11-0121 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4&t 4 4zQ,"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
Application Number: 1.1_0.0.0_12;1 Owner:
Property Address: 55700 PINEHURST PGA WEST RESIDENTIAL ASSOC
APN: 775-2'41-010- - - 54320 SOUTHERN HII._s
Application description: REMODEL - RESIDENTIAL LA QUINTA, CA 922
Property Zoning: LOW DENSITY RESIDENTIAL Other structi'a�L t
Application valuation: 4500
y 4
, 1
Contractor:
jG_A ��;ih3i'A
Applicant: Architect or Engineer: Owner �1nf or i:,t iii•3' ��
PIC
2/04/11
LICENSED CONTRACTOR'S DECLARATION .WORKER'S COMPENSATION DECLARATION
'r I hereby affirm under penalty of perjury that licensed -under provisions of Chapter 9.Icommencing with I hereby affirm under penalty of perjury one of thefollowing declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, :as provided .
License
Class: " ' •License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
'Issued. ,
Date: .Contractor: -I have and willmaintain workers' compensation insurance, asreouired by Section 3700 of the Labor _
Code, fortheperformance of. the work forrm
twhich this peiYis issued. My workers' compensation
OWNER -BUILDER DECLARATION. insurance carrier and•policy numberare:. >
I hereby affirm under penalty,of perjury; that l'amexempifromthe Contractor's State License Law for the Carrier -- - - - -'- - - -= `-= •-='----Policy Number
following reason (Sec. 7031..5, Business and Professions Code: Any city or county that requires'a permit to I certify, that,in the performance of the work for'which this permit is•issued,'l,shall'not employ any
construct; alter, improve, demolish, or repair any structure,prior to its issuance, also requires the applicant for the. person in any manner so as tombecome subject to the workers}compensation laws of California,
.permit:to file_'a signed statement that he or she is licensedpursuani-to the provisions of,the cci tractor'sm
'State - and agree that, if I•should become subjectao the.workers' copensaiion'provisions of Section -
License Law (Chapter,9 (commencing.with Section 7000)'of Division 3 of the'Business and Professions Code) or. 3700 of the Labor Code, I shall; forthwith, comply with ;those provisio
that he or she is exempt therefrom :and the basis for.the alleged exemption. Any violation Section 7031.5 by ry .K .VJ -
. " any applicanTfor. a permit subjects the applicant to a civil penaltyofnot more than fivehundred dollars ($500).: - ate: scant . " -Y yr �• �I
(_ ) I,.as owner oftheproperty, or my,employees with wages as their sole compensation,.uvill do the -work, and :. the structure*is.notintended or.offered for sale (Sec. 7044;,Business;and-Pr6fessions Code: The WARNING.:FAILURE.TO SECURE. WORKERS' COMPENSATIO OVERAGE IS UNLAWFUL, AND SHALL
Contractors' State Licanse,Law does not apply to an owner of; property who builds or improves thereon, ES SUBJECT AN EMPLOYER TO CRIMINAL PENALTIAND CIVIL NES UP T.O;ONE HUNDRED THOUSAND
and who does thework himself or herself,throughhis •or her own employees, provided that the DOLLARS.IS100,0001. IN ADDITION TO. THE -COST OF COMPENSATION; DAMAGES AS'PROVIDED FOR IN
improvements are novintended-or,offered for sale. If;however, the building or improvement is sold within SECTION370a OF THE LABOR CODE, INTEREST, AND'ATTORNEY'S FEES. -
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.). . -.. ,<... - - APPLICANT ACKNOWLEDGEMENT
i) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Businessznd Professions' Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who.builds or improves thereon, and who contracts for the projects with a contractor(s) licensed -1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).. - whose benefit work is. performed under or pursuant to any permit issued as a result of this application,
(_) I am exerilipt under Sec. , B.&P.C. for this reason 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
�n performed under or'following issuance of this permit.
Date: �^'I Owner: 2. Any permit issued as 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
10I AG C permit to cancellation.
I hereby affirm under penalty of perjury that there isrnsvuctown lendng agen y for the performance of the I certify that I have read this application and state that the above information is correct.) agree to comply with all
work for which this permit is issued (Sec.. 3097, Ci city and county ordinances and state laws relating to building construction, an.herebyauthorizerepresentatives.
of this ni to enter upon a above-mentioned propertfor in pection pur sas.
Lender's Name:
ate:`^'rl gnature (Applicant or Agent .
Lender's Address: 14
LQPERMIT
Application Number . . . 11-00000121
Permit BUILDING PERMIT
Additional desc .
Permit Fee 72.00 Plan Check Fee
46.80
Issue Date Valuation
4500
Expiration Date 8/03/11 .
Qty Unit Charge Per
Extension
BASE'FEE
45,:00
3.00 9,. 00,00 THOU BLDG 2,001-25,000
2.7.00
---------------
and Comments
REPAIR, STUD: FRAMING DAMAGED BY DRY.ROT,
• PER APPR6VED:ENGINEERING'._2010 CODES.
--.- - - - - - --------- 7------- -- ---------------- - - - - -
Other-Fees BLDGPSTDS.,ADMIN (SB1473)
-----------
1..00
: ENERGY REVIEYi FEE ,.
4:68 .
Fee summary:. Charged Paid Credited..
Due.
_.._ Permit. Fee .Total 72..00 .00 .00
72.00
Plan Check Total 4_6:80 . .00. 00
46•.80
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k 'gin'
Bin #
City "of La urnta ,
Building 8T S#q Division
P.O., Boz 1504; 78 495.Ca11e Tampico
La Quinta, CA 92253.- (760) 777-7Q 12
Building;Pe MI(Applicdtion and Tracking, Sheet
Permit #
Project Address: OO U
-
Owner's Name: % R (Df�il , l I►"itr
A. P. Number:
Address: t�4 I
s
Legal Description:.
City, ST Zip: .QU I2LJ3
�., I,.,( ��� � h y.� / /1 /
Contractor: T OA Wl?C I�f/1l9/ I'��/C�•
MOA
Tele hone: �>.�4�#':��:>'�i>?>.<x;>...Y•. ,�,
P f� �j 2 : •>': :E : €<s"<. < ^:<H ;
.
Address: 5%2D D
'.Project Description:'
City, ST, Zip: I • W?
W`�� S
M (VU WW 44
TelephonellJ✓ �23
<` "ssk;'a'',•.::�yFC'.•'"'
State Lic. # :
City Lic. #;
Arch., Engr., Designer.
Address:
City., ST, Zip:
{{i 'r, f+.�{+,,•:j;`;::•v,:j}}}}.vmv f'p',y:::::i•t
Telephone:A:.:;:
State Lic. #: r s .;<,;:;;;;...rr}:;;,: ;r ;>
Name of Contact Person:
°Construction type: Occupancy.:
Project type circle one New Add'n Alter Repair Demo
Sq. Ft.: # :Stories:# Units:
Telephone # of Contact Person:
; Estimated Value of Project: 5GU'
APPLICANT:
DO�NOT WRITE.B4ELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING s
PERMIT.FEES
Plan Sets ..
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed; ready for.corrections'
Plan Check Deposit
Truss Calcs.
Called Contact Person '
'Plan Check Balance
Title 24 Cales.
Plans picked no
Construction
Flood plain -plan
Plans resubmitted
Mechanical
Grading plan
2°" Review; ready for correctionsfisiue
.Electrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for correcdonstiissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
i
School Fees
Total Permit Fees