summary Charged
-------------------------------------
Paid Credited.
----------
----------
Due
Permit Fee Total
70.50
.00
.00
70.50.
Plan Check Total
39.23
.00
.00
39.23
Other Fee Total
3.51
.00
.00
3.51
Grand Total
113.24
.00
.00
113.24
LQPERM[T
Bin #
City of. La Quinta
Building a Safety Division
Permit # ^ P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: �_ -7
tJ Owner's Name: -FU LL zs;
A. P. Number: Address:
Legal Description: City, ST, Zip:
Contractor: Telephone:
Address:
l2 Project Description:
City, ST, Zip:��C 4,4� CA `P
Telephone: c1 ZZ 2 -
State
State Lic. # : t!p S� l z City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: Construction Type: Occupancy:
State Lic. #: Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: �570 _ ,2 Estimat d Val
N Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan
Grading,plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
e ue of Project:
APPLICANT:
DO NOT WRITE BELOW THIS LINE
Rec'd
TRACHING .
PERMIT FEES
Plan.Check submitted
3
Item
Amount
Reviewed; ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2nd Review, ready for correctionstissue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.I.
Plans resubmitted
Grading
'"Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees