09-0228 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09-00000228
Property Address: 50565 EL DORADO DR
APN: 777-290-007- - -
Application description: REMODEL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 10000 .
T,it4t 4 4 Q"
Applicant: Architect or Engineer:
��*d R�kai-
�
BUILDING &SAFETY DEPARTMENT
BUILDING PERMIT
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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 y License is in full force and effect.
/License Cla Li o.: 63749
✓ Date: ontractor: r
NER-BUILDER DECLARATION
I hereby affirm under penalty of perju tham exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Busi 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).:
(_) 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 r
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.).
( ) 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:
LQPERA11T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/09/09
Owner:
GLENN MADRIGRANO SR TRUST
4515 13TH ST
KENOSHA, WI 53144
( ,
Contractor: i
,.
GRAYSTONE CONSTRCTION COMPANY n
79405 HIGHWAY 111., SUITE 9-414
LA QUINTA, CA 92253
(760)564-6934 L�f
Lic. No.: 863749
-—--—-——---
• 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 STATE FUND Policy Number 1828934
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 worker ' nsation laws of California,
a d agree that, if I should become subject to the worker ' compensati n provisions of Section
700 of the Labor �si co w' provision
rDate: vpplicant:
WARNING: FAILURE TO SECURE WORKERS' C P P SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENAL 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 cessation of work for 180 days will subject
permit to cancellation. '
I certify that I have read this application and state that the above information is correct. I agree to cuNky with ail
city and county ordinances and state laws relating to building construction, and hereby uthor' a rese ativas
of this county o ter upon the above-mentioned property for ins p p ses.
✓Date: ignmure (Applicant or Agentl:
Application Number . . . . . 09-00000228
------ Structure Information EXISTING RESIDENCE
-----
Other struct info . . . . . CODE EDITION
2007
# BEDROOMS
----------------------------------------------------------------------------
.00
Permit BUILDING PERMIT
Additional desc REVISE GARAGE DOOR OPENING
Permit Fee 117.00, Plan Check
Fee
76.05
Issue Date . . Valuation
. . .
. 10000
Expiration Date 10/06/09
Qty Unit Charge Per
Extension
BASE FEE
45.00
8.00 9.0000 THOU BLDG 2,001-25,000
72.00
----------------------------------------------------------------------------
Special Notes and Comments
REMODEL OF EXISTING GARAGE DOORS (2-
81X71) INTO SINGLE 18 X 7 DOOR. 2007
CODE. -
----------------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
STRONG MOTION (SMI)
- RES
1.00
Fee summary Charged. Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 117.00 .00
.00
117.00
Plan Check Total 76.05 .00
.00
76.05
Other Fee Total 2.00 .00
.00
2.00
Grand Total 195.05 .00
.00
195.05
LQPERNIIT
Bin # City of La Quinta
Building & Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: "--->O j �j •j EL 00 tZA-Op 0Q, Owner's Name: M A.-1) RRl &R -A -N o
A. P. Number: Address: -5-0 -56, 5- C L 0oaA010
Legal Description: City, ST, Zip: LR d 1v1 Z Z�3
Contractor: 6-62, A- y 5i3 t,C CO IS . 4•, Telephone:
Address: 7 9- [/aS 1% L�,j / / 1 .0 9 _Project Description:
City, ST, Zip: t/2ZS�3 &-AM 6•z,- Doo&5 A--> Lo(..�+� ¢Cf-1Lo
Telephone: 760 SG t(- 6 cJ 3 y1 g
w� tr l — �r 7 DOOrl-
State Lic. #: Yj 6 j 7 1/ �/ City Lic. 4:1 o o4 3 Y
Arch., Engr., Designer: IZA
Address: o S,ti /Z -A„ e• s fio
City, ST, Zip: L_/,
Telephone: 5-6 V — G -7 9 Construction Type: Occupancy:
State Lic. #: C (ir 4-c/ 5 Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: G— y 5!
Estimated Value of Project: J G U0, —
HrrLIUAN
I: UV IVU 1 WKl l t tStLUW I Hits LIM
#
Submittal
Plan Sets
Req'd
Reed, . -
TRACKING PERMIT FEES
Plan Check submitted Item Amount
Structural Calcs.
Reviewed, ready for orrections 3 `g Plan Check Deposit
Truss Cales.
Called Contact Person 3 Plan Check Balance
Energy Calcs.
Plans picked up Y /1 Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2" Review, ready for correctio issue Electrical
Subcontactor List
Called Contact Person ttfl ol Plumbing
Grant Deed
Plans picked up V S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''" 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 i