12-0098 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 12-0000009
Property Address: 79420 CITRUS
APN: 772-140-013- - -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2262
Applicant: Architect or Engineer:
a� p
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.
License.Class: C8 C27 License No.: 921709
Date: 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.).
(_) 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 am exempt under Sec. , BAP.C. for this reason
pa[ 4
I hereby affirm under penalty of
work for which this permit is iso
Lender's Name:
Lender's Address:
LQPERMIT
/ CONSTRUCTION LENDING AGENCY
3t there is a construction lending agency for the performance of the
3097, Civ. C.).
Owner:
JAMES KELLER
79420 CITRUS
LA QUINTA, CA 92253
Contractor: !�
SANCHO'S LANDSCAPE r
82855, MARKET STREET I�
INDIO, CA.92201 { LA
(760)404-7045
LiC. No.: 921709,
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/02/12
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 MARKEL INS CO Policy Number MWC0010302-1
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
� 700 of the Labor Code, hall forthwith c m with those provisions.
atD e: plic
WARNING: FAILURE TO ECU WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,•AND SHALL
SUBJECT AN EMPLOYE TO RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000): DITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE ABOR 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 authorize representatives
oft ' county to enter upon the above-mentioned grope ty for inspection purposes.
Date: ature (Applicant or Ag
Application Number . . . . . 12-00000098
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 54.00 Plan Check Fee
35.10
Issue Date . . . . Valuation . . .
. 2262
Expiration Date 7/31/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
----------------------------------------------------------------------------
9.00
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 18.00 Plan Check Fee
4.50
Issue Date . . . . Valuation . . .
. 0
Expiration Date 7/31/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special .Notes and Comments
BBQ & FIREPIT INCLUDES 110 L.F. 3/4" GAS
LINE TO SUPPLY APPLIANCES. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
3.51
STRONG MOTION (SMI) - RES
.50
Fee summary. Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 72.00 .00' .00
72.00
Plan Check Total 39.60 .00 .00
39.60
Other Fee Total 5.01 .00 .00
5.01
Grand Total 116.61 .00 .00
116.61
LQPERMIT
CONTACT RE-EREIZE
SANCHM LA 475rAP
0"TRXTION
N 6' MASONRY BLOCK
RAISED GAS FIRE PIT
0'-4• HIGHT x 4•-g• WIDE
_ _ _ _ _ _
PROPERTY LINE
( PROPERTY
W/ TREES TPLANTERS O
,
(E) WROV6FiT IRON
C.A. 9T. UC. C77 4 c6 447T709
0'-6' INSIDE) x 1'-0' U
w/ 10' OVERHANG STONE CAS,
I T' 69.5'
GATE TO REMAIN
PHIL
760.404,1045
SNCCO TO MATCH EXISTIR6 '
(INS DE)AND LAVA ROCKS
- - _ - -
- - - -
1
/'
��V
MAINTIENANCE VIVISM
160516.1667
(E) RAISED PLANTERS
O
(� POOL ECUIPMENT
w/ TREES TO REMAIN
N CONCRETE SLAB
4 'Q
fV
I EO
I
TO REMAIN
TO BE INSTALLED
AROUND FIRE PIT AREA.
` _ _ i
(E)
POOL ��
I
I
iEl WROUGHT IRON
GATE TO REMAIN
(N) COURT 517E CAP
(E) PALMS TO REMAINLI.I
I
(E) MASONRY BLOCK
WALL TO REMAIN
T�-O• w/ 10' OVERHANG
10• CALOR, SUN SET GOLD
OVERHANG (N) b' MASONRY BLOCK
FRAME K/ 5TWCO FINISH AND
RARAISED LT�IP
I
I
COLOR TO MATCH EXISTING
G
6A5 BOO AREA
6' HIGH x 5'-0' WIDE
e�pA I
I
Q
HOME.
