09-1307 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4 Q"
Application Number: 09=00001307
Property Address: 81312 CANTOR CT
APN: 764-280-999-185 -300236-
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 1500
Applicant: Architect or Engineer:
ars
-
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
-------------------------------------------------
LICENSED CONTRACTOR'S - LARATION
hereby affirm under penalty of per' r that I am lic sed u pro ' o of Chapter 9 (commencing with
Section 7000) of Division 3 of th B sines an Pr essio Cod n my License is in full force and effect.
License Cla s: C 7 Lice o 379421
t ® ontra
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 orshe 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.).
(_ I 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.l.
(_) 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: 01 Fe
LQPERN1IT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/28/09
Owner: ,4 n
GOGUEN
81312 CANTOR COURT (/ •; .
LA QUINTA, CA 9225 �yf Ld i`fi�aa
Contractor:
ARTISTIC LANDSCAPE INC.
78206 VARNER RD, #D PMD244
PALM DESERT,'CA 92211
(760)360-1395
Lic. No.: 379421
------------------
WORKER'S COMPENSATION DECLARATION
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 DELOS INS CO Policy Number 01KDRM120OZt8
_ I certify that, in the perform a of the work for which th' permit is ' ued I shall not employ any
person in any manner to become su )ect to t w rkers' pen tion laws of California,
and agree that, if -I sI� u become su a to the ork s' co p nsati provisions of Section--
700 of the Labor Geo , I shall fort i c . y tho ovisio
ath: VRETO
ant,
WARNING: FAIECURE WORKERS'COMP NSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECTANEO 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 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 noLill
within 180 days from date of issuance of s permit, or ce anon of rk for 180 t
permit to cancellation.
I certify that I have read this application and stale that t above inf m tion is co ec . I re to l
d county ordinance and state laws relating t6 ilding cons c on, and r y a ho ze ree above-mentioned r rty for ins ct' n pu
Daj� 7/!/ 0 Signature (Applicant or A:
Application Number . . . . . 09-00001307
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . .
35.00 Plan Check Fee
22.75
Issue Date . . . .
Valuation . . .
. 1500
Expiration Date . .
6/26/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
10.00 2.0000
----------------------------------------------------------------------------
HND BLDG 501-2,000
20.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . . .
17.25 Plan Check Fee
4.31
Issue Date . . . .
Valuation
0
Expiration Date
6/26/10
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 . . . .
15.00 Plan Check Fee
3.75
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
6/26/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
314 " CONDUIT TO WATER FALL AND PREFAB
BBQ. BBQ INCLUDES 3 OUTLETS.GAS
LINE FOR
BBQ
-------------7--------------------------------------------------------------
Other Fees . . . . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
2.28
Fee summary Charged
---------------------------
Paid Credited
------------------------------
Due
Permit Fee Total
67.25 .00 .00
67.25
Plan Check Total
30.81 .00 .00
30.81
Other Fee Total
3.28 .00 .00.
3.28
Grand Total•
101.34 .00 .00
101.34
LQPERMIT
Bin #
City of La Qulnta
Building a Safety DMsion
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # /t
CA
Project Address: j 3) 2, G4L V G
Owner's Name: �-
A. P. Number:
Address: 1 zJ `��
Legal Description:
City, ST, Zip:
•
Contractor'
Telephone:
Address: tY G
—ti7s—;,�;:
Project Description: 1y5 L I Z c I r14,
City, ST, Zip: V"A L 11.,
Telephone: 0 Sb4l�
,..,::;jk>•.:.::1..
c
State Lic. Vy
City Lie. C
,
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone: < .« M
:> .•,.
State Lic. #:`'`
Construction Type: Occupancy:
Project type circle one)' New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft :#
Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Projec . pf �-�
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Pian Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Tide 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
M ROUSE:-
'`' Review, ready for correctionsriissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees