08-0149 (SOTB)P.O. BOX 1504.
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253 BUILDING & SAFETYjPARTMENT_
Application Number: 08-00000149
Property Address: 61704 TULARE LN
APN: 764-280-999-106 —300237
T Application description: STRUCTURES OTHER THAN BUILDI
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 500
Applicant:
�b
Architect or Engineer:
BUILD( PF
IG
01
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under.penalty of perjury that I am li ensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busines and Pr fessionals Code, and'my License is in full force and effect.
License CI�e�C8 C27 C29 License No.: 656128
- .r OW ER -BUILDER DECLARATION '
1 hereby affirm under.penalty of,perjury that 1 a xempt 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 7631.5,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 offeredfor sale. If, however, the buildingor 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.l: '
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Coder 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
5IT
Owner:
BLACKWELL RESIDENCE
17.04 TULARE LANE'
L QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280.
COACHELLA, CA 92236
(760)398-9222.
Lic. No.: 656128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/17/08.
WORKER'S COMPENSATION DECLARATION
1 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.
l,have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor .
` Code, fortheperformance of the' work for which this permit is issued. My -workers' compensation
insurance carrier and policy number are: .
Carrier SEABRIGHT '. Policy Number BB1080510
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 beme'subject to the workers' compensation laws of California;
and agree that, if. I should becomeobject to the the
compensation provisions of Section
3700 of the Labor Code hall fo hwith comply with those provisions.
Da_te:� Appli_ can �•
WARNING: FAILURE T.0'SECURE WO RS' COM NSATION COVERAGE IS UNLAWFUL, AND SHALL .
SUBJECT AN EMPLOYER TO CRIMINAL. PE 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-applica6t, 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 relatedto 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 perm' , 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 in ormation is correct. I agree to comply with all
city and county ordinances and state laws relating to building co st ction, and hereby authorize representatives
of'thiss c my t enter pon%the above -mentioned -prop y or 1 e ion purposes.
Date s/ Signature (Appli�Jant-or'A'gent):
Application Number . . . . . 08-00000149
Permit . . . BUILDING PERMIT
Additional desc .
• Permit Fee . . . 15.00
Plan Check
Fee
9.75
Issue Date . . . .
Valuation
. . .
. 500
Expiration Date . . 7/15/08
Qty Unit Charge .Per
Extension
• BASE FEE
----------------------------------------------------------------------------
15.00
Permit . . . PLUMBING
Additional desc .
Permit Fee 18.00
Plan Check
Fee
4.50
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 7/15/08
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
FIRE PIT ONLY PER APPROVED PLANS
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ENERGY
REVIEW FEE
.98
Fee summary Charged Paid
-------------------------------------
Credited
----------
----------
Due
Permit Fee Total 33.00
.00
.00
33.00
Plan Check Total 14.25
.00
.00
14.25
Other Fee Total .98
.00
.00
.98
Grand Total 48.23
.00
.00
48.23
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#4 BAR; VERT. AT. 32" O.C.
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Bin #
City ®f La Quint:aa
Req'd
Building:u Safety Division
Permit #
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit
Amount
Application and Tracking Sheet
Project Address: !, ��
Owner's Name: �L
Reviewed, ready for corrections Plan Check Deposit
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: ``
a °� `
Telephone:�Tgtit
Energy Calcs.
Address: C) , l
o Project Description:
City, ST, Zip:
CNc Lr
Cts qz.Z 6o
(} t�
Telephone: ] b - f L l:
Plans resubmitted Mechanical
X 0 N ,
NO
State Lic. # : j
Grading plan
City Lic. #:
Arch., Engr., Designer:
Address:
Subcontactor List
City, ST, Zip:
Called Contact Person Plumbing A5
Telephone:
t5 . - Construcfion Type: Occupancy:
State Lic. #:
k r Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: Estimated Value of Project: SOS
APPI ICaiVT. nn ldnT WQITC nei AIA/ TIJIQ 1 1Rl[!
#
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
Energy Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2nd Review, ready for corrections/issue Electrical
Subcontactor List
Called Contact Person Plumbing A5
ooZ(�Z.S
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
"d Review, ready for corrections/issue -Developer Impact Fee
Planning Approval
Called Contact Person MAP -
,p P,Pub.
Pub. Wks. Appr
Date of perm t isueITY
School Fees
BML
STR arr"',
Total Permit Fees