10-0223 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T,iht 4 4 Q"
Application Number: 10-00000223.
Property Address: 79135 SHADOW TR
APN: 649-030-069-10 -31310 -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: HIGH DENSITY RESIDENTIAL
Application valuation: 1200
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
------------------------ -------------------
ACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am lic s der provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busin ss and nals Code, and my License is in full force and effect.
License Class: C53 /License No.: 752433
`- OWNER -BUILDER DECLARATION
I hereby affirm under alt
peny.of pe jury that am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and rofessions 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 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.).
( 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:
YVETTE TANNER
79135 SHADOW TRAIL
LA QUINTA, CA 92253
(760)771-3345
Contractor: .
HAWAIIAN POOL &
417 W. FOOTHILL H
GLENDORA, CA 9174
(800)730-0935
Lic. No.: 752433
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
):'21dilk
Gat
Date: 3/18/10
WORKER'S COMPENSATION DECLARATION
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 p rmance of the k for which this permit is issued, I shall not employ any
person in any manner so a e subject to the workers' compensation laws of California,
and agree that, if I should beco to the workers' compensation provisions of Section
3700 of the Labor Cpde, I rthwith comply with those provisions.
WARNING: FAILURRTL_Sfi4:MTq 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 th' cion becomes I and void if work is not commenced
within 180 days from date of issuance of suc or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state t at rmation i ,correct. 1 agree to comply with all
city and county ordinances and state laws relating nstruc ' ,and hereby authorize representatives
oftthis county to enter upon he above-mentioned rt o coon purposes.
S' ature (Applic g nt)
Application Number 10-00000223
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
29.00 Plan Check Fee
18.85
Issue Date . . . .
Valuation .
. 1200
Expiration Date
9/14/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
7.00 2.0000
--------------------------------------
HND BLDG 501-2,000
-------------------------
14.00
-------------
Permit . . . .
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee
15.75 Plan Check Fee
3.94
Issue Date
Valuation . . .
. 0
Expiration Date ..
9/14/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 .7500
PER ELEC DEVICE/FIXTURE 1ST 20
.75
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
18.00 Plan Check Fee
4.50
Issue Date
Valuation
0
Expiration Date
9/14/10
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 WITH 1 OUTLET & -45
L.F 3/4" GAS
LINE, NO SINK. 2007 CODES.
----------------------------------------------------------------
Other Fees
. . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
1.89
STRONG MOTION (SMI) -"RES
.50
Fee -.summary Charged Paid Credited
Due
----------------- ----------
Permit Fee Total
62.75 .00 .00
62.75
Plan Check Total
•27.29 .00 .00
27.29
Other Fee Total
3.39 .00 00
3.3.9
Grand Total
93.43 .00 .00
93.43.
LQPERMIT
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Boz 1504, 78.495 Calle Tampico
La Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
�-
Project Address: 7 y—l%iJ(.t
Owner's Name: (V/L7-/7c---
A. P. Number:
Address: G
Legal Description:.�
City, ST, Zip:
Contractor: ,4(,t f��,N CUL
Telephone
`.air Y.':•
Address: Fr,v %�7Gli G
Project Description:
City, ST, Zip:
'•`.'':;.isiv(..C,:•':'??,?j<C\::rttiQi:•S:i�• ^v?):ij rii'
Telephone: W— 730 v/35 .Y1::;??•!F•:•;}::v:: SYiY•iYYYii}iYf:?v.'•:i!%t'i
State Lic. #: 75Z533 City Lic.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
<`':�;:`;,.' ?t. ;• ; >:
ty::i.: 4`"_Vif::.C�S�H• : •�:�:v.� :ytyr
u•>�«>s�>E<r..fr•<�>:,>:s,••.x:;::s':4>
' .. '<;;<• <;;:>::::...,:
Construction Type: ..
yp(� Occupancy:
State Lic. #:
_3
Project type (circle one): Ne Add'n Alter Repair Demo
Name of Contact Person:�� p /�.
Sq. Ft.:
# Stories:
# Units: '
Telephone # of Contact Person:$QlG _ 730 —0'5? 3S—
Estimated Value of Project: ZO I>'
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 Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionstissue
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.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
.fit ..PA440
ry
re tvO/
r
)istd7.oq4n
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to ctnotes.
ron J. R.C.E. 58878
Q E Ineering
Hawaiian Spa CITY OF LA QUINTA '
417-B W.foothill Bfvd., #107 BUIL
DING &SAF`E,TY DEPT.
Gfendom, CA 91741 ; # /dA�i P P R O i/ E
(800) 730-0935 FOR ONSTRUCTION -
DAT 3 BY '_7_
' -79 13