-=T.-
x 5'-6' U w/ STONE CAPS
and 5TUGCA FINISH TO
MATCH EXISTING HOME.
NOTE. FIELD VERIFY NEW
I
---���----
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I
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Ln
(fl KEYNOTE
UJIZ m
em,mcere raai.
17•Hg•
CONCRETE FOOTING FOR
5'-4' MASONRY BLOCK FRAME FOR
iv FIRE PIT.
WO-
I
PRIOR TO
PRIOR
FRAMING OPENING m
I,®I
�ffjJ
FRONT VIEW
i
i
Lu
0-
C
h/- /r W
` ra IT"L I I B' (N) RT SITE
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Oa CAP
ANO
A�LOR�SIRI
g�-O•
D
OVEWIAN6 4
(1U 6' MASONRY BLOCK
N
Y�L.
SETBACK<
FRAME u/ STUCCO FIN15H AND
Z
O
B-
SETBACK
I
_ COLOR TO MATCH EXISTING
HOME.
Ql) 12' -Ib'
J
(Lb
Q&
CONCRETE FOOTING FOR
MASONRY BLOCK FRAME FOR
FIRE PIT.
3 t
V
0 K a Q
0
ry
0 S
i f51DE
f
(E) WROUGHT IRON
VIEW
2 A
,
GATE TO REMAIN
m
I
A ELEVATIONS
(EJ 6A5 METER
-
a
c
0 MASONRY BLOCK I
HALL TO REMAIN I
(F`•
I O Qn Q
LC—
TO REMAIN
(E) MAIN POKER
METER TO REMAIN
gg
N
ITBLAB
DRIVEWAY
0
O
()t
TO REMAIN
fl
CITY OF LA QUINTA
ryQ -
(� PALM TREE
BUILDING & SAFETY DEPT.
. I
(E) PALM TREE _ -
TO REMAIN
-TO REMAIN
APPROVED
F
PROPERTY LINE
64.92'
FOR CONSTRUCTION
LL
G I TRUS AVE
DATEa a /2
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REwsloNs
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P.O. Box 1504
LA.QUINTA, CALIFORNIA 92247-1504 BUILDING &t SAFETY DEPARTMENT.
78-495 CALLE TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760)-777-7011
PROPERTY OVM- ERS PACKAGE
Disclosures & -Forms for Owner-luffders Applying for Construction Permits
Dear Property Owner.
tUi. application for a builitingpermit has been submitted in your. name Usti % youfself as the builder of the property
impro"ments specified at 7�j f 2 CO.
rT� cJS l 4� i�
We ane providing you with. an Owner-Buddef AclmovdeElgment and Information ` erification Foci to make amu aviM' of your
eespew bilines and por'ble risk -you -may incur 6y h9ving d& pemnit ismed in your name as .the
Owner -Builder. We will not issue a building permit until you hsve read, initiated your. wade: -nding of eachvrw4 ion,
signed, and returned thin form to us at our official address indicated. An agent of the owner cannot execute thin notice
unless you, the property owner, obtain the prior approval of the permitting authority.
9 "%ai' . 0 '- o: � e� e � a� ar:a� ru J � � � � :� :� �..r u • u � r . � ;.a:a
G 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing hisor her own labor and material personaft-1, as
an Owner -Builder, may be held liable and subject to�otrs'fmmcid rick for env_, i��ries c��c �: by an urilioensed M son
and his or her employees while wo on m
�g Y . Piny My homeowner's insurance. may not provide coverage for those
injuries• I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
®n my. property.
C (--2. I understand building Burg permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
�C3. I understand as. an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
`<J ". I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total valuf
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employe
under state and federal law.
