08-1982 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
rApplication Number:
08-00001.9.8'2
PropertgAddress:
575 S93 SANTA.ROSA TR
APN:
762-460-016- - -
Application description:
REMODEL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
STONE DIANE.D/STONE ERICA D
57539 SANTA ROSA TR
LA QUINTA,.CA 92253
(
Application valuation. 10000 - - • -
Contractor:
Applicant: Architect or:Engirieer: MC'•;,DO_NOUGH, CONST CO,: ROBERT
', CREEKFORD ROAD
�0r R 8942
Y4 LAKESIDE; CA` -9:20'40
(619)749.-5339
VOICE (760) 777-7012
FAX (760)' 777-7011
INSPECTIONS (760) 777-7153
Date: 8/21/09
LQPERAIIT
Lic. No..: 352420
" LICENSED CONTRACTOR'S,DECLARATION-
WORKER'S COMPENSATION DECLARATION ,.
: I hereby affirm under penalty of perjury[hat lam licensed underprovisions•ofChapter 9 (commencing ;with'' '
,l hereby affirm under:penaltyof perjury one of the following declarations:
Section 7066),6f Division 3 of the Business and Professionals Code,.and my -License is in full force and effect.,.
;�. •E `_ I have and'will maintain a certlhcate of consent to self -insure for•w6rkers' compensation, as provided
License Class: B.-•- -'License:Nd.: -3'52420 �.»<.,• :�, -
�. "' `
- for'bySection 3700.of the LatiorCode, for.the•performanceof thework for.which.this permit.is
'.: '
issued. `' '- - r. -. �. _ - :. � •� � .
Date Contractor. - '- -
I have and will maintain workers' compensation insurance; -as required by Section 3700 of:the�Labo
Code'- for the performance of the•work'for-which this permit is issuetzi. workers' compensation '
OWNER -BUILDER DECLARATION .+ -. -'
:'� ' insurance carrier and_ -policy number are: ` - -
phereby affirm'under penalty cif -perjury that I,am exempt from the Contractor's State License Law for the'
Carrier STATE FUND- - Policy Number" 23800.11583
following reason (Sec. 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 islissued, I shall not employany
- construct, alter; improve,.demolish,'or repair any structure prior rwiits.issbance, also'requires,the applicant for the'
_
person.in any;mann r o asto'become subject to the workers'. compensation laws of California,
' permit to file a signed statement that he or she is license pursu8nt'to•tke provisionsof. the Contractor's State. •
and agree that; ifi li Id' become subjectte'workersl coin en'sahom provisions of .Section'
6%;.
License Law (Chapter9acommencing, with Seciioh 7000) of Division '3 of the; Business°and Professions Code) or
- - 3700 of:the Labor, o e, I shall forthwithy with those rovisions. ?
.that he or.she is ekempt*therefrom and the basis for the alleged exemption: -Any violationof Section 7031 5`by
r�. -
-
• any applicant for a permit subjects the applicant to a civil penaliy'of not more than five hundred'dollars ISSOOL:-
Date:9 Applicant•
- f_) -I,.as owner:oFthe property, or rnyemployees with wages,asrtheir sole�compensafion, will do the work,. and
'' '.
• the structure isnot.intended or. offered for sale (Sec: 7044 Business and Professions Code: The
-- WARNING: FAILURE TOlSECURE ORKERS' COMPENSATION COYERAGEIS'UNLAWFUL; AND SHALL
. Contractors: State License Law'does not apply to an owner of property who'bbilds'or:improves thereon,
-SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND,CIVIL FINES,UP TO ONE. HUNDRED THOUSAND
x and who-�do(;s the work.himself or herself through his or her own employees,provided that the
DOLLARS 15160,000). 1N ADDITION TO THE COST, OF'COM0ENSATI6N,. DAMAGES AS PROVIDED FOR IN
., improvements are nct6'ntended: or offered I& sale-. If, however, the building or improvementis'sold within "-
SECTION 3706bFTHE.LABOR CODE, INTEREST, AND ATTORNEY'S FEES.. -
of completion, the owner -builder will have theburden of prov(ng;that.he or°shedid nit build:
- one yearm
- improve for the. purpose of sale.)'.'
