05-3731 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
105_000.03731
53330 DEL GATO DR
770-350-016- -
STRUCTURES OTHER THAN
LOW DENSITY RESIDENTIA
8000
Architect or
Tityl 4 XP Qu M
BUILDING & SAFETY DEPARTMENT
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 Professionals Code, and my License is in full force and effect.
A+vJ
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).:
(_ 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.).
1 _ 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.).
(_ 1 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
VOICE (760) 777-7012
FAX (760) 777-7011, ,
INSPECTIONS (760) 777-7153
Date: 8/23/05
Owner:
CHANTLAND DENNIS ARNOLD
53-330 DEL GATO DRIVE
LA QUINTA, CA 92253
Contractor:
AINSWORTH POOL CONSTR, ROBERT
WCC: VIRGINIA SURETY
WC: 005-0024833 01/01/06
CSLB: 598681 07/31/06
----------------------------------------------—
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
Kissued.
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 C53 Policy Number - - - - - - - - - - - - - --
_ 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
21 3 000 of the Labor Co//d�I� shall forthwith compl with those provisions.
ate: 0 IAPPIicaMor: / 1 Y�S�/(1�iTl�
WARNING: FAILURE To SECURE WORKERS' COMPENSATION COVERAGE 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 issuenc suc permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state hat the ab ve info ation is correct. I agree to comply with all
city and county ordinances and state laws relating to building onstr ion, ereby authorize representatives
of this o my t enter upon the above-mentioned ro rty fo insp ion rposes.
1 r
6atd: 1 Signature (Applicant or Agent):
Application Number . . . . . 05-00003731
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee
99.00
Plan Check
Fee
64.35
Issue Date . . . .
Valuation
8000
Expiration Date
2/19/06
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
6.00 9.0000
----------------------------------------------------------------------------
THOU BLDG
2,001-25,000
54.00
Permit . . .
ELEC-MISCELLANEOUS
Additional-desc .
Permit Fee . . .
15.45
Plan Check
Fee
3.86
Issue Date . .
Valuation
0
Expiration Date
2/19/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
. 1.00 .4500
---------------------------
EA ELEC
-------------------------------------------------
DEVICE/FIXTURE >20
.45
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
27.00
Plan Check
Fee
6.75.
Issue Date
Valuation
0
Expiration Date
2/19/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
2.00 6.0000
EA PLB
FIXTURE
12.00
----------------------------------------------------------------------------
Special Notes and Comments
TWO ENTRY FOUNTAINS ONLY.
7 --------------------------------------------------------------------
Other Fees . . . . .
. . . . ENERGY REVIEW FEE
6.44
Fee summary Charged
-------------------------------------
Paid Credited
--------------------
Due
Permit Fee Total
141.45
.00
.00
141.45
Plan Check Total
74.96
.00
.00.
74.96
Other Fee Total
6.44
.00
.00
6:44
Grand Total
222.85
.00
.00
222.85
LQPERMTT
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133.48INV 2 134.16INV
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155.42'
`2
f .s
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N
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F
AM -11-0
G 4.221 O-.,--�-�•'°:� z
' r\ HIS ; S �: a-:< c},
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r-
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3.121NV 2 c >';� �' r MASTE
\'A'I BEDROOM " 3�
)TWA
' HERS TSF `/
SLEEPING CLOSET
=X6=GK 1
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135.90TG 2
r-
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PA R001
;36 .95TG ;
PA SINN 2
rj<• - 136.70 2 ` � '• ;, ' - , /"
>� 6.60TG _ r - i•� 134.701 V ' ''
- 1g4521NV f ;O O
-;FOYER `.
tr
/' !n \/
` rte, (-� ' •%f ;� t
Powder
�/\ . :. i • ' - �\ %! � � � N'f rte\ !X'
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136.601 V 2 " 134.701NV w� OF L; i-{�TA r
134.52 N /� %` P A �; % T '
i BUIL NG & SAFETY DEPT.
PA PA DINING
y PF? E® ✓
;y'n, !,� / N_ '�• F STRU
Pantry K%` '' i
S �,,
BY
S
GALLERY
KITCHEN
• - 136.70TG
F. '~•�%: Z BREAKFAST
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BEDROOM 139.00TW
. LAUNDRY 6"X6"TE
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6
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An #
City of La Quinta
Building 8L 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:
L 'A r d
Owner's Name: X N= N J
A. P. Number:
Address: X q-13 b 1"0
Legal Description:.
Contractor: X l ids(.} OOLS
City. ST, Zip: >L 3 Aji S
Telephone:
Address: s G� �` N i� t�
Project Description:
l
City. ST, Zip: 1 L/5�J//� L lit
Telephone: Y 2 ci 1
............................... .........
State Lic. # : K 'TjjD
Citv Lic. #:
Arch.. Engr., Designer:
p-rj
Address:��
City. ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:U� L
•
Construction Type: Occupancy:
Project type Ie one Ne%% Add' n Alter Repair it Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: 7C
Estimated Value of Project: x i(s 606"
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
$
Item
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
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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
•
Total Permit Fees