07-0718 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4bt °F XP Q"
Application Number:
07-00000718
Property Address:
61403 TOPAZ DR
APN:
764-280-999-12 -300237-
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
3900
Applicant:
Architect or Engineer:
P /A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DILLENDER
61403 TOPAZ DRIVE
LA QUINTA, CA -92253
Contractor: `
ARTISTIC LAND
81217 AVENIDA �S6
LA QUINTA, CA 9�
(760)360-1395
Lic. No.: 379421
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/08/07
ANC �� ',, `'�' �OJ•�,e,...:., �1
_ — _ _ _ _ _ _ _ _ _ _ _ —A_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
I hereby affirm under penalty of perjury tlfat I am licens��i and rov' ' Chapter 9 (commencing with
Section 70001 of Division 3 of the Busi ss and Prof 5 on Cod a License is in full force and effect.
/ / 6WNER-BUILDER DECLARATION
I hereby affirm under penalt�/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 withwagesas 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.).
( 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: 9 In
Lender's Address: IF
LQPERMIT
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 SIRIUS AMERICA 4 Policy Number OIKDRM11000540
_ I certify that, in the perfrmanbrof the work for which this 't is issue , I s I not employ any
person in any manner so a o become subj tothew ker comp' atio laws of California,
and agree that, if I sh uld 'come sub' t the wor rs' mpe,s ion p visions of Section
/ ))qq 700 of the L r d I shall forth ' h o r ply w' t se p v' ions.
Date: /!/ licant:
WARNING: FAILURE TO SE RE 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 this application becomes null and void if work is not commenc
within 180 days from date of issuance of such mit, or cessation of work for 0 days` sub' t
permit to cancellation.
I certify that I have read this application and state that the ove inform on ' orrect I agree -to co ply w' h all
city and county ordinances and stat aws relating to buil ng construc i here out ize rep septa ves
of this o my to a ter upon th ove-mentioned/prop y for inspe roses. `
te��pplicant
or Ag IL
Application Number . . . . . 07-00000718
Permit . .
BUILDING PERMIT
Additionai.desc .
Permit Fee
63.00
Plan Check Fee
:40.95
Issue Date
Valuation . . .
. 3900
Expiration Date
9/04/07
Qty Unit Charge
Per
Extension,
BASE FEE
45.00
2.00 9.0000
----------------------------------------------------------------------------
THOU _BLDG 2,001-25,000
18.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . .
18.00
Plan Check Fee
4.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
9/04/07,
Qty Unit Charge
Per
Extension
BASE FEE
15.00
4.00 .7500
----------------------------------------------------------------------------
PER ELEC DEVICE/FIXTURE
1ST 20
3.00
Permit . . .
PLUMBING
Additional desc .
Permit Fee
18.00
Plan Check Fee
4.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
9/04/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 3.0000
EA PLB GAS PIPE
1-4 OUTLETS
_3.00
--------------------
Notes and Comments
BBQ &.ELECTRIC FOR FOUNTAIN, PER
APPROVED PLANS
-------------------------------------
Other Fees . . . .
---------------------------------------
. . . . ENERGY
REVIEW FEE
4.10
STRONG
MOTION (SMI) - RES
.50 -
Pee summary Charged
Paid
Credited
Due
Permit Fee Total
99.00
.00 .00
99.00
Plan Check Total
49.95
.00 .00
49.95
Other Fee Total
4.60
.00 .00
4.60
Grand Total
153.55
.00 .00
.153.55
LQPERMTf
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Bin #
Permit #
Project Address: lD y
A. P. Number.
Contractor:
Address: U
City, ST, Zip: o� i
Telophona
State Lie. # d z
Arch., Engr., Designer; '
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Telephone # of Contact Person
# Submittal I
Plan Sets
Stractaral Calcs.
Truss Cales.
Energy Cala.
Flood plain plan
Grading.pian'
Subconta¢tor Litt .
Great Deed
H.O.A. Approval
IN HOUSE:-
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quint -
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name: 1
Address: 0 r
City, ST, Zip: Z,44- /Q, , 4_.,
Project Description:
Lie. #:
FOR CONSTRUCTION
DATE---,BY�
Total Permit Fees
Construction Type:
Occupancy:
Project type (circle onc): New n Add Alter Repair ' eP Demo
L/
Sq. Ft :
# Sto 'es:
�
#Units:
Estimated Value or Project.
0O
APPLICANT:
DO NOT WRITE BELOW THIS UNE
I
TRACIMG .
PERMIT FEES
Plan Check submitted
item
Amount .
Reviewed, ready for corrections
Plea Check Deposit
Called Contact Person
Plan Check Balance
Plans Picked.ap
Contraction
Plans resubmitted
Mechanical
2" Review, ready for corrections/issue
Electrical
Called Contact Person
_
Plumbing
Plans picked ap.
ov
- S.M.L -
Plans resubmitted
Grading
Review, ready for.correctionsrusae
Developer Impact Fee
Called Contact Person
A.LP.P.
J.Datt
of permit issue
FOR CONSTRUCTION
DATE---,BY�
Total Permit Fees
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• + ' 1 � 1
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