APPLICANT ACKNOWLEDGEMENT,_ '
1, as owner of. the property, amexclusively contracting with licensed contractors -to construct the project (Sec.
IMPORTANT Application is hereby made tothe 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 pwnerof
conditions and �iestrictions set forth on this application. .
- property who builds pr: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' Staten�Lioense Law.). - -
whose benefit work is performed under or pursuant to any permit issued as.a result of this application,
am exempt under Sec.' BI P:C.-for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La ouinta, its officers, agents,and employees for any act or omission related to the work being
/
performed under or following issuance of this permit.
Date: Owner:
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
CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state 'hatt above information is orrect. I agree to mply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws -relating to buil ng construction, an ereby authorizer resentatives
of this county to enter upon the above-mentioned propertfor inspection purp s.
Lender's Name:
Date:'�gnature (Applicant or Agent
Lender's Address:
LQPERAIIT
s
Application Number . . . . . 08-00001982
------ Structure Information EXISTING RESIDENCE -----
Construction Type . . . . TYPE V, UNPROTECTED
Other struct info . . . . . CODE EDITION 2007
# BEDROOMS .00
------------------------------------------------------------ 7 ---------------
Permit . . . BUILDING PERMIT INV FEE
Additional desc . .
Permit Fee . . . . 234.00 Plan Check Fee
Issue Date Valuation
Expiration Date 2/17/10
76.05
10000
Qty Unit Charge Per
Extension
BASE FEE
90.00
8.00 18.0000 THOU BLDG 2,001-25,000
--=-------------------------------------------------------------------------
144.00
Permit . . . ELECT - ADD/ALT/REM INV FEE
Additional desc .
Permit Fee . . . . 46.50 Plan Check Fee
5.81
Issue.Date . . . . Valuation
0
Expiration Date 2/17/10
Qty . Unit Charge Per
Extension
BASE FEE
30.00
11.00 1.5000 PER ELEC DEVICE/FIXTURE 1ST 20
16.50 .
---------=--------------------------------------------------7---------------
Special Notes and Comments
REMODEL / CONVERSION OF THIRD CAR GARAGE
(286 SF) TO UNCONDITIONED STORAGE RM.
WINDOW and DOOR CHANGE -OUTS AFFECTED
SHEAR WALL CONNECTIONS TO FRAMING.
STRUCTURAL REPAIR INCLUDED IN THIS
PERMIT. WORK WAS PERFORMED WITHOUT A
VALID PERMIT.PER CBC 113.1.INVESTIGATIVE
FEES ASSESSED PER CBC 108.4. 2007 CBC.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
7.61
HOURLY PLAN CHECK
70.00
STRONG MOTION (SMI) - RES
1.00
'Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 280.50 .00 .00
280.50
Plan Check Total 81.86 .00 .00
81.86
Other Fee Total 79.61 .00 .00
79.61
Grand Total 441.97 .00 .00
441.97
LQPERNUT
CITY OF LA CQUINT�1.► SUB-Q; MT_ ACTOR LIST
OWNER J�/1/ �, 5%��G BUILDE 41)IJ .12L
JOB ADDRESS �'S � ib--W PERMIT Nl9MBER za
This form shall be posted' on the job. with the Building inspection Card at all times in a conspicuous place. Only persons appearing on this list or 'their employees are aut orized to won,
on this job. Any changes to this list :must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidanc
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an, acceptable response.
Trade �i �.a.-a*t.,..
PrP
.:.....:.. .
r`sntrar*.,.
Statc:Centracter's l,cense
:: Workers COmpensation:�ri�uractte ":<`:: , ;><:; ::::::: <<
:..City.. Bustles
Comp z Name
Class.(' tion
(e.g. AXC-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund,'CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
Ucense Number
(xxxx)
Exp. Date
Ixx/xx/xx)..
EARTHWORK (C.12)
CONCRETE (C-81
FRAMING 1C
STRUCT.`TEEL•IC-Sa) '
1
:MASONRY i6-29)
PLUMBING. (C-36)
LATH*, PLASTER IC.351-
s
DRYWALL (C-9)..'
