13-1097 (SPIN)TAiyl
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'r
' Date: 9/03/13
Application Number: 13-00001097 Owner:
Property Address: 44071 W SUNDOWN CREST DR KIREJIAN MARY
APN: 604-100-067-145 -19903 = 44071 W. SUNDOWN CREST
Application description: SPECIAL INSPECTION LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL ( D
Application. valuation: ' 0
Contractor:
Applicant: Arc hi ect or Engineer: Owner
cid,
. °Far r�a
------------ _
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' compensation, as provided
License Class: License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
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 workerscompensation
• 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 - - - - - - - - - - - - - - - - - - - - - - -Policy Number
following reason (Sec. 7031.5, Business and Professions Code: Any city or county thatrequires.a permit to_ I certify that, in the performance of the work for which this permit is issued, l 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 1 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, hall fo with-comply with the 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: 9 ($500).:_Applicant: - a
(� 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' COMPE ATI N 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 A D 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.). APPLICANT ACKNOWLEDGEMENT
(_ 11, 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 personatwhose request and for
pursuant to the Contractors' State Licerise Law.). whose benefit workJs 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 e 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
�- - 1 - performed under or following issuance of this permit. -
D�• ate:'�q-�� /J� O CJ - 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
CONSTRUCTI LENDING AGENCY _ permit to cancellation.
I hereby affirm under penalty of perjury that there is a constr, ction lending agency forthe performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to-enter upon the above-mentioned property fo �acproperty foLender's Name:._Date:_-3=L Signatur entl:Lender's Address: �(
LQPERMIT
Application -Number 131-00001097
Permit SPECIAL INSPECTION
Additional desc .
Permit Fee- 71.50 Plan,Check Fee
.00 -..-y
Issue Date -Valuation . . .
. 0
Expiration Date 3/02/14
Qty Unit Charge Per.
Extension
' •1.00" X71.5000 EA MISC SPECIAL INSPECTION
71.50
-------- - - - - -
Special Notes. and Comments`
-
,
SPECIAL INSPECTION FOR IID RELEASE..
<
Fee .summary Charged Paid Credited
Due
-- - - - - - - - - - - - - ----=.-- - - - - ------ - - - - ------ - - - - ---
Permit Fee Total -71.50 00 '.00
--- - - - - --
71.50
Plan Check Total 000 .00 ..00.
00
Grand Total' 71.50 :00. :00
71.50
LQPERD1IT
E
Bin #
City of La Quinta
Building 81: Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta; CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
P # ^
Project Address:
Owner's Name: (fie l
A. P. Number:
Address: Q sem
Legal Description:
Contractor:
City, ST, Zip:
Telephone:
Address:
Project Description: t' a -'1 -(
City, ST, Zip:
6L,6 Gil S' 'CI
Telephone:<%?<::;
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:•;>:.;
r S f'
State Lie. # :
City Lie. #;
Arch., Engr., Designer:
Address:
q�
City., ST, Zip:
Telephone:
Construction Type: n A 0 Occupancy:
Lie. #:
roJ ect tYPe cir le one • New' Add'n Alter Repair Demo
Name of Contact Person:
-Sq-.Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for correctionsfissue
Electrical
Y
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
1
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
i
Total Permit Fees