11-0155 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4 Q"
Application Number: 11 00000155
Property Address: 61030 DESERT ROSE DR
APN: 764-270-999-126 -300231-
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 10000
Applicant:
Architect or Engineer:
, IA
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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.
LicenseClass: 27 License No.: 898417
C ractor e-- �
OWNER- UILDER DECLARATION
I hereby affirm under penalty of perju t t I am exempt m the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions We. 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 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.).
(_) 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 1 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: 1��1
Lender's Address: T'
LQPERMIT
Owner:
SUE APPLBAUM
61030 DESERT ROSE DRIVE
LA QUINTA, CA 92253
Contractor:
DESERT LANDSCAPE ASSOC
79405 HWY 111, STE #9,
LA QUINTA, CA 92253
(760)399-9600
Lic. No.: 898417
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/14/11
D �H -7
S FAQ 1 1011
M 427
CIT.' 4F LA CAUINTA
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
K�( issued.
Y� 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 NORGUARD INS Policy Number
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 become subject to the workers' compensation provisions of Section
700 of the Labor Code,, II�KERS'COM
shall forthwith comply with those provisions.
D Z I u icant: WARNING: FAIL E TO SECURE NSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,0001• IN ADDITION TO THE COST F 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.
1 certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of�ounty tto� tenter upon the above-mentioned property or inspection purposes.
ate:4 yA _ L Si ture (Applicant or Agent):
Application Number . . . . . 11-00000155
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 117.00 Plan Check Fee.. 76.05
Issue Date . . . . Valuation . . . . 10000
Expiration Date . . 8/13/11
Qty. Unit Charge Per Extension
BASE FEE 45.00
8.00 9.0000 THOU BLDG 2,001-25,000 72.00
----------------------------------------------------------------------------
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date
Expiration Date .
ELEC-MISCELLANEOUS
15.75 Plan Check Fee . . 3.94
Valuation . . . 0
8/13/11
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 8/13/11
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
VENTLESS OUTDOOR FIREPLACE & FIREPIT.
PROJECT INCLUDES 135 L.F. 1 1/2" & 1"
GAS LINE AND 60 L.F. ELECTRIC RUN. 2010
CODES.
----------------- w
Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
ENERGY.REVIEW FEE 7.61
STRONG MOTION (SMI) - RES 1.00
Fee summary
-------------
Permit Fee Total
Plan Check Total
Other Fee Total
LQPERMIT
Charged Paid
150.75 .00
84.49 .00
9.61 .00
Credited
Due
.00
150.75
.00
84.49
.00
9.61
Application Number
Grand Total
LQPERMIT
. . . . . 11-00000155
244.85 .00 .00
244.85
Bin #
City of LA Quinta
Building 8L Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 6 Q 3 0 0e ,e i-7 R d 5 c
Owner's Name: I
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A. P. Number:
Address: 1 0 3 d (ie $t?f' & Se
Legal Description: 0- 126
City, ST, Zip: L,5� Lt,) V)rtc� Cc, 52253
Contractor:
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Telephone: �� x� y:.: ;>.11.,
3
Address: l � � s few td s'e I
Project Description:
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City, ST, Zip: r,- I Kfk Ca 7
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Telephone: 760 � 1 '� Z ? y
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State Lic. # : g Lf 7
City Lic. #.-
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Arch., Engr., Designer: I e h
Address: 3 bUtvq 5Td vi e. Ori C
City., ST, Zip: L(CL
Telephone: VZ y
Construction Type: t �
9-U) Occupancy:7
Project type circle one New Add'n Alter Repair Demo
State Lic. #: 8 I"1 �
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Name of Contact Person: �e noy,
Sq. Ft.: J 1460
# Stories:
It Units:
Telephone # of Contact Person:
Estimated Value of Project: 0 J0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
8 t /
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 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
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