HVACiC-201
ELECTRICAL (C-10Y
SHEET METAL IC-43)
•
FLOOERING 4.0151
GLAZING IC 17)
-INSULATION
(.. 2
-SEWAGE DISP: (C-42) . .
PAINTING (C=33):
r.
cE.RAmic TILE is-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING
POOL (C-53)
SANTA ROSH TRAILS HOMEOWNERS ASSOCLATION
ARCHITEMRAL IMPROVEMENT
APPLICATION AND REVIEW FORM
u�Owner: �F .t� . 5%D/!/�' Date: 6&4tt,
Property Address: jai 75.3 ��il �EI�S1. Ti4�/L Phone:
Nature of Improvement: �/I 4A19 AM- !00 �.51/.�16o2 Aid ,z 5�:t'3''Lc�i��
'W/Tiy ! �.P..ri✓�°// .�-Oozs-V4,2 o "X/
IAI AM^ 14/Y1b .2 —X10 r 131"10&4�.
r17i!►Tldn/Tr!�'�u',!!��7�'aJ'! r
- ...2--liagi
Construction Material (if applicable):
Supplier:Azd�4 mate Cost: ��� d� s
1��.�
(One set of plans of all improves must be attached to this application to show location and dimensions.)
Send to: Santa Rosa Trails Homeowners Association
C/O Gold Coast Enterprises, Inc.
34400 Date Palm Drive, Suite A
Cathedral City, CA 92234
n .. OR FAX TO: 760.202.9260
R:HNTERNAL USE ONLY
Date Received:
Inspection Date:
M
Date Approved tD Start: j - l") Disapproved On:
Signed by Committee Chairperson:
10-7 /5s-"
i
SANTA ROSA,TRi1ILS:: HOMEOWNERS ASSOCIATION
FACING 'AND ADJACENT NEIGHBOR STATEMENT'
FACING NEIGHBOR:
AQP. 1440
Address �Svnl
FACING NEIGHBOR:
Name Address Signature
ADJACENT NEIGHBOR:
Name Address Signature
ADJACENT NEIGHBOR: -
Name
Signature
The above neighbors have, seen the plans I am submitting for Architectural Committee
approval. I understand- neighbor. objecuons do .not, in th�emselves' cause denial,
however, the Architectural :Committee will: "contact the neighbors to determine their
objections and their,.appropriatbness, if necessary.
Submitted y:
Name: Date. D�
5�1
w
•`� �� �� 706
FACING AND d' QLACE TT NEIGHBOR BOR S` ATE ENT
..ING NEIGHBOR:
Tie .jkddress Signature
:ING NEIGHBOR: �" }
ne Address S'lgna ulre
JACENT NEIGHBOR:
ire-------_----���C; e55
',CENT NE &HBOR:
ne
f tri .`Z�ri.^.h.-•°-c n- r�
' aa.'�. a c,.. ane+ g 1[r -. s : ;b y
se n tf.�c a.7.' ` .f. -a'.• �yq..... ...�: � G'�.Y p �t'FS"G 1""�^.f r•��mi•"a'��
``1S'e, . .1 - p3 : f S.. ... �L:, ::�: A f :. o a-, i a -...i11 i ii i c I i.:.en
t:ii t- ��jjy�""�.�in+•-ise`.�/Py
Ira, v �%i•. �.m, de sta i�
f Sv�'f :i%�I: - VV i[v v
�r
• e
"� .vim
,t �. itis: � [ ti.: S�
r'nn. Inn.,
n i f. b;
levlee j the ! ar tri iter -u Gi�
r mi S- a �F i..ea-
rre , t ': { (i�`�a�. Wil LV> .i.�ll.1.
:--.
is ;dy
+�F....: b-.-« t ^"^'° '1"p'�.w:n
i :vo��.'i- L: �l.r a.: t.r i�..f t ,ri :�
`�
.heir
r. s a ni.. :.te i Ir ?,4-rf�:�!
-mite f `
-;Z�l
t °
a1JAAj,
lei �-
S,7