09-0953 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tjht 4 4au&rw
Application Number: 09-00000953
Property Address: 60890 DESERT ROSE DR
APN: 764-270-999-184 -300233-
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 1000
Applicant:
Architect or Engineer:
PJA
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
HARR
60890 DESERT ROSE DRIVE
LA QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
LiC. No.: 656128
VOICE (760).777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/04/09
0
SEP Os 2009 IU,
LA QUINTA
-------------------------------------------------------------------------------7-----------------
LICENSED CONTRACTOR'S 9ECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under pr ions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 70001 of Division 3 of the Business and Professionals , and License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
LiceWf.496s: C8 , 10 , 27, 2 se 6 6128 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is.
L issued.
Date: Co actor: 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
0 N 'BUILD DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am&j pt from to Contractor's State License Law for the Carrier SEABRIGHT Policy Number BB1080510
following reason (Sec. 7031.5, Business and Profe ions Co Any city or county that requires a permit to _ I certify that, in the performance of the wor� r which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any ructur rior to its issuance, also requires the applicant for the person in any manner so as to becom abject to the workers' compensation laws of California,
permit to file a signed statement that he or she is ' d pursuant to the provisions of the Contractor's State _ �^d agree that, if I should become !c he workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or �/ X2.700 of the Labor Codrrl-Qall wjtfi r,6mply with those 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).:
(_) 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 I 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:
LQPERMIT
WARNING: FAILURE TO SECURE RAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER T IMIN L P ALTIES AND CIVIL FINES PTO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. IN ADDITION T E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, EREST, 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 t bove inform atio
' Orrect. I agree to comply with all
city and c my ordinances and state laws re ting to wilding nstructio d hereby authorize representatives
of this to enter up n the above- boned grope forrposes.
/D.e: Signature I pplicant or Agent):
Application Number .
. . . . 09-00000953
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee
25.00 Plan Check Fee
16.25
Issue Date . . . .
Valuation . . .
. 1000
Expiration Date
3/03/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
5.00 2.0000
----------------------------------------------------------------------------
HIND BLDG 501-2,000
10.00
Permit
ELEC-MISCELLANEOUS
- Additional desc .
Permit Fee . . . .
15.75 Plan Check Fee
3.94
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
3/03/10
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 .7500
--------------------------------=---------------------
PER,. ELEC DEVICE/FIXTURE 1ST 20
----------------------
.75
Permit
PLUMBING
Additional desc .
Permit Fee . . . .
18.00 Plan Check Fee
4.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
3/03/10
Qty Unit Charge
Per
Extension
BASE FEE
15..00
1.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00 .
---------------------------7------------------------------------------------
Special Notes and Comments
FIREPIT INCLUDING 100
L.F OF -1.511
POLYLINE GAS RUN & GFI
ELECTRICAL
OUTLET.
---------------------------------------------------------------------------
Other Fees . . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEWFEE
1.63
Fee summary Charged
Paid Credited
Due
---------------------------
Permit Fee Total
------------------------------
58.75 .00 .00
58.75
Plan Check Total
24.69 .00 .00
24.69
Other Fee Total
2.63 .00 .00
2.63
Grand Total
86.07 .00 .00
86.07
LQPERAIIT
Bin #
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
Permit #( , �GJ�
0
Project Address:TD— �v
wner's Name:
A. P. Number: L, /Lr lv
Address: .�
Legal Description: rl/Le VV
Contractor: �_ Rai
City, ST, Zip: L
Telephone:
Address:g(o—, 00 V S'
Project Description:
City,ST,Zip: C0604— L C,4 -7Z -Z36,
Z20 �,,/� LAI
Telephone: 3y rjZLL
C / Glr `L1e Z d/LbL-'e-
State Lic. # :
City Lic. #:
106 (g- FE:�--
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle 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
#
Submittal
Req'd
Rec'd
TRACKING. I
PERMIT FEES
Plan Sets
Plan Check submitted
3
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
�p
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionstiissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Lf e writ -15
Grant Deed
Plans picked up
S.M.I. f
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'" Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
In
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