6. I understand if I am considered an "employer" under state and federal law, I must register with the state and feden
government, withhold payroll taxes, provide workers' compensation disability insufance, and contribute to unemploymet
compensation for each "employee." I also understand my failure to. abide by these laws may subject me to serious fuiewcu
risk
d� 7. I understand under California Contractors' State. License Law, an Owner -Builder who builds single-family residenti
structures cannot legally build them with the intent to offer .them for sale, unless all work is performed by licens
subcontractors and the number of structures does not exceed four'within any calendar year, or all of the work is perform
under contract with a licensed general building Contractor.
�8. 1 understand as an Owner -Builder if I sell the'property for which this permit is issued, I may be held liable for any
financial or personal: t4ar= suslalrted by any subsequent owners) that result from any latent constlaCtion defects in the
workmanship or materials..
9: I .understand.) may obtain• more information regarding MY' obligations as an"employee" from the Trrtet rl I ei�enue
Service, the United States Sniall Business Administration, the California Department of Benefit Payments, and the CaR"Qrnia
Division of Industrial Accidents. 1 also understand I may contact the California Contractors' State License Board (CSLM at I -
800-321-CSLB (2752) or www.cs[b.ca.gov for more information about licensed contractors.
AO. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand Haat I am the
party legally and tinancially responsible for proposed. construction activity at the following address:
V 1. I agree that, as the party legally and ftnamcially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as well m employers.
y l�-l2. I agree to notify the issuer of this form immediately of away additions, deletions; or ckgooes to any of the idwmatiew I
have provided on this form Licensed contractors are regulated by laws designed to protect the public. If ynu Coateaet with
someone who does not have a license, the Contractors' State License Board may be unable to astt you with tray fin al. Ivan
you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may, be in'crivd 00vrt. It is also
important for you to understand that if *a unlit onsed Contractor of =Vloyee of that individual of ihm is iqiured while worlemg
on your property, you may be bead WAe for damages. If you obtain a permit as Owner -Builder and wt* to hire Cenuumns,
you will be responsMo for va*ing w1wdw ormot those Contrxcum are Vwpedy Iieensed and the ulnas of dMiF wc&as'
Compensation insurance covenw.
Before a building permit can be issued, this form must be completed and signed by the property owner aad returned to
the agency responsible for issuing Me per'mit. Node: A copy of stce proprxV owner's & vcr'v fwM Ouft*WIvp or
other verification aecep"k too die agency is required to be presented when dtv pmrdt is ivaued to vM* t(te
owner's signature. 2
Signature of property own Date:
Note: The following Authorization Form is required to be completed by the prop" owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORMATION OF AGENT TO ACT ON PROPERTY_OWNER'S BIMRn
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following persons} to act as my agetat(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am theproperty owner for the address listed above and I personally filled out the abo-
information and certify its accuracy. Note: A copy of the owner's driver's license, form hotariaation, or other ve4cwion
acceptable to the agency is required to be pm -wiled when the permit is issued to verify the property owner's signature.
Property Owner's Signature: Date:
C11TRU8 -�766
COURSE HOMEOWNERS ASSOCIATION
NOTICE OF APPROVAL
January 25, 2012
The Keller Family Trust
4813 Old Stump Dr NW
Gig Harbor WA 98332
RE: 79420 Citrus
Dear The Keller Family Trust:
PA7e
Your Request for an architectural change has been approved. Specifically, you have approval to proceed with the following
Install built-in raised black gas fire pit. Das line will be 2 feet Inside property line.
We reserve the right to make a final inspection of the change to make sure it matches the Request you submitted for Approval. Please
follow the plan you submitted or submit an additional Request form if you cannot follow the original plan.
Your approval is conditional with the stipulation of the following: Must obtain a Building Permit from the city for the gas line.
You must follow all local building odes and setback requirements when making this change. A Building Permit may be needed. This
can be applied for at the City offices.
Our approval here is only based on the aesthetics of your proposed change. This approval should not be taken as any certification as to
the construction worthiness or structural integrity of the change you propose. If applicable, please be aware that you are responsible
for contacting the appropriate utility companies before digging.
