13-1555 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00001555
Property Address: 78390 PALM GARDEN PL
APN: 643-181-004-41 -2117 -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
pplicatiQn iluatien: 2000
Applicant: Architect or Engineer:
----------------
LICENSED CONTRACTOR'S DECLARATION
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 o the Business and Professionals Code, and my License is in full force and effect.
License Class: C53 cense No.: 85 702
Contractor: 4e
.
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.). f,— '
(_ 1 1, 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 am exempt under Sec. , B.&P.C. for this reason '
Date: Owner:
CONSTRUCTION LENDING AGENCY
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. 30Af97, Civ. C.).
Lender's Name: 11
I
Lender's Address: IN-
{ LQPERMIT
! -
a•
Owner:
BRIAN BROWN
78-390 PALM
LA QUINTA,
(76.0)275-667
Contractor:
VOICE (760) 777-7012.
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
n e
G t� N
C8. 53 �E� 0 2 2013
CITY OF LA QUINTA
FINANCE DEPT.
OJEDA POOL & oro-
52815 AVENIDA MARTINEZ
1AA QUINTA, CA 92253
(760)564-6274
Lic. No.: 859702
Date: 12/02/13
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.
fttave 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 NORGUARD INS Policy Number EDWC424858
I certify that, in the performance of 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 Imply with se provisi ns.
ate: 11, — — I AAplicalm 1 -
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERA E"IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO'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 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 authZsentatives
of cot/u�nty enter upon the above-mentioned p p y f inspection urposes.'
Date `� " L,i tature (Applicant or Ade"
Application Number
13-00001555.
Permit
ELECTRICAL 2013
Additional desc..
Permit Fee_ . . .
23.83
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
5/31/14
Qty 'Unit Charge
Per
Extension
1.00 23.8300
EA, ELEC OTHER
EQUIP.
23.83
Permit . . ... . .
PLUMBING 2013'
Additional desc
Permit Fee . . . .
11.92
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
5/31/14
Qty Unit Charge
Per
.Extension
1.00 11.9200
EA PLBG WATER
INST/ALT/REP
11.92
--_--------•------------------------------------------------------------------
Other Fees,,. . .
. . . PERMIT
ISSUANCE M/P/E
'90.57
Fee summary Charged
Paid
Credited
Due `
Permit Fee Total
35.75
.00 .00
35.75
Plan Check Total
.00
.00 .00
.00
Other Fee Total
90.57
.00 .00
90.57
Grand Total
126.32
.00 .00
126.32
>3►n #
City of La Quinta
Building 8t SafetyDivision
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
4/VVY
ar�N
Owner's Name: ' r iRA V-0u
A. P. Number:
Address: 8 — 31 a PO4-1
A
Legal Description:
City, ST, Zip:
Contractor::'
Telephone: 5 _(� (� —
:r. •:':.'`?>'`;'<>««<s>!'
Address: ' _Auf
vu
do
Project Description: MPod
6uldmekf
City, ST, Zip:
State Lic. # :CS3 951-702
City Lie. #•:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone::.:::
State Lic. #:,.>;~:.<......;:;;.;<
Name of Contact Person:
;:::> •: •;•>;;;::><:;:•s;;:z:>::>:.:;•;::>:::
;:<; ::::so:::s >>:.<.•>:>:>%>;:<. ,::::::<;>.•>:>:.:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
Iq
#Units:
Telephone #,of Contact Person:
Estimated Value of Project: bb
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES,
Plan Sets I
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check D:posit
Truss Calcs.
Called Contact Person
Plan Check BAance
Tide 24 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
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading '
IN HOUSE:-
'"' Review, ready for correctionsCssue
Developer Im[ act Fee
Planning Approval
Called Contact Person,
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Tees
ANOv?001 i e 0 Fey
q �
e . � 3,
�0
POOis
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