09-0537 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
I T -,&t 4 4 Q"
Application Number: 069"00000537
Property Address: 53357—VI9'BELLAGIO
APN: 772-500-063- - -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 4190
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
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 of the Business and Professionals Code, and my License is in full force and effect.
License Class: B icens o.: 819174
Date: � 22-.4/,. U (�ontractor':
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 1$5001.:
(_) 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, 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 _ 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
Owner:
MR. & MRS. ED KARRELS
53-357 VILLA BELAGIO
LA QUINTA,.CA 92253
(
Contractor:
KG CONSTRUCTION
73416 SILVER MOON TRAIL
PALM DESERT, CA 92260
(760)346-6639
Lic. No.: 819174
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
I
Date: 7/21/09
JUL 2 4 2603
------------------------------------------------
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 EXEMPT Policy Number EXEMPT
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 he workers' compensation provisions of Section
3700 of the Labor Code, I sha orthwith c ply ith tho provisions.
Date: 72V_0q ppl
A, icant:J �C
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 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 h eby authorize representatives
of this county to enter upon the above-mentioned property fo coon purpos
Date7_k7 ignatutre (Applicant or Agent):
LQPERMIT -
Application Number
. . 09-00000537
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee'
72.00
Plan Check
Fee
46.80
" Issue Date . . . .
Valuation
4190
Expiration Date
1/17;/10
Qty Unit Charge
Per
Extension
BASE FEE
45.00
3.00-- 9.0000
THOU BLDG 2,001725,000
27.00
Special Notes and Comments
TRELLIS ADDITION 315
SUARE FEET PER
APPROVED PLANS & AJ
----------------------------------------------------------------------------
Other Fees . . . .
•. . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
4'.68 -
Fee summary Charged
Paid
Credited
Due
r Permit.Fee Total
72.00
.00
.00
72.0.0
Plan Check Total
46.80
.00
.00
46.80
Other Fee Total
5.68
.00
.00
5.68
Grand Total
124.48
.00
.00
124.48
LQPERMIT -
F3
Bin #
City of La Q=6
Building & Safety Division 1 APermit
P.O. Box 1504, ' .J a
#
78-495 Calle Tampico I
0 Quinta, CA 92253 1 `
- (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:
Owner's Name:
A. P. Number:. Address:
� O
Legal Description: LOr City, ST, Zip: V ' . 9W53
s:<:>?>::>::'<::'•
Contractor:k No,
SCH A-1 'L7 . Telephone: f•: :r•:;.,•.,.{.... ::•:;::;:.:.;::.;;
Address: .O '
� Project Description: ,
City, ST, Zip -BALM' Iffislig Mia Lis Am -nM
Telephone: :.:<:>.>:.;::>::::<:>:>:: »>•;:!»:::::>:>.:»:;<:
State Lic. #: City Lic. #:
Arch., Engr., Designer Apg... `
`
Address: — S ( )
City., ST, Zip.
Telephone: � -
:;:•.,:••>:<:;: ;: >: <::>:z>.:>.>>: o w�;: ; Construction Type: %4—M Occupancy: ..
State Lic. #: C :. .,.:•::..... ... f..,:.:,, -
S . w: >:;::.:;<-;;:;;.;:.;:::<> ProJect type circle one): New, AlterRepair Demo
Name of Contact Person: ;t,C4X 115 -Sq. Ft.: 3
#Stories:
#Units:
Telephone # of Contact Person: O `-nEstimated Value of Project:
'1Ziti1N►Wr Jo#
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plari Sets
Plan Check submitted .9( Item
Amount
Structural Calcs,
Reviewed, ready for corrections 4 Plan Check Deposit
Truss Cafes.
Called Contact Person Plan Check Balance
Title 24 Cafes.
Plans picked up tJ Construction
Flood plain plan
Plans resubmitted.: 11 Mechanical'
Grading plan
2"" Review, ready for correctio she (�
Electrical
Subcontactor List
Called Contact Person L .� Plumbing j
Grant Deed
Plans picked up. S.M.I.
H.O.A. Approval '
Plans resubmitted . Grading
IN HOUSE:- -
'"' Review, ready for correctionsrssue Developer Impact Fee
Planning Approval
Called Contact Person I•p,p,
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Z116 i,
y
'�/1' ��,�p�g►ieD--rte. •
CITY OF LA QUINTA
PLAN CHECK CORRECTION LIST
Young Engineering June 4; 2009
(760) 360-5770
PLAN CHECK NO. 09-537 FIRST/FINAL CHECK
ADDRESS 53-357 Via Bellagio OCCUPANCY R -3/U
SCOPE OF WORK New Patio Cover TYPE -OF -CONST. VB
(Structural Review Only)
The submitted plans and specifications have been reviewed by the VCA CODE GROUP. In our
professional opinion the plans. are in substantial .conformance with the building codes ands
regulations adopted by the CITY OF LA QUINTA and the State of California Amendment.
APPROVAL FOR A BUILDING PERMIT IS HEREBY RECOMMENDED SUBJECT TO
OBTAINING APPROVALS/CLEARANCES FROM ALL APPLICABLE CITY
DEPARTMENTS, AGENCIES, AND ASSOCIATIONS
Plans checked by
Hue C. Luu, P.E.
VCA CODE GROUP
2200 W Orangewood Ave; Ste 155
Orange, CA. 92868.
(714) 363-4700 ext. VCA File No. LQ -21643.A
r
1
' QUINTA SU KBCON
�
OWNER ~|�K�
' J -BUILDER
^ - ' e job with the Ailcfingj�specti�h Card at all times.in a conspicuous place. Only/ persons appearing on this list or their employees are muthonoeo'no work.,
on this job. Any changes to ' a list must be ��rove by the Bui|dihQ Division prior to oomnnen6ernent.of work. Failure to comply will result in a stoppage of work and/or`thm voidance.
of building permit. For each applicable trade, all information reouested belowbe completed by applicant. "Un File'! is not an acceptar)le response.
'
Classification
License Number
Exp. Date
Carrier N i ame
P olicy Number,
Exp. Date
License Number
Exp. Date
d, CalComp)
(Format Varies)
(xx/x
on
Ag
9.1
Nsy A.
'