BSPN2014-000278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
TO�D / a� VOICE (760) 777-7125
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
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 Professions Code, and
my License is in full force and effect.
License Class: LICENSE CLA�SSIF�ICATION License No.: 924123
/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).:
( ) 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 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
Lender's Add
tf
(714)630-7149
Llc. No.: 924123
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. 410111 coq!*2, I
I have and will maintain wor rs' compensation insurance, as required by
Section 3700 of the Labor Code, for/e performance of the work for which this permit is
issued. My workers' compensatioV insurance carrier and policy number re:
Carrier: _ Policy Number:-mS' -m wpAr. _w(e �( D
_ I certify that in the performance o 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 3700 of the Labor Code, I shall forthwith
comply with those provisio�ns.�
date: —1i applicant:
WARNING: FAILURE TOSECURE WORKERS' COMPENSATION COVERAGE ISUNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TOTHE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'SFEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official 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 tothe 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
construction, and hereby authorize representatives of this ty to enter upon the above-
mentioned property for in;pection purposes. n n
`/
Date: —` Signature (Applicant or A en
Date: 7/1/2014
Application Number:
BSPN2014-0002
Owner:
Property Address:
50628 CEREZA
CITRUS EL DORADO
APN:
776340013
1157 N RED GUM ST
Application Description:
FINAL HTE#07-3184
ANAHEIM, CA 92806
Property Zoning:
Application Valuation:
$25,000.00
Applicant:
Contractor:
LANE BUILDING SYSTEMS INC
LANE BUILDING SYSTEMS INC
1732 YERMO PLACE
1732 YERMO PLACE
FULLERTON, CA 92833
FULLERTON, CA 92833
LICENSED CONTRACTOR'S DECLARATION
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 Professions Code, and
my License is in full force and effect.
License Class: LICENSE CLA�SSIF�ICATION License No.: 924123
/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).:
( ) 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 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
Lender's Add
tf
(714)630-7149
Llc. No.: 924123
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. 410111 coq!*2, I
I have and will maintain wor rs' compensation insurance, as required by
Section 3700 of the Labor Code, for/e performance of the work for which this permit is
issued. My workers' compensatioV insurance carrier and policy number re:
Carrier: _ Policy Number:-mS' -m wpAr. _w(e �( D
_ I certify that in the performance o 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 3700 of the Labor Code, I shall forthwith
comply with those provisio�ns.�
date: —1i applicant:
WARNING: FAILURE TOSECURE WORKERS' COMPENSATION COVERAGE ISUNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TOTHE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'SFEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official 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 tothe 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
construction, and hereby authorize representatives of this ty to enter upon the above-
mentioned property for in;pection purposes. n n
`/
Date: —` Signature (Applicant or A en
DESCRIPON, TI
FINANCIAL •• 1•
ACCOUNT QTY.. ;:'AMOUNT
PAID
PAID DATE
SPECIAL INSPECTION
*NONE*
1
$72.50
$72.50
7/1/14
PAID'BY:
tom. ; METHOD
RECEIPT#
CHECK#
CLTD BY
CITRUS ELDORADO LLC
CHECK
R235
30792
BHA
DESCRIPTION k
ACCOUNT
QTY
AMOUNT :.
PAID
PAID DATE
SPECIAL INSPECTION PC
*NONE*
1
$178.75
$178.75
7/1/14
PAID.BY
METHOD
RECEIPT#
CHECK#
CLTD'BY
CITRUS ELDORADO LLC
CHECK
R235
30792
BHA
Total Paid forCOMPLIANCE SURVEY/SPECIAL INSPECTIONt. $251.25 $251.25
:DESCRIPTION-
ACCOUNT
QTY .
AMOUNT
PAID
PAID DATE
PLAN CHECK, WALLS
1.016e+013
$60.06
PAID BY
METHOD
RECEIPT.#
CHECK #
CLTD BY
Total Paid for PLAN CHECK, WALLS: $60.06
FA
Permit Number: BSPN2014-0002
Applied: 6/30/2014
Issued: 7/1/2014
Status: ISSUED
Parent Permit: SFD-07-3184
Parent Project:
Approved:6/30/2014
Finaled:
Description: FINAL HTE#07-3184
Site Address: 50628 CEREZA
City, State Zip Code: LA QUINTA, CA 92253
Applicant: LANE BUILDING SYSTEMS INC
Owner: CITRUS EL DORADO
Contractor: LANE BUILDING SYSTEMS INC
Details:
SPECIAL INSPECTION TO FINAL SFD - LOT 13, PLAN 2BXR, 3676 SF. PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS OR
DRIVEWAY APPROACH. 2001 CBC, CMC, CPC, 2004 CEC, 2005 ENERGY CODES.REFR TO HTE # 07-3184 FOR INSPECTIONS.
Printed: Tuesday, 01 July, 2014 1 of 1
LJ 1.J Sr5Tfn15
RETURNED
SENT DATE
DUE DATE
-TYPE
CONTACT
STATUS
REMARKS
DATE
Review Group: AUTO
6/30/2014
6/30/2014
7/5/2014
NON-STRUCTURAL
BURT HANADA
APPROVED
Notes:
Printed: Tuesday, 01 July, 2014 1 of 1
LJ 1.J Sr5Tfn15
Bin #
Qty of La Quanta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Z Building Permit•Application and Tracking Sheet
Permit #
w0w(4 —
Project Address:50 1 0z S
Owner's Name: Citrus El Dorado LL(C
A. P. Number: -VIU340D15-3Address:
1157N. Red Gum Street
Legal Description:
Contractor: Lane Building Systemsstems
City, ST, Zip: Anaheim, CA 92806
Telephone: 14 ) 630-76 $ 5
Address: 1732 Y er m o Place
Project Description: Single Family Home
City, ST, Zip: 'Fullerton, CA 92833
Ql„ *-rig;
Telephone: (714) 630-7149
..>....�::::::.,:.;:,;;:<.,.::::::.�::
state Lic. # : 924123
City Lic. #.:
Arch., Engr., Designer: Kevin L. Crook Architect,Inc.
Address: 1360 Reynolds A ve.
City., ST, Zip: Irvine, C A 92614
Telephone: (949) 660-L15$7
........................:...........................
Construction Type: Resident ia 1pccupancy:Single. Family
C15561
eAddn Altar Repair Demo
roJect tYP �carcle one
Name of Contact Person: Debbie Adams
Sq. Ft.:#
Stories:
# Units:
Telephone # of Contact Person: (714)630-7149
1 Estimated Value of Project: VvMM
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Pian Sets
2
Plan Check submittedItem
Amount
Structural Calcs.
Reviewed, ready for corrections Plan Check Deposit
Truss Calcs.
Called Contact Person Plan Check Balance
Title.24 Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
god Review, ready for correctionissue 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 correction u r I pact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue nniti
School Fees
XN Z.10
OF Qu",
rr)MtAU,,zV otal Permit Fees