07-1923 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:. 07-000019.23
Property Address: 79650 RANCHO LA QUINTA DR
APN: 649-550-006- -
Application description: ADDITION - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 8075
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Professionals Code, and my License is in full force and effect.
License Class: B License No.: 79223811
Date Contractor:
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 ($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
r 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.).
I _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7944, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thlan 666, analw 10 CUnitatlt5 iUi the piUjeuie oolll, v ,,,,rtt�aaladal lieoneod
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 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: 7/23/07
Owner:
BERLIN HARRY
1407.BROCKTON AVE APT NO 9.
LOS ANGELES, CA 90;025 a
Contractor: - JUL 31 2001
RISEN CONSTRUCTION
82775 CHARLESTOWN AVENU CITY OF LA QUINTA
INDIO, CA' 92201 FINANCED{EPT.
(760)347=6399
Lic. No.: 792381
--------------------------------------------
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 STATE .FUND Policy Number 229-0025305
_ I certify that, in the 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,
an agree that, if I should become subject to the workers' compensation provisions of Section
3 00 of the Labor C I shall forthwith comply with those provisions.
DagpA � Applicant � ��/ �� it
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 ($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 Fanh nrrsnn rUlOn wh050 b0half this application -is made, each person at whose request and for
whose benefit work is performed under or pursuant to any peeMit ISSUad as a result ui uiis appllwdu,,,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quints, 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.
Icertify 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 c s ction, and hereb resentatives
of th�i�s cc9uunty er upon the above-mentioned, pro erty ..i pe io
Dates/�/Y, Signature (Applicant or Agen 1
Application Number. . . . . . 07-00001923
Permit BUILDING PERMIT
Additional desc .
Permit Fee 108.00 Plan Check'Fee
70.20
Issue Date Valuation
8075
Expiration Date 1/19/08
Qty Unit Charge Per
Extension
_ BASE FEE
45.00
.' 7.00 9..0000 THOU BLDG 2,001=25,000
63.00,
Permit ELECT - ADD/ALT/REM
Additional desc .
Permit Fee 15.02 Plan Check Fee
3.76
Issue DateValuation
0
Expiration Date.. 1/19/08
„
Qty Unit Charge Per:
Extension
,
BASE FEE
15.00
1.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL
.02
Special -Notes and Comments
412 SQ. FT. GARAGE ADDITION.
Other Fees . . . . . . . ENERGY,REVIEW FEE
7.02
STRONG MOTION (SMI) - RES
.80
Fee summary Charged Paid Credited
Due
Permit Fee Total 123.02 .00 .00
123.02
`'Plan Check Total73.96 .00 00
73.96
- Other Fee Total- 7.82 _00 .00
7.82
Grand Total 204.80 .00 .00
204.80
LQPERMIT -
.
Bin #
City of La Quintal
Building & Safety Division. `
P:O. Box 1504, 78-495 Calle Tampico
La Quinta, CA, 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
q
Project Address: _ 6 r
Owner's Name: it ym(cwty
A. P. Number:
Address: 7 _
Legal Description:
Contractor: il(J S 0
City, ST, Zip: j22v r /q zZs
Telephone:.
Address: , e
Project Description:
City, ST, Zip:
Telephone: (7MJ S S 7, e-)'
a
State Lic. # : 7qZ %
City Lic. #:
Arch., Engr., t
Address: 570-7b/ 1ti� �� Ae /(0 12-
Al ff
City, ST, Zip: k4- , /� 9 ZZS-
Telephone:(76d) % 1 172L t
State Lica#:
Name of Contact Person: �t f.
Construction Type: Occupancy:
Project -type (circle one): New Add' --i Alter Repair Demo
Sq. Ft.: # Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets.:
Plan Check submitted
Z
Item
Amount
/21
Structural Calcs.
Reviewed, ready for corrections -
Plan ChecN Deposit
17,1
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Constructi,)n
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for correctios/issu
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.corrcctions/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr. .
Date of permit issue
School Fees
Total Permit Fees
D(L6 -711010-7
M