07-1038 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO .
LA QUINTA, CALIFORNIA 92253
T,i . ut 4 4Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
0700001038
Property Address:
51275 CALLE JACUMBA
e APN:
770 -165 -013 -2 -000000 -
Application description: _
_ STRUCTURES OTHER THAN BUILDINGS _
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
500
Applicant:
Architect or Engineer:
I�
-----------------
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.
License Class: License No.:
Date: Contractor:
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
anpplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (55001.:
(y a1 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.).
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,contractorls) licensed
pursuant to the Contractors' State License Law.).
I 1 I am exempt under Sec. , B . or this r n
ot
ate: caner:
CONSTRUCTION LENDING AGENCY
1 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: d Pr
LQPERMIT
Owner:
BELTRAN BENJAMIN
51275 CALLE J
LA QUINTA, _CA
-------------
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/04/07
------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 Policy Number
I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any
person in any manner so as to becon3wt-05IMNio the workers' compensation laws of California,
and aEyn
me bject to t workers' compensation provisions of Section
3700fo hwith co ly with those provisions.
e:
/WAR INE 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 of this 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 of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state informatio is correct. I agree to comply with all
city and county ordinances and state laws rela ' g to building cpstr
on, aV hereby authorize representatives
of this ounty to enter upon the bove-mentio ed property f s
atzl e:` Si ture (Applicant or Age
trio�oses.
Application Number . . . . . 07-00001038
Permit . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
15.00
Plan Check Fee
9.75
Issue Date . . . .
Valuation . . .
. 500
Expiration Date
10/01/07
- Qty Unit Charge
Per-.
Extension
----------------------------------------------------------------------------
BASE FEE
.._ - _-
_15.00_
Permit . . .
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . .
16.50
Plan Check Fee
4.13
Issue Date . . . .
Valuation . . .
. 0
Expiration Date ..
10/01/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2.00 .7500
----------------------------------------------------------------------------
PER ELEC DEVICE/FIXTURE 1ST 20
1.50
Permit . . .
PLUMBING
Additional desc . .
Permit Fee . . . .
18.00
Plan Check Fee
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
PROPANE GAS BBQ WITH
1 LIGHT OUTLET
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . ENERGY
REVIEW FEE
.98
STRONG
MOTION (SMI) - RES
.50
Fee summary Charged
---------------------------
Paid Credited
------------------------------
Due
Permit Fee Total
49.50
.00 .00
49.50
Plan Check Total
18.38
.00 .00
18.38
Other Fee Total
1.48
.00 •.00
1.48
Grand Total
69.36
.00 .00
69.36
LQPERMIT
Bin #
City of La Quinta
Building 81 Safety Division
P.O. Box 15041 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 15-1 a L
Owner's Name: T )% 4
A. P. Number:
Address:�j(Z-7l r^
v
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
Address: 1
Project Description:
City, ST, Zip:
Telephone:
State Lic. #:
City Lic. #:
i O
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: Q �—
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACHING _
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
SOTA
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issue
Electrical
„
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date o
f permit issue �Q*Siva
School Fees
V
d1Nino vi :10 ADO
Total Permit Fees
CI
F
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I�ro��,i>v
1 q 2r0
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*TIDIN% 8&SADEPT.
APPROVED
FOR P YS�TRUC qN
DATE BY
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TELEPHONE (760) 777-7012 FAX (760) 777-7011
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for atbuilding permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection, ou should be aware that as "Owner/Budder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the followi� g information for your benefit and protection.
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) isi$200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations include State and Federal income tax withholding, federal social security taxes, worker's
compensation insur{ance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's' compensation insurance.
1.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally orthrough their own employees, without a licensed contractor or subcontractor, only under limited
conditions. �J
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California -95814.
#,
Please complete and return the enclosed owner -builder verification form so that we can confirm ttiat you are aware of
these matters. The, budding permit will not be issued until the verification is returned.
s
Very truly yours,
CITY OF LA QUINT
DEPT. OF BUILDING AND SAFETY
78-49 Calle Tampico
La Qu ta, CA 92253
(760) 77-7012 1
PROPERTY ADDRESS
I.
PERMIT NUMBER(S)
P