08-1143 (AR)4 P.O. BOX 1504�" VOICE (760) 777-7012
78-495 CALLE TAMPICO - FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY, DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/11/08
Application Number: 08-00001143 _ Owner:
Property Address: 54015 SOUTHERN HILLS ROBERTS
APN: 775=101-033- S4-015 SOUTHERN HILLS
Application description: ADDITION - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6070 ,
Contractor: /f
Applicant: Architect or Engineer: CBR ENG CONTRACTOR n
540.15 SOUTHERN HILLS
LA QUINTA,, CA 92253 .
(760)771-2278
PIA Lic . No , 504183
----------------------------------------------------------"-------------------- -----
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION'
I 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' compensatio pro ded
_ License Class: A-B 0ense No.. 04 - for by Section 3700 of the Labor Code, for the performance of the work for which this p tis
issued.
Date:/_O�� C ractor: y 1 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 STATE FUND Policy Number 1542568-2008
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to_ I certify that, 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 abor Code I shall forthwith p - ith t provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 byany applicant for a permit subjects. the applicant to a civil penalty of not more than five hundred dollars IS5001.: Date pplicant: ..�Mdd�ycG��—��i" _
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: FAI URE 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 woik himself or herself through his or her own employees; provided that the DOLLARS 15100,0001. 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 improvementissold 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.). APPLICANT ACKNOWLEDGEMENT '
(_) 1, 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 issuedas a result of this application,
(_ 1 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, or cessation of work'for 180 days will s ect
CONSTRUCTION LENDING AGENCY ,permit to cancellation. - -
I herebyaffirmunder 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 information is corre I agree c p th all
work for which this permit is issued ISec. 3097; Civ. C.). city an ounty ordinances and state laws relating to building construction, a er y thori re e n tives
of county to enter upon he above-mentioned property spection p pos
Lender's Name:
Date: gnature (Applicant or Agent):
Lender's Address
LQPERMIT
Application Number 08-00001143
Permit . . . BUILDING -PERMIT
Additional desc .
Permit Fee 90.00 Plan Check
Fee
58.50
Issue Date . . . . Valuation
. . . .
6070
Expiration Date 3/10/09.
Qty Unit Charge Per
Extension
BASE FEE
45.00
5.00 9.0000 THOU BLDG 2;001-25,000
45.00-
Permit . . . ELECT - ADD/ALT/REM
esc
Additional desc-
Permit Fee- 16.68 Plan Check
Permit
Fee
4.17
- Issue DateValuation
0
'Expiration Date 3/10/09
Qty Unit Charge Per.
Extension
BASE FEE
15.00
48.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY
1.68
Permit . . MECHANICAL
Additional desc'.
Permit Fee 24.00 Plan Check
Fee
6.00
Issue.Date -Valuation
0
' Expiration -Date 3/10/09 .
Qty. Unit Charge. Per
Extension
BASE FEE
15.00
1.00 9.000.0 EA MECH_APPL REP/ALT/ADD
-----------------------------------------------------------------------------
9.00
Permit PLUMBING
Additional desc
Permit Fee. . . . . 27.00 Plan Check..Fee
6.75
Issue Date . . . . Valuation
0
.Expiration Date ... 3/10/0.9.
Qty Unit Charge Per
Extension,
BASE FEE
15.00
.1.00 6.-0000 EA PLB FIXTURE
6.00
1.00 6.0000 EA - PLB ROOF DRAIN
6:00 ,
------------
Special Notes and Comments -
48 SQ. FT. KITCHEN•ADDITION AND 250 SQ.
FT. PATIO .
LQPERASIT
.
Application Number
-08-00001143
Other Fees
ENERGY REVIEW
FEE
5.85
-STRONG'MOTION
(SMI) - RES'
:60
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
157.68'
.00
..00
157.68
Plan Check Total
75.42
.00
.00
75.42
Other Fee Total
6:"45
.00"
.00,
6.45
Grand Total
239.55
.00
.00
239.55
LQPE&\f IT
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Total Permit Fees I
�I�
9M ArprxED
Bin IfCity
of La Quinta
Building U Safety Division
Pe it #
I1 j�
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: �70/�� 'v
/ Owner's Name.
A. P. Number.
Address:
Legal Description:
City, ST, Zip: 3
Contractor.
_
Telephone: ~
Address:
— D
Project Description: —' / �
City, ST, Zip:
2.
Telephone:Z
7 12
-4
State Lic. # : g-?jCity
Lie.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
P cY=
State Lie. #:
Project type (circle one): NewAdd'nter
Repair Demo
Name of Contact Person: �l
r Sq. Ft_: L # Stories: 1 # Units:
Telephone # of Contact Person: 7 (,0 —% 7 Z Z76 Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
Req'd
Rec'd
TRACIQ!•1G
PERMIT FEES
FSubmiftml
Plan Check submitted
Amount
4-1
Structural Cafes.
Reviewed, ready for On.
Plan Check Deposit
Tress Glu.
Called Contact Person
Plan Check Balance
Energy Coles.
Plans picked up
tX,
I VA
Construction
Flood plain plan
Plans resubmitted -
pa
Diechanical
Grading plan
P' Review, ready or correctio ueElectrical
Subcontactor List
Called Contact Pe
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctio issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Eves
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�S u!s APW48
Total Permit Fees I
�I�
9M ArprxED