BRES2014-1070(760)497-7654
Llc. No.: 962128
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LICENSED CONTRACTOR'S DECLARATION
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 Professions Code,
and my License is in full force and effect.
License Class: B. C29, C53 License No.: 962128
Date Contractor
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
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).:
(_) 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 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 contractor(s) licensed pursuant to
the Contractors' State License Law.).
(__j 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
Lender's Address:
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 ork for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
Sect, 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:- Policy Number: _
_ 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 the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
f,
Date Applicarit
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE NLAWFUL,
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 Building Official 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 hereby authorize representatives of this city to enter upon the above-
mentio ed pro erty for inspection purposes.
Date: Signature (Applicant or Agent I
78-495 CALLE TAMPICO
D
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/22/2014
Application Number: BRES2014-1070
Owner:
Property Address: 48443 STILLWATER DR
TAMMY JENTZ
APN: 623530015
48443 STILLWATER
Application Description: GAS AND ELECTRICAL FOR FUTURE USE
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $1,000.00
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r
Applicant:
pp
Contractor:
A LSD
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DERYK AIREY
DERYK AIREY
m c
40262 EASTWOOD LANE
40262 EASTWOOD LANE
c o c
PALM DESERT, CA 92211
PALM DESERT, CA 92211
� v �'
(760)497-7654
Llc. No.: 962128
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t --=------------
LICENSED CONTRACTOR'S DECLARATION
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 Professions Code,
and my License is in full force and effect.
License Class: B. C29, C53 License No.: 962128
Date Contractor
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
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).:
(_) 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 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 contractor(s) licensed pursuant to
the Contractors' State License Law.).
(__j 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
Lender's Address:
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 ork for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
Sect, 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:- Policy Number: _
_ 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 the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
f,
Date Applicarit
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE NLAWFUL,
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 Building Official 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 hereby authorize representatives of this city to enter upon the above-
mentio ed pro erty for inspection purposes.
Date: Signature (Applicant or Agent I
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FINANCIAL INFORMATION
Z"
DE-SCRIIPIT�ION'� ACCOUNT :
AMOUNT
PA16- PAID DATE
BSAS SB1473 FEE 101-0000-20306
0
$1.00
$0.00
-:..-PAID BY 'MET 0
H D I.. ' ,
, RECEIPT
HECK #
C CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
'DESCRIPTION—.
-*ACC 6NT-
i �.T.Y
AMOUNT
PAIDj,'
PAID b ATE
DEVICES, FIRST 20
101-0000-42403
0
$23.83
$0.00
PAID,BY..
ME,THOQ,
RECEIPT#
CH ECK4
CLTD -13
DESCRIPTION;vo-
ACCOUNT
QTY.
T
AMOUNT: i�
'PAID'
;PAID�DATE-
DEVICES, FIRST 20 PC
101-0000-42600
0
$23.83
$0.00
BY
-,'METHOD
RECEIPT #
CHECK
CLTD BY.::
Total Paid for ELECTRICAL: $47.66 $0.00
.1-DESCRIPTION -r-,
.ACCOUNT,r
�QTY
'AMOUNTr..,
PAID -7
A
PAID DATE!
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$11.92
$0.00
1
-APA,16 BY
METH D
RECEIPT #
#
CLTD BY,
.CHECK
DESCRIPT6W'�-`---
ACCOUNT',,.-
CiTy,
AM UNT
0
p AID.A-�
tPAID'DATE
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$23.83
$0.00
PAID BY
RECEIPT #
CHECK #
CLTD BY=
•METHOD
Y
Total Paid for PLUMBING FEES: $35.7.5 $0.00
'*--DESCRIPT IONi
CITY
AMOUNT-
PAID DATE
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
$0.00.
r PAID BY.
METHOD
RECEIPT# t
"'CHEC K.#,,
Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $0.50 $0.00
TOTALS: $84.91 som
w
Bin #
City of -La Quinta
-Building 81; Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta,CA 92253 - (760) 777-7012
Building Permit Application and Track
Permit #
ProjectProject Address: 3 s i i 4 �. �C
Owner's Name: Y J tN i Z
A. P. Number:
Address:
Legal Description:
City, ST, Zip:LA C g RRS&
Contractor:
:..:..:........
Telephone: ....:............
Address: 4QA6E)f5'[W&0g) LtJ •
Project. Description:
City, ST, zip -Vow I
Telephone: 97 •-765
`'<#=>;:N?,.<.;.?.:.; :.;;..:.,�, ::;x:; :•;:.
State Lic. # : 6
City Lie. C
Arch., Engr., Designer:
Address:
City, ST, Zip.
Telephone:
State Lic. #:>
w ..
` '' " i"'+" "'' ``''`` '-''=
..........................................
Construction Type: Occupancy
Project a circle one): New Add'n Alter Repair Demo
Name of Contact Person: F2y K
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:? g ]_ 6 �yc
Estimated Value of Project: Q c'a
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACMG
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 corrcctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'"` Review, ready for correctionsfissue
Developer Impact Fee
'
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue.
School Fees
Total Permit Fees
c�
a. Fouf IS. C�.nk�en
r F l aaement
-.P'0
July 21, 2014
t
ADiane Cooley - i •• .. • , � • . - i '.
48443 Stillwater
' P
La Quinta, CA 92253 {.
RE: Architectural Request Approval
Dear Diane Cooley, ;
The Architectural Committee at Hidden Canyon has approved your ARC request for
installation of a backyard barbeque and pavers.at your property located at 48443 Stillwater,
La Quinta, CA 92253 as subinitted.
Please note the following:
All necessary City requirements must be met and any. permits must be obtained.
- The height of the BBQ must "not exceed the height of the backyard perimeter wall:.
Common area/streets'cannot be used for equipment or material storage:
Damage caused to common area/streets is your responsibility.
The Board asks that your contractor honors the Rules and Regulation of the association
while performing the work. Should you require`a copy of the pertinent information, please
do not hesitate to call our office. M
t Sincerely,
Cidra Holm
Avail Property Management 1
service@availhoa.com
51350 Desert Club Dr.; Suite 4, La Quinta, CA 92253
a " Tel: (760) 771=9546 Fax (760) 771-1655 . '
>1VE1rJ AI
Y IST Nf� Fool-. _
�S1 iN n� SipCt.��r
1' C♦riz ,
IF
BUILDING & SAFETYDEPT.f
'.
- - DATE