10-0671 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO :
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application. valuation:
Applicant:
_r10 -0;00067-13-
80093
r10-000006 13_
80093 VIA'PESSARO
772-.550-024- -
SPECIAL INSPECTION
LOW DENSITY RESIDENTIAL
0
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT .
Owner:
JEFF.RIPPEE
PO BOX 9080
RANCHO -SANTA FE, CA.92067
--------------------------
Contractor:
Owner
VOICE (760) 777-7012
FAX. (760) 777-7011 .
INSPECTIONS. (760) 777-7153
Date: ' 7/21/10
e 0 JUL z2 201
IA
------------------- - - - - -- -
- LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm.und& penalty of perjury that I am licensed under provisions of Chapter 9 .(commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3'of the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: License No.:
_ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
- - -
issued.
Date: Contractor:
_ 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier - Policy Number'
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws•of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
-
3700 of the Labor Code, I hall forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)•:
icant:
1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, andthe
ci
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The .
WARNING: FAILURE TO SECURE WORKERS' COMPEN ION COVERAGE IS UNLAWFUL, AND SHALL
- Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.' '
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.). -
APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
' conditions and restrictions set forth on this application. '
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose'behalf this application is made, each personatwhose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application, '
(_ 1 I am exempt under. Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Ouinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
Date: Owner:
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 .
CONSTRUCTION L DING AGENCY
.permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for theperformance of the ,
I certify that I have read this application and state that the above information is correct. I agree to comply with all. '
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
• -
of this county to enter upon th bove-mentioned prope.1 for inspec on purposes '
Lender's Name:
ate/ S' ature (Applicant or Agent):
Lender's Address:
•.
/
1
LQPERMIT
Application Number 10-00000671
-Permit . . . SPECIAL'INSPECTION
Additional desc .
Permit Fee, 100.00. Plan Check Fee
.00
Issue Date Valuation
0
Expiration Date'., 1/17/11
Qty Unit Charge Per
Extension
BASE FEE
100.00
----------------------------------------------------------------------------
Special Notes and Comments
SPECIAL INSPECTION TO FINAL OUTSTANDING
PERMITS: 07-194 GARAGE, 06-4092 FIRE PIT
' AND 06-4091.POOL.
Fee, summary Charged Paid Credited
Due
Permit Fee Total 100.00 .00 .00
100.00
Plan Check Total -:00- .00 .00
00
Grand Total 100.00 .00 .00
100.0.0
LQPERMIT
Bin #
City of La Quinta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet ti
Permit #
O 41
Project Address:
Owner's Name:
A. P. Number:
Address -'P, Q
Legal Description:
Contractor:
City, ST, Zip:„� 9 R
Telephone: ya:.:v � a t •p
Project Description:
Address:
City, ST, Zip:
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Telephone: >•; . .�.>;x•; .`.��.�:<�.:�� 3f�:
P c ,�:, ;y`< ?tic;>::fi�:f•>
State Lic. # : City Lic. #;
Arch., Engr., Designer:
P
Address:
City., ST, Zip:
Telephone:: S :
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State Lic. #:
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Name of Contact Person:
Construction Type: Occupancy:
cY:
'Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft:
#Stories:
F# Units:
Telephone # of Contact Person:
Estimated Value of Project: .
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2' Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. A r
PP
Date of permit issue
School Fees
i
Total Permit Fees