07-2020 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
: LA QUINTA, CALIFORNIA 92253
Application Number: .07-00002020
Property Address: 81145 SHINNECOCK HILLS
APN: 762-340-008-
Application
62-340-008 Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 20,00
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I tkn licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Bus' ess an Professionals Code, and my License is in full force and effect.
License Cl ss: C8 C27 C29 license No.: 656128
Date+ ��Contract
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 15500).:
(_) 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 orher 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.). `
(_) 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 ISec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner.:
REED RESIDENCE
81-145 SHINNECOCK HILLS
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/10/07
Contractor: D
TESERRA
P.O. BOX 1280 JUL 11 �UUI
COACHELLA, CA 92236 /
(760)398-9222 C!
LiC. No.: 656128 FNgN�QUINre
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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 SEABRIGHT Policy Number BB1070510
certify that, in the performance f the work for which this permit is issued; I shall not employ any
person in any manner so as to ecome subject to the workers' compensation laws of California,
and agree that, if I should beco a subject to the workers' compensation provisions of Section
.,.'y►/ 3700 of the Labor Code, I shall orthwith comply with those provisions.
Date: I I/� O Ito i7_ApplicanC -
WARNING: FAILURE TO SECURE ORKERS' 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 in rmation is correct. I agree to comply with all
city and county ordinances and state laws relating to building constr ction, and hereby authorize representatives
of this county/t/oenter upon the above-mentioned property ins ec *on purposes.
Date:�7 Signature (Applicant or Agent):
Application Number 07-00002020
., Permit BUILDING PERMIT
Additional desc
,
Permit Fee
45.00
Plan Check Fee
29.25
Issue Date
Valuation
2000
Expiration Date
1/06/08
Qty Unit Charge
Per
Extension
BASE
FEE
15.00.
15.00 2.0000
-------------------------------------------------
HND BLDG
501-2;000
---------------------------
30.00
Permit . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee
18.00
Plan Check Fee
4.50
Issue Date
Valuation . . .
. 0
Expiration Date
1/06/08
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
4..00 .7500
PER. ELEC
DEVICE/FIXTURE 1ST 20
3.00
----=-----------------------------------------------------------------------1
Special Notes and Comments
BBQ PER APPROVED PLAN
ONLY .
Fee summary Charged
Paid Credited
Due
----------------- ----------
Permit Fee Total
----------
63.00
---------- ----------
.00 ..00
63.00
Plan Check Total
33.75
.00 .00
33.75
Grand Total
96.75
.00 .00
96.75
LQPERAIIT
Bin ##
City of. La Quinta
Building 8L Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
La QuintA, CA 92253 - (760) 777-7012
-J. Building Permit Application and Tracking king Sheet
Project Address:
Owner's Name:
A. P. Number: '
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone: 00
Address: "x
L2 Project Description:
City, ST, Zip:e�C
Telephone: moo( g_ I ZZ Z
State Lic. # City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #: Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: C—•
Z —QrL Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: -2U570— -2 E�.
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
imated Value of Project:
APPLICANT:
DO NOT WRITE BELOW THIS LINE
Rec'd
TRACKING .
PERMIT FEES
Plan.Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2nd Review, ready for correctionstiissue
Electrical
4- FtxzJ
Called Contact Person
Plumbing
Plans picked up
S.M.I.
Plans resubmitted
Grading
Review, ready for corrections/issue
Called Contact Person
ATYQ151LA
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Date orpermit issue
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