07-1946 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 1 07-00001946
Property Address: 79610 RANCHO LA QUINTA DR
APN: 602-210-002= - -
Application description: .ADDITION - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5351
Applicant:
i
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.
Licen�se%CI s: Br / /J,, LicenseNo.:
77922381 /
Date! 3� Contractor:�i(/ (,f61�f/�ILG
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 thatrequires 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 70001 of Division 3 of the Business and Professions Code) or -
that he or she is exempt therefrom andthe 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).:
(_) 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 wnU uuauS Ui unpiuves tireieun, and vvhv wuiit pie 6 thu p—i-U .: 115 a aantraatar(al lioonood
pursuant to the Contractors' State License Law.). -
1 _ I I am exempt under Sec. B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty ofperjury 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:
'f
LQPEWMIT .
Owner:
MR & MRS GOLDSTEIN
76-610 RANCHO LAQUINTA
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760),777-7011
.INSPECTIONS (760) 777-7153
Date: 7/23/07
-----------------------------------------------
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, .
and agree that, if I should become subject to the workers' compensation provisions of Section
700 of the Labor Code, I shall forthwith comply with those provision
Date � Applicant:,a"
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 • each pnrrnn npnn whnse hahalf this annlinatinn is made. each oarwn at N/h4;@ rgquest and for
whose benefit work is performed under orpursuantto 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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building constru t ,wand hereby authorizer presentatives
of thisis co�r upon the above-mentioned Property f'r in o _-
Datil! D Signature (Applicant or Agent):
Contractor:
RISEN CONSTRUCTI
82775 CHARLESTOWN AV
INDIO, CA 9.2201
F�Np
(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, .
and agree that, if I should become subject to the workers' compensation provisions of Section
700 of the Labor Code, I shall forthwith comply with those provision
Date � Applicant:,a"
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 • each pnrrnn npnn whnse hahalf this annlinatinn is made. each oarwn at N/h4;@ rgquest and for
whose benefit work is performed under orpursuantto 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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building constru t ,wand hereby authorizer presentatives
of thisis co�r upon the above-mentioned Property f'r in o _-
Datil! D Signature (Applicant or Agent):
" Application Number 07-00001946
Permit . . . . . BUILDING PERMIT'
Additional desc .
Permit Fee 81.00 Plan Check
Fee
52.65
Issue Date Valuation
5351
Expiration Date 1/19/08
Qty Unit Charge Per
Extension -
BASE FEE
•45.00
.4.00 9.0000 THOU BLDG 2,001-25,000
36.00
Permit . . . ELECT - ADD/ALT/REM
Additional desc .
Permit,-Fee15.02 Plan Check
Fee
3.76
Issue'Date Valuation
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
273SQ. FT. GARAGE ADDITION
Other Fees ENERGY"REVIEW FEE
5:27
STRONG MOTION (SMI)
- RES
.53
Fee summary Charged Paid Credited
Due
Permit Fee..Total 96".02 .00
.00
96.02 .
Plan Check Total 56.41 .00
.00
56.41
- Other Fee Total 5.80 .00
.00
5.80
Grand Total 158.23 .00
.00
158:23
LQPERDIIT
.
%haCC6 AsnAPAX41C
Bin #
City of la Qu inta
Building& Safety Division
P.O. Box 1.504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building.Permit Application and Tracking Sheet
Permit .#
Project Address:';�o (0 k?'lluciza
Owner's Name:
A. P Number:
Address: ..62
_76-6106AAU"a�4
Legal Description: 2/O .00
r: L9; 03 =
Contracto P- j]WC—T-1C..,qj
O
Pity, ST, Zip do, "A4 C/,+ ZZL
�
Telephone:
P ect Description:
Address:--77!9-r0i C
&j
City, ST, Zip: C
Telephone: y60 3476397 :"Nm
State;.Lie. #:
City Lic. #:
Al
.792-.'f>R1 *
— 7�e: ,
Engr., fesign r:
Arch., D, -1 - ,
Address:74
so U24id7cf/ LeYU
City, ST, Zip:el.- Ou I ,V" C
Telephone: 67(0) 7 71 -'17
State Lic. #:
Name of Contact Person:Sq.
Construction Type: Occupancy:
Project type (circle one): New Add. -M' Alter Repair Demo
FL-
# Stories:
#
Telephone# of Contact Person: -4 TEstimated
Value of Project:
'APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec.'d
TRACEjNG.-
-PERMIT FEES
Plan Sets
Plan Chick submitted`
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Chec1t Deposit
T� acs.
Called Contact Person
PlanChecl: Balance
Energy Calcs;
Plans picked up
Constructian
Flood plain.ptan.
Plans resubmitted
Mechanical
Grading, plan'
2°" Review, ready for correrti4�.
NN(
[Electrical:
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.MX
H.O.A. Approval
Plaits resubmitted
Grading
IN HOUSE:-
Review, ready for corrections . rissue
Developer Impact Fee
Planning Approval
Called' Contact Person
A—ULP.P.'
.Pub. Wks. Appr
Date of permit Issue
School Fees
Total Perrait Fees
If/5 --"r)/
T-
,,0"'6 �1-41067