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12-1387 (SOTB)fo P.O. 8OX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Numbers- 12--0 0 0 013 87 Property Address: 79850 TANGELO APN: 772-230-012- - - Application description: STRUCTURES OTHER THAN BUILDINGS Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 15000 Applicant: Architect or Engineer:. Cl/ BUILDING & SAFETY DEPARTMEN BUILDING PERMIT Owner: STEVE SEHER 79850 TANGELO LA QUI NTA, CA 92253 Contractor: tl D UNIQUE CONSTRUCTIOt VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153. 3 2012 Date: 11/28/12 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 contractorls) 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: Y r LQPERMIT 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. 1 agree to comply with all city and ounty ordinances and state laws relating to building construction, and hereby authorize representatives of th' col t t enter upo [he above-mentioned pro rt r for inspection purposes. ate: �`':J gnature (Applicant or Agent): 83740 CITRUS AVE.,` IT J INDIO, CA 92201 ��u1�1TA (760)342-2730 �,'``pY�� �pEpT• I Lic. No.: 943480 ------------------------------------------- LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided Li ense Class: B icense -o.: 2&348.0 - for by Section 3700 of the Labor Code, for theperformance of the work for which this permit is Date: / 1 S� Z ontractor: 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 • - OWNER -BUILDER DECLARATION - insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EXEMPT. Policy Number EXEMPT following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to •I c=at, in the performance of the work for which this'permit is issued,'I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions. of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthw' com itt.Awffl provisions. - that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 9 /� any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:ate: ��/`? ppIicant: / _ - 1 1 1, 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE.HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000): IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 contractorls) 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: Y r LQPERMIT 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. 1 agree to comply with all city and ounty ordinances and state laws relating to building construction, and hereby authorize representatives of th' col t t enter upo [he above-mentioned pro rt r for inspection purposes. ate: �`':J gnature (Applicant or Agent): . Application Number . : . . . 12-0UUU138'1 Permit . . . ELEC-MISCELLANEOUS Additional desc . Permit Fee 22.50 Plan Check Fee 5.63 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/27/13 Qty Unit Charge Per Extension BASE FEE 15.00 10.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 7.50 Permit PLUMBING Additional desc.: Permit.Fee . . . . 18.00 Plan Check Fee 4.50 Issue Date Valuation . . . . 0 Expiration:Date.•. 5/27/13-, 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_ISLAND WITH SINK PLUMBED TO KITCHEN. CLEAN-OUT, 10•ELECTRIC OUTLETS, 365 L.F. 2" GAS LINE, 9"3/4" RISERS, FIREPIT & 2 WALL MOUNTED HEATERS. 2010 CODES. ------------------------------------------------ Other Fees . . . . BLDG STDS ADMIN (SB1473) 1.00 STRONG MOTION (SMI) - RES 1.50 Fee summary Charged Paid Credited Due ----------------- ---------- Permit Fee Total 40.50 .00 .00 40.50 Plan Check Total 10.13 .00 .00 10.13 Other Fee Total 2.50 .00 .00 2.50. LQPERMIT - - . Bin.# 0f LA Quinta Building 8l' Safety Division P.O. Box 1504;78-495 Calle Tampico 14.Quinta, CA 92233 - (760) 777-7012 Building Permit Applicatioaand Tracking Sheet Perirllt # Project Address: Owner's Name:. Y VL S� A. P. Number. Address: -7q 66 u Legal Description: C G Contractor: Lih / a-4/1 o�267'1?Z-,!U 'itt G � O h City, ST, Zip. Telephone: � � Address: 83 71/0 C,t7ZK AVC � i'7 � Project Description: �.e3s �rl� � Use �+'L �t/r G psi City, ST, Zip: ZN Al-0 CA 12z o 1 I° Telephone: % 60 67&/ 5 41) f 0-,c State Lic. # : 9�� y�Q City Lic: k 61.7.3 G, 3/ _ Arch., Engr., Designer Address: City., ST, Zip: Telephone: . ... ` State Lic. #: , ,� Construction Type: Occupancy: -oject type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.:#Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: apt) • . APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACKNG PERMITFEES Plan Sets Plan Check submitted Item Amount Structural Calm Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calci. Plans picked up Construction Flood plain plan Plans resubmitted Mechatilcal Grading plan 2" Review, ready for correctionstiissue Electrical Subeontactor List Called Contact Person Plumbing Grant Deed Pians picked up SALL 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 PAL fp-> I 371 -Off 271-6f# ��p Au- -761 L N F --r Lf ICAL -Is it e t.G S 2a, oo6-rLA )FAC (4 (2e.0 --A AY -o.7— Tz m m WOM �X2