09-0990 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t!t 4 e(P Q"
Application Number:
09-00000990
Property Address:
81288 CANTOR CT
APN:
764-280-999-187 -300236-
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
2000
Applicant: Architect or Engineer:
V
a1A
----------------
ENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of per' y that I a licens under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the fu`
and ro ovals Code, and my License is in full force and effect.
License Cla C8, 10, 27, 2 License No.: 656128
ate: 6 ontractor:
.-BUILDER DECLARATION -
I hereby affirm under penalty of perjury that I WNEexempt 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
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.).
(_ I 1 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
Owner:
EUL
81288 CANTOR
LA QUINTA, CA
COURT
9225
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 9223
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/14/09
------------------
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 ber are:
Carrier SEABRIGHT olicy Number BB1080510
_ I certify that, in the performance a work for which this permit is issued, I shall not employ any
person in any manner so as to bec gbiecte workers' compensation laws of California,
and agree that, if I should become ubjrkers' compensation provisions of Section
�700 of the •abor Code, I shallfhwi se provisions.
ate: '(/9/�(�/ pplicant:
WARNING: FAILURE TO SECURE WORKER i%SANNSDACIVIL
TION COVERAGE , AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENA 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 person upon 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 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 bove in mationrrect. I agree to comply with all
city d county ordinances and state laws relating to buildi constru do reby authorize representatives
of is coyflty touter upon th bove•mentioned property f inspec r e .
Y/��
Date: Si ature (Applicant or Agent): —
Application Number . . . . 09-00000990
Permit . . .
BUILDING PERMIT
Additional desc . .
Permit Fee . . . .
45.00 Plan Check Fee
29.25
Issue Date . . . .
Valuation . . .
. 2000
Expiration Date
3/13/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
15.00 2.0000
----------------7-----------------------------------------------------------
HND BLDG 501-2,000.
30.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . .
17.25 Plan Check Fee
4.31
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
3/13/10
Qty Unit Charge
Per,
Extension
BASE FEE
15.00
3.00 .7500
----------------------------------------------------------------------------
PER ELEC DEVICE/FIXTURE 1ST 20
2.25
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
18.00 Plan Check Fee
4.50
Issue Date
Valuation . . .
. 0
Expiration Date
3/13/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
BBQ & U.L. APPPROVED
FIRE RING•@
FIREPIT. -100 L.F. 1
1/2" GAS LINE. 2007
CODES.
----------=-----------------------------------------------=-----------------
Other Fees . . . . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
2.93
STRONG MOTION (SMI) - RES
.50
Fee summary Charged
---------------------------
Paid Credited
------------------------------
Due
Permit Fee.Total
80.25 .00 .00
80.25
Plan Check Total
38.06 .00 .00
38.06
Other Fee Total
4.43 .00 .00
4.43
Grand Total
122.74 .00 .00
122.74
LQPERMIT
Bi" #
City of La Quinta
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 # (� ,O
Project Address: - � e q Qr
Owner's Name: L
A. P. Number: j�7/�
Address: 4e5 /--
Legal Description: �j vl'City,
Contractor: Zo a4
ST, Zip:
Telephone:
Address: g(�- 00 V ; -5-q
Project Description: T3611 TT7- ;9;g
City, ST, Zip: e0 = UCi¢ 7-Z3 is
IO !/ 7417— ill + :!t7—
Telephone:
State Lic. # :
City Lic. #:
�z vT 1,
Arch., Bngr., Designer:
/
Address:
lOO
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:L
Sq. Ft.: v
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACIONG
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
Energy Calcs.
Plans picked up
Construction
Syrra
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical*
LS
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I. J
H.O.A. Approval
Plans resubmitted
Grading
M HOUSE:-
Review, ready for corrections./issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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