Thank you for submitting your application and we look forward to receiving your notice of completion upon commencement of
completed work. For your convenience a "notice of completion" document has been attached.
We appreciate your cooperation in submitting this Request for Approval. An attractive Community helps all of us get the full value
from our homes when we decide to sell.
Sincerely,
�U
Ann Miller
Assistant Association -Manager.
Citrus Course HOA
Encl. 1
P.O Box 12920 Palm Desert, CA 92255 ' .41-865 Boardwalk, Suite 101, Palm Desert, CA 92255
760.346.9000 ' FAX 760.346.9997 ' www.cibmwoursehoa.com
CITY OF LA QUINTA SUB -CONTRACTOR LIST 72��
JOB ADDRESS PERMIT NUMBER -OWNER 7Z6 k"`c lel c 1-;0fy'1 y BUILDER
This form shall 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 authorized to work
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 wor and/or th voidance
of building permit. Foreach.applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.C:/�
Trade / Classification
Ggttactor
$tat. Corttractor's .License
Vllofkers C. . .. .. tion Insurante
cityf3usit#ess License
Company Name
Classification .
(e.g. A, B, C-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)
License Number
(xxxx)
Exp. Date
(�/xx/xx/xx)
EARTHWORK (C-12)
�,1I
I`�i J
C-2� ��fi
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U�'�� I
��/��. z- /A,5,,
M GUGd010.0�
d8 �t7
0 �o
-`/ 9 1.2
CONCRETE (C-8)
FRAMING (C-5)
STRUCT. STEEL (C-51)
MASONRY (C-29)
PLUMBING (C-36)
LATH, PLASTER (C-35)
DRYWALL (C-9)
HVAC (C-20)
:ELECTRICAL (C-10)
.
ROOFING (C-39)
SHEET METAL (C-43)
FLOORING (C-15)
GLAZING (C-17)
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING (C-33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27)
POOL (t;-53)
Eln.#
.. ty 0f Ld Qutnta
Buildtrig a Safety Div 6n
P.O. Box 1504,76-495 Calle Tamptco
La.Quinta, CA 92253 - (760) 777-7012 -M L)5-7
Building Permit Application and Tracking Sheet
Permit # n
\�
Project Address: -7C/'Zc� 072 t)5
Owner's Natne:.1io"rZ5i
A. P. Number.
Address: . ��v C 2Evs
Legal Description:
Contractor. '54A)6f,-a5 G SCA�'e
City, ST, Zip
Telephone:
Address: Z .
Project Description: / µ3S 7Apc e_- 1166
/a 1
l
City, ST, Zip: T -A b% Zi aza0 f
G4 -S
Telephone:r
I
,,,, 11
fVP_(A) ft
State Lia #: �I %O City Lie #;
Arch4 Engr., Designer.
Address:
City., ST. Zip:
• Telephone:
State Lic. #:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.; k) A- # Stories: ,tj .4 IN Units: 1014-
Name of Contact Person: fA_U4.. s,¢,v 5
Telephone # of Contact Person: ��0 — � = 76 y Estimated Value of Project: F,57
APPLICANT: DO NOT WRrrt BELOW THIS UNE I�. % — �� �7
# Submittal Req'd Recd TRACKMG PERMTF FEES
Plan Sets
Plan Cheek submitted Iteut Amount
Structural Cales.
[reviewed, ready for corrections Plan Check Deposit. .
Truss Cales.
Called Contact Person Plan Check Balance
Title 24 Cates.
Plans picked up Constracdon
Flood plain plan
Pians resubmitted.. Mechanical
Grading plan
2'' Review, ready for correctionsfissue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up SMI.
H.O.A. Approval
Plans resubmitted Grading
IN ROUSE:-
''a Rayiew, ready for correctlonsthssuc Developer Impaet Fee
Planning Approval
Called Contact Person
Pub.". Appr
Date of permit issue
School Fees
Total Permit Fees