07-2207 (AR). B
t
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
.Application Number: e07`,00002207
Property Address: 78048 SAN -TIMOTEO 'ST
APN: 646 -160 -028 -
Application description: ADDITION - RESIDENTIAL—
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5000
Applicant: �5V- Architect or Engineer:
---------------------------------------------------
LICENSED
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LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm under penalty of perjury that I am ' ensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business 9Pro essionals Code, and my License is in full force and effect.
License Clas : B cense No.: 807645
• Date: U C�tractor.-
O NIR -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 Cade) 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.).
(_) 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 Name:
Lender's Address:
LQPERMIT
Owner.
HOSP
78048 SAN
LA QUINTA,
TIMOTEO STREET
CA 92253
Contractor:
SCRIVENS CONSTRUCTION
P.O. BOX 13302
PALM DESERT, CA 92255
(760)837-9918
Lic. No.: 807645 -
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/10/07
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 Numb 229-2947707
1 certify that, in the performance of the work which this permit is issued, I shall not employ any
person in any manner so as to become ect to the workers' compensation laws of California,
and agree that, if I should be m su ct to the workers' compensation provisions of Section
"37700 of t(�e Labor Code, I all with compl ith those provisions.
Date: ,/ v7 eApli)cant: M
WARNING: FAILURE TO SECURE WORKER C ENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIES 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 not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
certify that I have read this application and state tha a ov formatiKndhereb
rect. I agree to comply with all
city and county ordinances and state laws relating t buildi nstructio authorize representatives
of this c ncvt enter l�on the above-mentioned o�rinspecti oses.
Date, Signature (Applicant or Ag t):
Application Number . . . . . 07-00002207
------ :Structure ,Information 37SF ADDITION TO DART GARAGE/V-NR-1
-----
Other struct info . . . . CODE EDITION
2001/2005
FLOOD ZONE
,
NO
GARAGE SQ FTG
37.00
Permit BUILDING PERMIT
Additional desc .
Permit -Fee . . . 72.00 Plan Check Fee
46.80
Issue Date . . Valuation
5000
Expiration Date 2/06/08
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
27.00
Permit . . . ELECT - ADD/ALT/REM
Additional desc .
Permit Fee 15.74 Plan Check Fee
3.94
Issue Date' Valuation
0
Expiration Date 2/06/08.
Qty Unit Charge Per
Extension
BASE FEE
15.00
37.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL .74
----------------------------------------------------------------------------
Special Notes and Comments
37SF ADDITION TO CART GARAGE/V-NR/U
[ENGINEERED] 2001 CBC, 2004 CEC, 2005
ENERGY CODES. August 10, 2007 3:08:34
PM AORTEGA
7 ------------------------------------------------------------------------
Other Fees . . . . . . ENERGY REVIEW FEE
4.68
STRONG MOTION (SMI) - RES
.50
Fee summary Charged Paid Credited
=---------
Due
-----------------------------------------------
Permit Fee Total 87.74 .00 .00
87.74
Plan Check Total 50.74 .00 .00
50.74
Other Fee Total 5.18 .00 _ .00
5.18
Grand Total 143.66. .00 .00
143.66
LQPMIIT
sin #
City of La Qu►nta
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 #
Project Address:'
Owner's Name:
A. P. Number:
Address: 2 e Q e,e g
Legal Description:
City, ST, Zip: G" cd�' C./4 �PZ Z j 3
Contractor: C, • 7cri O... ji7- . (,.
j Telephone:
Address: Pty p
Project Description: 67 -*t-
\\33
City, ST, Zip: h ✓ Psa� C/�" 7ZZ.5�
C"
Telephone: %CU 3 7 'PFr 6
State Lic. # : t�v2 6 � City Lic. #:
Arch., Engr., Designer: ,.�
GG i
WIN
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person: SGS 5,1
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.; p
#Stories:
#Units:
Telephone # of Contact Person: �.3/ ►7 y
Estimated Value of Project: baa o
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
P Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Coles.
Called Contact Person
/
Plan Check Balance
Energy Calcs.
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
I
Grant Deed
Plans picked up
S.M.I. r
H.O.A. Approval
Plans resubmitted
Grading
IN 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
1 ..
Total Permit Fees
Tb Tom,