08-0634 (SPIN)P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA-„ CALIFORNIA 92253 - BUILDING & SAFETY DEPARTMENT.
BUILDING PERMIT
Application Number: 08.7_00000634 , Owner:
Property Address: 79255 RANCHO' LA QUINTA DR' TD DESERT DEV L
APN: 649-370-030- - - 79285 RANCHO L
Application description: SPECIAL INSPECTION LA QUINTA, CA 3
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 100
Contractor: 01;
Applicant: Architect or Engineer: TD DESERT DEV
VOICE (760) 777-7012.", .
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Dater 4/17/08
r 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
o La Jumta, 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 Wbuildingt
e sation of work for 180 days will subject
permit to cancellation. I certify that I have read this application and state th-on' correct. I agree to comply with all
city and cn[y ordinances and state laws relating to d hereby authorize representatives
of this co my to enter upon the abov -mentioned prposes.
Date: Sign a (Applicant or Agent):
LA QUOINTA,7ICA 92247 Prtq�l
(760)771-1941
Lic. No.: 762987
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION "
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 Icommencing with
I hereby affirm under penalty of perjury one of the following declarations:
- Section 7000) of Division 3 of the Business and Pr fessionals 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 C ss: B
Li ense No.: 762987
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Dractor,
/
issued.
X 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
0NER-BUILDER
DECLARATION
insurance carrier and policy number are:
1 hereby a firm under penalty of .perjury that 1 am a mpt from the Contractor's State License Law for the
Carrier COMPWEST Policy Number CA005001482003 '
following reason ISec. 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, I 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 to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become ubject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Lab Code, I shall fo hwith co I7th those provisions.
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).:
ate. 1 scant: -
(_ 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
WARNIN FAIL E TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ,
• and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 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
1—) 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, Business and 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 benefitwork is performed under or pursuant to any permit issued as a result of this application, -
• (_) I am exempt 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
f
r 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
o La Jumta, 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 Wbuildingt
e sation of work for 180 days will subject
permit to cancellation. I certify that I have read this application and state th-on' correct. I agree to comply with all
city and cn[y ordinances and state laws relating to d hereby authorize representatives
of this co my to enter upon the abov -mentioned prposes.
Date: Sign a (Applicant or Agent):
Application Number 08-00000634
Permit . . . SPECIAL INSPECTION
Additional desc .
Permit. Fee. - 100.00 Plan Check
Fee
00-�
Issue Date Valuation
. .
. 100
Expiration Date 10/14/08
Qty ..Unit Charge Per
Extension
BASE FEE
100..00
---------------------------
• Special Notes and Comments
------
--------- - - - - -- .
SPECIAL INSPECTION TO FINAL STRUCTURE
(RETURNING TO SFD FROM DESIGN CENTER).
Fee summary Charged Paid Credited
Due
Permit Fee Total 100.00 00
00
100.00
Plan Check Total .00 .00
.00
Ob
Grand Total 100.00 .00
.00
100.00
Certificate.of Occupancy
Building &Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this. structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building.
construction and/or use.
BUILDING ADDRESS: 79-255 RANCHO LA QUINTA DR
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 08-634
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
a, —
l
Owner of Building: TD DESERT DEV
Building Official
Address: 79-285 RANCHO LA QUINTA DR
City, ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: APRIL 18, 2008
POST IN A CONSPICUOUS PLACE