06-4169 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
ceii`!t 4 4v Q"
Application Number: 06-0.0004169
Property Address: 79152 TOM FAZIO LN S
APN: 766-042-004- - -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 8000
Applicant:
Architect or Engineer:
PIA
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Professionals Code, and my License is in full force and effect.
Licen ass: C53 License No.: 853887
Date: ontractor:
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 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 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.).
(_ ) 1 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:
LQPERI%11T
Owner:
WINCHESTER DEVELOPMENT
78034 CALLE BARCELONA,
LA QUINTA, CA 92253
Contractor:
OUTDOOR SOLUTIONS INC
78034 CALLE BARCELONA
LA QUINTA, CA 92253
(760)777-1199
Lic. No.: 853887
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/04/06
DEC 0 4 2006
o
C Cid OF LA
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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 performance of the work for hich this permit is issued, I shall not employ any
person in any manner so as to becom subi to the workers' compensation laws of California,
anagree that, if I sho Id co ect the workers' compensation provisions of Section
00 of the Labor o ith mply with those provisions.
Ddfe: � � applicant:
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 ofthis 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 o ork for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that thea v ion is orrec 1 agre o comply with all
city and county rdinances and state laws relating t0 bui c stru tion, a here authori representatives
of this c y t enter upon th bove-mentioned prop/er/L r spect p r ses.
nature (Applicant or Agent): �"
Application Number . . . . 06-00004169
Permit . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
99.00
Plan Check
Fee
64.35
Issue Date
Valuation
. . .
. 8000
Expiration Date
6/02/07
Qty Unit Charge
Per
Extension
BASE FEE
45.00
6.00 9.0000
--------------------------------------------------------
THOU BLDG 2,001-25,000
----------------------
54.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee
17.25
Plan -Check
Fee
4.31
Issue Date . . . .
Valuation
0
Expiratic--i Date'.
6/02/07
Qty Unit Charge
Per
Extension
.
BASE FEE
15.00
3.00 •.7500
PER ELEC DEVICE/FIXTURE
1ST 20
2.25
----------------------------------------------
Special Notes and Comments
---------------------------
---
BBQ, ANSI Z21-58-1995
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . ENERGY
REVIEW FEE
6.44
STRONG
MOTION (SMI)
- RES
.80
Fee summary Charged Paid
----------------- ------ - --- ----------
Credited
---------- ----------
Due
Permit Fee Total
116.25
.00
.00
116.25
Plan Check Total
• 68.66
.00
.00
68.66
Other Fee Total
7.24
.00
.00
7.24
Grand Total
192.15
.00
.00
192.15
LQPEPJMT
City of LaQUIn ta
Building 8L Safery Division
G P_O. Box 1504, 78-495 Calle Tampico E
Perrni[ '
01 La Quinta CA 92253 - (760) 777-7012 t
Building Permit Application and Tracking Sheet
Project Address: yrs 'aM 2ia { 0%vner's Name:
A. P. Number:
Address: V vT
Legal Description: ` t$— 2 ZL®�'
Cio,; ST, Zip: �v �.,�� f 22� 3
Contractor: our—r>."— So�-v"n �c,
FTelephone: iaU
Address: 9 _ 03*
e e Or�!/� �
Pr6ject Description:
City: ST, Zip:. C4 1A C/- 91115 3
—
Telephone: .'rt.
State Lic. N
Arch.. Ener.- Designer:
Cit}• Lic. N: 9807
6 9
20 ` 33 f r
Address:
Sg B— rQ-tJS t 7- 7-1 —59
City. ST. Zip:
_
Telephone:
Construction Type: . p Occupancy:
Project r\ -pe (circle one Nzcc Add'n Alter Pepair Demo
Slate Lic. N:
Name of Contact Person: s`V6
CVJVZ06g&-�-
Sq. Ft.: �
H Stories:
Y Units:
�
Telephone # of Contact Person: GTJ -%l "f —69 Q
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
q Submittal Req'd Recd TRACKJNG PERMIT FEES
Plan Sets Plan Check submitted Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
—
Energy Calcs.
—
Plans picked upC
onstruction
Flood plain plan
Plans resubmitted
mechanical
Gradin Ian
Grading P
Subcontactor List
2 nd
_ Rei tetiv. rcadt for correcttons/issue
Called Contact Person
Electrical
Plumbing ill A
3>t-, )LT,)K-
�.^'
Grant Deed
flans picked up
S.PLI.
H.O.A. Approval
y—
Plans resubmitted
Grading
IN IIOUSE:-
Planning Approval
Pub.Wks. APPr
—
Revic-, rcadY for corrections/issue
Called Contact • scrn
at o rt�t �t • CV:Ty 0.
Developer Impact fee
-
School Fccs
-
---
----
---
-
----�a�gI�STRUCT10N-
— —
�
-
-. , ..
Total f er init---
DATES Y�—
7-- I SZ To/� 21� �°l OF LAS. QUINTA'SU.B-CONTRACT'0R LIS
JOB ADDRESS 1 �—PEMIT NUMBER
This form shall be os ed on the 'ob with the Building Ins c ion Card at all times in a OWN BUILDER
on this job. Any changes to this list must be a cons is ous lace. Only persons a S
approved by the Building Divisioncommencementt appearing on this list or their employees are authorized to work
of building pp 9 prior to f work Failure o comply will I f -
g permit. For each applicable trade, all information requested below must be completed by applicant. "OnilFile"tis not an acceptable'res otnpe age o work dor the 'voidance
Trade /Classification nCD
:..:...
Contractbr- :.:
::::;
State:::Contractor'-s Liceri
YVorkeis:.C.om eitsatioh-Arisurance:
City -Business Licen_SRs:
Company Name Cl
EARTHWORK (C-12)
CONCRETE. IC -8)
FRAM (C-
STRUCT. ST��L iC-53)
MASONRY (C-291
PLUMBING (C-38)
L_ THi PLASTER 4C-35)
DA`f'.l1 AL. (+3-9)
HVAC (C-21ci
------------
'EL ECTR-3CAL
C��r15�G C-39)
asslflcatlon
(e.g. A, B, C-8)
License Number
(xzxxxx)
Exp. Date
Carrier Name
�'t1J c� c' t► 6 r
(xx/xx/xx)
(e.g. State Fund, CalComp)
/ n ;
8-0 2i o %
! 3/fa
s �
C- 2-1
i-�•�D6L ��I4 IML C�3 �L-y�o
m
Policy Number
!Format Varies)
00)OSie- 06 -
Exp. Date License Number
(xxlxx/xx) .(xxxx)
ExP, Date
(xx/xx/xx)
'211-07
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