13-0452 (SOTB)ar
P.O. BOX 1564''. R.
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number: 13-00000452
Property Address: 57535 SEMINOLE DR
APN: 762 -350 -029 -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 600
Applicant:
V
Architect or Engineer:
N
—-——--———---
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: A C8 License No.: 310985
Date: Contractor: `�� C;rit..•..0 %�vV
H f's
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 _ 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.).
( •) 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 contractors) licensed '
pursuant to the Contractors' State License Law.).
( ) '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:
R
I,QPER3N1IT r+
/ VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner: _
HARRISON
57535 SEMINOLE C
LA"QUINTA, CA 92253
(760)250-6731 ino
Contractor:-
CANYON SPECIALTIES
77590 MOUNTAIN VIEW
PALM DESERT, CA 92211
(760)345-8200
LiC_ No.: 310985
------------------
WORKER'S COMPENSATION DECLARATION
Date: 4/10/13
APR ?02013
OF LA QUINTA
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 SOUTHERN INS Policy Number PWC00464612
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 1 should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions. -
Date: Applicant:-.. rz;&..4,0x
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 co truction, and hereby authorize representatives
of this county
��t��o��enter upon the above-mentioned property f i pection purposes.
Date: T1_� Signature (Applicant or Agent): .
6QYFRD1IT '
...'Application Number - - . . 13700000452
Permit ELEC-MISCELLANEOUS
Additional desc .
Permit Fee 15.75" Plan Check Fee
3.94
Issue Date z Valuation . . .
. 0 .
Expiration Date . 10/07/1"3
Qty", Unit Chargee Per.
Extension
BASE FEE
15.00
1.00 .'7500 PER ELEC'DEVICE/FIXTURE.lST 20
.75. .
Permit PLUMBING
Additional desc
Permit Fee 18.00 Plan Check Fee
4.50
Issue .Date Valuation.
0
'Expiration Date 10/07/13"
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 AND 85LF"OF'1' GAS,PIPE-WITH
ELECTRICAL.'2010 CODES.'
Other Fees . . : BLDG.STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 33.75 .00 .00
33.75
Plan Check Total 8.44 .00 -00
'8.44
Other" -Fee Total 1.00 .00 .00
1.00
Grand Total 43.19 .00 00
43.19
6QYFRD1IT '
5cc5 Glo,e.
IWO
PGA WEST®
FAIRWAYS ASSOCIATION
April 4, 2013 i
Thomas Harrison
12255. Clydesdale Drive
Rancho Cucamonga, CA 91739 r
Re: Architectural Application — 57535 Seminole
Dear Thomas Harrison:
The Architectural Committee has reviewed'your request for the installation of a BBQ, fire pit and pavers
in the rear yard of your residence. I am pleased to inform you that the Architectural Committee has
approved the application as submitted.
Enclosed is Exhibit C — the Compliance Review Request form. Please complete this form after the work
is completed and return it by mail or fax to the address below so the completed project can be inspected.
If you have any questions, please contact Cassie Gertz, Operations Manager at 760-776-5100 Ext. 345 or
email Cassie.Gertz(a�Managementtrust.com.
Sincerely,
For the Architectural Committee
PGA WEST Fairways Association
e McD nald, CCAM, PCAM
ss iatio Manager
Enclosure: Exhibit C — Compliance Review Request
cc: Lot File .
Architectural Committee
Post Office Box 1690 • La Quinta, California 92247 • Phone (760) 776-5100 • Fax (760) 776-5111
Bin.# city Of Quints
Building 8r Safety Division
Permit # P.O. Box 1504,78-495 Calle Tampico
1.a.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: , j -� S 3 S— Se $411 Owner's Name:.
M
•
A P. Number.
Address: 7 S-3.5-- S wt i h . b(
City, ST, Zip: =--
Telephone: -7&o a.5-0 (9 7 3
Project Description:
/ G S (/ Gc
i
Lo A,
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories:#Unit$:
Estimated Value of Project Q -
WRITE BELOW THIS UNE
Legal Description:
Contractor. t/(4 A14 Ohl dV
Address: % 7 Lljyi Owl ki e
City, ST, Zip: a
Telephone: 76o 3C s- ), d a r
State Lic. # : City Lie'. #;
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
APPLICANT: DO NOT
#
Submittal
Req'd
Reed
TRACICIPIG PERMIT FEES
PIan Check submitted Item
Amount
Pine Sets
Strgctural Calcs
Reviewed, ready for corrections
Plan Check Deposit. .
'Russ Calcs.
Called Contact Person
Pian Check Balance•
Tule 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted_.
Mechanical
Grading plan
2`! Review, ready for correctionsliissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed.
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
DY HOUSE:-
'`° Review; ready for correctionslissae
Developer Impact Fee
Planning Approval
Called Contact Person
A.%P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees