07-1037 (SOTB)P.O. BOX'150:_4, VOICE (760) 777-7012
78-495 CALLE,TAMPICO ' Tit . 1 4,14FAX (760).777-7011
LA QUINTA; ,CALIFORNIA 92253 7. BUILDING & SAFETY DEPARTMENT - INSPECTIONS (7.60) 777-7153
+ BUILDING PERMIT
Date: 4/04/07
Application-Nurhber. .'07-060-01037 ' Owner
Property Address:' 61744 TOPAZ DR: PETROTTA_RESIDENCE
APN: 764-280-999-135.-300237- 61-744 TOPAZ'DR.
Application description: STRUCTURES OTHER THAN BUILDINGS + LA QUINTA, CA 92253 -
Oroperfy Zoning: - MEDIU_M HIGH DENSITY RES-'_
Application valuation: '1500 _
# Contractor: d -
Applicant: - Architect or Engineer: - TESERRA , D a
P.O BOX' 1280
COACHELLA, CA 92236 0,4 2007
(760)398-9222 i APR APR
Lic. No.:,656128
CITYOFLA 41A;
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LICENS C RACTOR'S DECLARATION _ WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that 1 am Ii ed der 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 BusinA and Pr fess Is 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
License C s: C8 C27 C29 .Licenser -656128 - - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is -
r- issued.. •.
Date: Contractor: _ 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
0 ER- ILDER 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 SEABRIGHT Policy Number `'BB1070510
• followirig reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to ` r _ I certify that, in the performance of the ork 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 beco a- ject 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 shoul come s jec to the workers' compensation provisions of Section ,
jLicense Law (Chapter 9 (commencing with Section.7000)-of Division 3 of the Business and Professions Code) or 700 of the Labor Co , I hall fort comply with those provisions.
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).: Date: -7 Q Applicant::•
(_ 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 - WARNING:. FAILURE TO SECURE W KERS' 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 1$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 provingthat he or she did not build or - - -
- - improve for the purpose of sale.). L APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to -construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the ,
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. - -
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). - - whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I—) I am exempt under Sec. B.&P.C. for this reason - 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. '
Date:. Owner: _ 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, cessation of work for 180 days will subject '
CONSTRUCTION, LENDING AGENCY permit to cancellation. '
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance.of the I certify that I have read this application and state that the above info, ion is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and 'co
ty rdinances and state laws relating to buildi constru ion nd hereby authorize representatives
of this cou t enter upon the above-mentioned propert f r ins cti n oses.
Lender's Name: -
- - Date:. / Z , 0 Signature (Applicant or Agent):
'Lender's Address: _ ..
LQPERMIT '.
Application:Number 07.-00001037•
Permit . : . . . BUILDING.PERMIT
-
`Additional-desc .
Permit Fee:: 35.00 Plan Check Fee:.22.75
- Issue ,Date Valuation
1500
Expiration Date '10/01/.07,
Qty Unit Charge Per:.
Extension
BASE t: FEE `
15:0 0. ••
10.00 2.0000 HND BLDG -501-2,000
20.00.
Permit -PLUMBING.
Additional desc
Permit -Fee 18:00 PlanCheckFee `.
4 50-
.Issue Date. :-_ Valuation
0
Expiration Date 10/01/07
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;:: -
FIREPIT/AGAL 496 PER APPROVED PLAN.
-----Other
Fees ENERGY REVIEW .FEE
2.28
Fee summary Charged Paid. Credited.
"Due
Permit. Fee Total 53.00 00 00
53:00
Plan Check Total 27.25.• .00 .00
27.25
Other - Fee Total 2.28 :00 .00
2.28
Grand -Total- -82.53 00 .00
82.53 '
LQPERMIT -
Bin #
Permit #
Project Address:
A. P. Number:
Legal Description:
Contractor: —
City of. La Quinta
Building 8L 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.`�T
Address: \ -?LIE TG PAZ c� iZ
City, ST, Zip: L.r,
�7 Telephone:
Address:
Project Description:
City, ST, Zip:��C L l Vim- Cly Cfu�
Telephone: 1 ZZ 2—
State
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— Ill
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person: oZ E0 _
Z
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted ' 12--
Item
Structural Calcs.
!--
Reviewed, ready for corrections
Amount
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Flood plain plan
Construction � 3
Plans resubmitted
Mechanical
Grading plan
2"d Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Grant Deed
Plumbing �� OJZt2
Plans pi
S.M.I.
H.O.A. Approval
//''��
Plans re ubig- Or
rading
IN HOUSE:-
7rd Revi w, rea I>
SA
c
Developer :Impact Fee
Planning Approval
Called ontacl r n OV
A.LP.P.
Pub. Wks. Appr
Date o permit issue Rul -- N
School Fees
DATE ._
Total Permit Fees
S