11-0122 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11-00000122
Property Address:
52965 HUMBOLDT BLVD
APN:
767-200-091.- -34968 -
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
10000
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
Ce I, k;1V-4,e_c E. Wcwp
#232.74
--------------------------------------------------
LICENSE CONTRACTOR'S DECLARATION
1 hereby affirmUunderlty of perjury that I censed under provisions of Chapter 9 Icommencing with
Section 7 001 3 of the Business a d rofes io s Code, and my License is in full force and effect.
License asgs:Lic se No.: 915336
✓ate, 1tractor:
NER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I a xempt 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 ($5001.:
(_) 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
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 1, 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.).
1 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: _
Lender's Address:
LQPE%NIIT
VOICE (760) 777-7012
FAX (760) 777-7011 .
INSPECTIONS (760) 777-7153
Owner:
D'ADDARIO JIM & JANET
52965 HUMBOLDT O
LA QUINTA, CA 92253�Li 2'Z01�
_.�v nF �Qu1NTA
Contractor:
DBCA INC
P.O. BOX 1482
LA QUINTA, CA 92247
(760)393-5271
Lic. No.: 915336
------------------
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 TRAVELERS PROP Policy Number YEUB282D779708
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should bePOSTOF
the workers' compensation provisions of Section
3700 of the Labor Code, d,
s mply with those provisions.
Date% * � Vpplicant: .
WARNING: FAILURE TO SECURE WORKERSION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THMPENSATION, 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 that the above i o4nation is correct. I agree to comply with all
city and county ordinances and state laws relatingto building cons u ion an ereby authorize representatives
of this county to enter upon the above-mentioned property for ins c n rpose -
Date r r Signature (Applicant or Agent):
/11
Application Number .
. . . . 11-00000122
Permit
BUILDING PERMIT
Additional desc
-.
Permit Fee . . . .
117.00 Plan Check Fee
76.05
Issue Date . . . .
Valuation_
10000
Expiration Date
8/28/11
Qty Unit Charge
Per
Extension
BASE FEE,
45.00
8.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
72.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc
Permit Fee
18.00 'Plan Check Fee _
4.50
Issue Date . . . ..•
Valuation
0
' Expiration Date
8/28/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
4.00 .7500
PER ELEC DEVICE/FIXTURE 1ST 20
3.00
----------------------------------------------------------------------------
Special Notes and Comments
6 FOOT DIA. METAL SPIRAL STAIRWAY
ATTACHED TO 2ND FLOOR
BEDROOM TERRACE
PER ENGINEERED PLAN. 2010 CODES.
----------------------------------
Other Fees . . . . .
-----------------------------------------
. . . . BLDG STDS ADMIN (SB1473)
1.00
-
ENERGY REVIEW FEE'
7.61
STRONG MOTION (SMI) - RES
1.00
Fee summary Charged Paid Credited
--------------------
Due
-----------------
Permit Fee Total
--------------------
135.00 .00 .00
135.00
Plan Check Total
80.55 .00 .00
80.55
Other Fee Total
9.61 .00• .00
9.61
Grand Total
225.16 .00 .00
225.16
LQPERYIIT
V
Bin #
•
City of La Quetta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
010 La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address;62, 16 S Nil aw
Owner's Name• O
A. P. Number: • 880 •D2
Address: 6 IMP.
Legal Description:
City, ST, Zip:46 6% lfffi�
Telephone:
Contractor.LAI;V
Address:
Project Description:
City, ST, Zip:
AGIL
Q D
' .'.f;:.yj�$j+til i::Syr\5`:�:�j:: nC}ni;%i� y� f>.•': j:.i::j�::
Telephone:^�;,'`•�,�{%s�i'�.�>*r.��"^K;%t�.,:.�<'3>
State Lic. #: City Lic. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
P
State Lic. #:
,:;>s?:>'<::
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k''<si '��.' „ciii,i,i,,.. G. �•:4ii"�ii :::
><' ""` ' `"' "'<a`i 4H 4
a'.+y42>'s�;:4i'i:; •r.;,%;':.il:�±�<:
Construction Type: Occupancy:
'
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:Sq.
Ft.:
# Stories: Ai
#Units:
Telephone # of Contact Person:
Estimated Value of Project: a Moor -
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
pS
Plan Check submitte
a
Item
Amount
Structural Cal cs.
Reviewed, ready for orree
17
Plan Check Deposit
Truss Calcs.
Called Contact PersonPlan
iConstruction
Check Balance
Title 24 Cales.
Plans picked up GAG
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" 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:-
''" Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
a /azy
ILI
71-.780 San Jacinto Dr. Ste. E2, Rancho Mirage, Ca. 92270 ph. (.760) 834-8860 fax (760) 834-8861
Letter of Transmittal
To: City of La Quinta
Today's Date:
2-28-11
78-495 Calle Tampico
City Due Date:
3-3-11
La Quinta, CA 92253
Project Address:
52-965 Humboldt Blvd.
Attn: Phillip
Plan Check #:
11-122
Submittal:
❑ 1st ❑
4th
Approval
® 2nd ❑
5th
Revised Structural Plans
❑ 3`d ❑
Other:
We are forwarding:.
® - By Messenger ❑
By Mail (Fed Ex or UPS)
❑ Your Pickup
Includes:
# Of
Descriptions:
Includes: # Of
Descriptions:
Your Files
Copies:
Per Your Request
Copies:
Your Review
❑
Approval
Structural Plans
® 1
Revised Structural Plans
❑
Other: ❑
Structural Calculations
® 1
Revised Struct. Calcs
❑
Truss Calculations
❑
Revised Truss
❑
Soils Report
❑
Revised Soils Report
❑
Structural Comment List
❑
Approved Structural Plans
®
1
Redlined Structural Plans
❑
Approved Structural Calcs
®
1
Redlined Structural Calcs
❑
Approved Truss Calcs
❑
Redlined Truss Calcs
❑
Approved Soils Report
❑
Redlined Soils Reports
❑
Other:
Comments:
Structural content is approvable.
,i al C. A.e asi
I ... 1
l r
By: John W. Thompson
Rancho Mirage Office: ® (760) 834-8860
Other: ❑ -
t.
�' ,t MAR 0 1 2p11
This Material
Sent for:
❑
Your Files
®
Per Your Request
❑
Your Review
❑
Approval
❑
Checking
❑
At the request of:
Other: ❑
By: John W. Thompson
Rancho Mirage Office: ® (760) 834-8860
Other: ❑ -
t.
�' ,t MAR 0 1 2p11
5296
THE -
MADISON
CLAUS
March 9, 2011
Mr. Jeff Prevost
1'.0. Bax 182
Lit Quinta, CA 92247
RE: Villas Moslificaitiun
Villn 4 — Exterior Stotir Addition
Dear Me. Prevost:
� lA YJI RfJ�1Tj'
The MLidiKt>r, (,4111113 1)e,jiKn Review (Iom r►ilteo reviewed Lind approved the reyucst to
Haiku minor modilicntiotiq to ViIILi 4 k1tied on the Iden imbmittal received by you
showing the limited view ol'ihe ttddilion.
The project is Lipproved to wtirl eons(ruclion. Pleme contact Brook M►rshnll tit (760)
219-HO57 Lir by e11111il Lit htrcu>It(11)(l(',rr.(!()Ili with Lilly questions regarding this review.
Sincerely,
MitdlNon Club 6esign Review Committee
W: DKC 1100
611