09-1160 (GRES)4
P.O. BOX 1504 VOICE (760) 777=7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/20/09
Application Number: 09-00001160 Owner:
Property Address: 61064 DESERT ROSE DR GUREVITCH MICHAEL/WYNSTOCK L
APN: 764-350-005- - -
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 12407
Contractor: D 6
Applicant: Architect or Engineer: SHEA HOMES, INC.
00 TRILOGY
BQUINTA, CA 92253AY
LADEC 01 20-39
\' (760) 777-6005 e1
�+ Lic. No.: 672285 C'ry FdgQUINTA
F'fkA.Pdd g ()EP
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Cl ss: 13 License No.: 672285
Dat Contractor:w
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
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.).
(_) 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 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
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 NTL UNION INS Policy Number WC698782
_ I certify that, in the nce of the work for which this permit is i ued, I shall not employ any
person in any�a Mn �s to become ubje t to the workers' comp nsa�Ja of California,
and agree fiat, if I sh u d b`2 me sub e't ewvorkers' compensa on s of Section3700 o the La or C de, I sh forth i o ply with rhos provisi si�
4ate: is nt-.
WARNING: FAIL E TO S URE 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 cessatioLrrect.
180 d s will subject
permit to cancellation.
I certify that I have read this application a ate h t e abov i formation isree c mply with all
Aa,t44,gnatutre
y ordinances as[atea s relating o b ding cos ugfon, and iz esentatives
toenterup he abov mentioned rope orintl n purpos
(App ca t or A U:
.1 i
Application Number . . . . . 09-00001160
Permit . ...
CARPORT/GARAGE
Additional desc .
Permit Fee . . .
. 144.00 Plan Check Fee
93.60
Issue Date . . .
. Valuation . . .
. 12407
Expiration Date .
. 5/19/10
Qty Unit Charge Per
Extension
BASE FEE
45.00
11.00 9.0000 THOU BLDG 2,001-25,000
99.00
----------------------------------------------------------------------------
Special Notes and
Comments
633 S.F. DETACHED
GARAGE ADDITION. 2007
CODES
----------------------------------------------------------------------------
Other Fees .
. . . . BLDG STDS ADMIN (SB1473)
1.00
STRONG MOTION (SMI) - RES
1.24
Fee summary
-----------------
Charged Paid Credited
----------------------------------------
Due
Permit Fee Total
144.00 .00 .00
144.00
Plan Check Total
93.60 .00 .00
93.60
Other Fee Total
2.24 .00 .00
2.24
Grand Total
239.84 .00 .00
239.84
LQPERMIT
Bin #
City of La Quinta
Req'd
Permit # n
Building & Safety Division
PERMIT FEES
-.P...O.,Box+1504, 78=495 Calle Tampico } �1
Plan Sets
La Quinti, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: I O (p L4 0 e—SeJA-k p�i
Owner's Name: Shea Homes
A. P. Number: -1&4—z7,50 —00
Address: 60-800 Trilogy Parkway
Legal Description: Trilogy @ La Quinta
City, ST, zip: La Quinta, CA 92253
Contractor: Shea Homes
Telephone: 760-777-6032hvrTi
Plan Check Deposit
Address: 60-800 Trilogy Parkway
Project Description: 'o,� 12$
City, ST, zip: La Quinta, CA 92253
aS7 7 JEJXk ,_ fN c�A +. V r
Telephone: 760-777-6032'
. +.,
De Q• (�3 3 sf
Energy Calcs.
State Lic. #: 640934
City Lic. #:
Arch., Engr., Designer:
Address:
Flood plain plan
City, ST, Zip:
hone:
VrrConstruction
xtTele
►
Type: Occupancy:
State Lic. #:
r . ,:�`•
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Gabbie C. Nieto
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: -0q
APPLICANT: 00 NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
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
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god 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 of permit issue
School Fees
Total Permit Fees