09-0494 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
T-it(t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
-------------------------- -----------------------
LICENSED CONTRA T R'S DECLARATION
I hereby affirm under penalty of perjury that am licensed and r ovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busiruss nd Professional C e, and my License is in full force and effect.
License CI ss: C53 - cans No.: 866518
i
ate: ontractor:
\---- OWPfiR-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am eUmpt 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 ($500).:
(_ 1 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 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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_ 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: , \J
Lender's Address: I� D
t
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/18/09
----------------------------------------------—
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 DELOS INS CO Policy Number 02 KRM220010101
_ I certify that, in the performa a of the work for which t s permit is issued, I shall not employ any
person in any manner so 'to become subject to a orkers' compensation laws of California,
a d agree that, if I s oul ecome subject to the or ers' compensation provisions of Section
00 of the Labor C d I all forthwith comp w' h those provisions.
/ApA a t:
WARM G: FARICO E TO SECURE WORKERS' COM SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTI AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE CO T 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 wor for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is cor ct I agree to comply with all
city and cou 'y dinances and state laws relating to building construction, and h eb authorize representatives
of�this cou o/�_me, upon the above-mentioned properly f r inspection purpo s.
/Date: U I ignature (Applicant or Agent):
09-00000494 - - �`�—]
Owner:
60629 LACE LEAF CT
RICHARD HIRSH
764-270-999-116 -3002311 `;�t
60629 LACE LEAF COURT
STRUCTURES OTHER THAN BrI NGS I?�,_
LA QUINTA, CA 92253
MEDIUM HIGH DENSITY RES c'v
3000
Contractor:
Architect or ngin er. M:�[:✓ � �
GARY & SONS
67621 CACTUS APPLE
DESERT HOT SPRINGS, CA 92241
G
(760)251-8945
Lic. No.: 866518
-------------------------- -----------------------
LICENSED CONTRA T R'S DECLARATION
I hereby affirm under penalty of perjury that am licensed and r ovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busiruss nd Professional C e, and my License is in full force and effect.
License CI ss: C53 - cans No.: 866518
i
ate: ontractor:
\---- OWPfiR-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am eUmpt 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 ($500).:
(_ 1 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 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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_ 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: , \J
Lender's Address: I� D
t
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/18/09
----------------------------------------------—
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 DELOS INS CO Policy Number 02 KRM220010101
_ I certify that, in the performa a of the work for which t s permit is issued, I shall not employ any
person in any manner so 'to become subject to a orkers' compensation laws of California,
a d agree that, if I s oul ecome subject to the or ers' compensation provisions of Section
00 of the Labor C d I all forthwith comp w' h those provisions.
/ApA a t:
WARM G: FARICO E TO SECURE WORKERS' COM SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTI AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE CO T 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 wor for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is cor ct I agree to comply with all
city and cou 'y dinances and state laws relating to building construction, and h eb authorize representatives
of�this cou o/�_me, upon the above-mentioned properly f r inspection purpo s.
/Date: U I ignature (Applicant or Agent):
Application Number . . . . . 09-00000494
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 54.00
Plan Check Fee
35.10
Issue Date . . . .
Valuation . . .
. 3000
Expiration Date 11/14/09
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
----------------------------------------------------------------------------
9.00
Permit ELEC-MISCELLANEOUS
Additional desc..
Permit Fee . . . . 15.75
Plan Check Fee
3.94
Issue Date
Valuation . . .
. 0
Expiration Date 11/14/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 .7500 PER ELEC DEVICE/FIXTURE
1ST 20
.75
----------------------------------------------------------------------------
Special Notes and Comments
WATER FOUNTAIN: 18" DEEP, 3' MASONRY
WALL, 1 ELECTRIC OUTLET.
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
----------------- ---------- ----------
Credited
---- ------ ----------
Due
Permit Fee Total 69.75
.00 .00
69.75
Plan Check Total 39.04
.00 .00
39.04
Other Fee Total 1.00
.00 .00
1.00
Grand Total 109.79
.00 .00
109.79
LQPERMIT
�'r
Bin #
Permit #
0�
Project Address:
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
�v Owner's NameA�
A. P. Number:
Address:
•� v
Legal Description:
City, ST, Zip!
l vL
Telephone:
Contractor:
Address: b -
Project Description:
City, ST, Zip:
n c / .14
44
Tele hone:
City Lic. #•:
State Lic. # :
!
s' �mr. o , G,n�
Arch., Engr., Designer::
.
Address:
City., ST, Zip:
Telephone:
<z<.`>.«'.:z:<.::`•>;<:;r..:xs.;;:::.:::•.,
.. .
r.:,:•,.:,,;'
Construction Type: Occupancy:
State Lic. #:
Project a circleone . New Add'n Alter Repair Demo
Name of Contact Person:.
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
(p.
Estimated Value of Project:-L3.OUcU .
APPLICANT: DO NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
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
Title 24 Calcs.
Plans picked up
Construction
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:-
'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
Total Permit Fees