10-0736 (RER)r"
P.O. BOX 1504 ;
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000736
Property Address: 80634 SPANISH BAY
APN: 775-320-002- -
Application description: REMODEL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3500
4 VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/09/10
Owner:
OSTLUND SCOTT R
80634 SPANISH BAY
LA QUINTA, CA 92253.
r� n n.
I_)_l; Contractor:_ _......._..__...__.__..-----___.._— -----
......
.._._._.
Applicant: Architect or Engine r: q (� NICHOLAS INC, TD
AUS 0 j-?8IO IVUs P.O. BOX 1543
K-1
- -- - - WILDOMAR, CA 92595
�...._ _ G1TY,0F!!11,r,,.6,�8NTA (951)245-2559
tic. No.:'581497
LICENSED CONTRACTOR'S. DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Pr essionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class:, B License No.: 581497 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
..issued.' -
Contractor: 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
NER-BUILDER DECLARATION - insurance carrier and policy number are: --- -
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier SPARTA INS Policy Number 003WK05311 -
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 is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State - and agree that, if I should become subject p the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of.the Labor Code, I shall wi comply with those provisions.
- 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).: _Date//� Applic`_ an—`:
-• - - - ----1—_ 1 I,,asowner 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 WARNING: FAILURE TO SECURE RKERS' C MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
—Contractors' State License Law does not apply to an owner. of property who builds or improves thereon,.. ... ..... .. -SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES -UP TO ONE HUNDRED THOUSAND- -
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). . - .... - APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am'exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the 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 owner of conditions and restrictions set forth on this application.
property who builds or 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' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as a result of this application,
( 1 I am exempt under Sec. , B.&P.C. for this reason . the owner; and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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
LQPERAIIT
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, gn er,06y authorize representatives
of this counter upon the above-mentioned property for inspection o
Date`s Signature (Applicant or A_ gent)'_ I
LQPERMIT-
Application Number 10-'00000736
Permi..t _. . . . . . BUILDING PERMIT
Additional desc
- Permit.Fee... . . . 63.00 Plan Check'Fee
40.95,
Issue. Date Valuation
3500.-
Expiration Date 2/05/11
Qty Unit Charge Per .-
Extension
BASE FEE
45.00
2..00 9.0000 THOU BLDG 2,001-25,000
18.00
------------
Special.Notes and Comments
REPLACE SHOWER DAM & SHEARWALL REPAIR
P:PPROVED—PER—B'. H .
.
----------------------------------------------- --
= Other.:Fees .. . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
4.10
:. - -- • ' CFee :summary Charged Paid Credited
= -`-==----------------`------------------------------
----------
Due -,
PermitGFee Total .00A 63.00 .00
.00
63.00
:Plan ..Check Total:. 9_"40.95.. 00
.00
40.95
,C OthercFee Total i" 5.10 .00�
00
.
-5.10
Grand =Total _ .. 109.05. .00
.00
109.05
_
1
)
LQPERMIT-
Bin #
City Of . a Quinta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
0 Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: �C (S S N/Jrf4
Owner's Name: if. OST L q
A. P. Number:
Address: �,Q
Legal Description: 'V� (�D
City, ST, Zip: v -
Contractor: y�
SIJ • /
Telephone: n �? :• .:. :" Y . `
Address: e
Project Description:
City, ST, Zip: �1L. 3 �q1eZ_:>DS
! DLl- /,o fA•v
Telephone:
"citvie.
A17 S CSC. 6
State Lic. # #,/06z!Z_6
Arch., Engr., Designer.
7b tie- P
Address:
City., ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:tYP
ect Pro a (circle one): New Add'n r Re Demo
Name of Contact Person: `�, L �Z1�5
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person: ,57"',:5_Z Z- 76
Estimated Value of Projec .
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Tide 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanlcal
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.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees