11-0624 (TT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-00000624
Property Address: 80429 VIA PESSARO
APN: 772-520-056- - -
Application description: TEMPORARY TRAILER
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 0 -
Applicant:
Tay/ 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/09/11
Owner:
BRUCE KANTER
.80429 VIA BELLAGIO }gLA QUINTA, CA 92253 Ai
JJ �9 Ea.p0 2919
Contractor: _...�
FEDDERLY & ASSOCIATES CITY OF"'A0.flWA
38747 NOPALES ROAD ref'" `•►•
PALM DESERT, CA 92211
(760)773-5205
Lic. No.: 762889
one year of completion, the owner -builder will have the burden of proving that he or shedidnot 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 contractorls) 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
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 orrect. I ree t c mply with all
city and county ordinances and state laws relating to building co coon, ereby t ri r resentatives
of this counto a er upon the above-mentioned property f ns do rp es.
pate: Signature (Applicant or Agentl:
" LICENSED,CONTRACTOR'S DECLARATION -
WORKER'S COMPENSATION DECLARATION
hereby affirm under 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�ofthe Professionals C and my License is in fullforce and effect.
Ihave and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Clas -.l isse 62889- \ k
_
for by Section 3700 of the Labor Code, for the performance of the work forwhich this permit is
/�issued.
Date: V �,
_ 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' compensatiori '
- OWNER -BUIL DECLARATION •
insurance carrier and pnliry number are:
hereby affirm under penalty of perjury that I am exempt fr the Contractor's'State License Law. for the -
Carrier EVER . INS Policy Number -76000044008'1 - ` • "
following reason ISec. 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 t4wPiprovisons. orker, ' mpensation 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 me subj to the ensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
700 of the. Labor Cod all fo ith om �-
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).:,
ate: 6� Applicant:.
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
COVERAGE
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPEN 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 AN 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 1$100,0001. 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 shedidnot 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 contractorls) 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
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 orrect. I ree t c mply with all
city and county ordinances and state laws relating to building co coon, ereby t ri r resentatives
of this counto a er upon the above-mentioned property f ns do rp es.
pate: Signature (Applicant or Agentl:
Application Number
. . . . 11-00000624
Permit . .
. TEMP TRAILER
/ MOBILE HOME
Additional desc .
Permit Fee . . .
. 200.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
0
Expiration Date
12/06/11
Qty Unit.Charge
Per
Extension
BASE
FEE
200.00
Fee summary
.Charged
Paid Credited
Due
Permit Fee Total
200.00
.00
:00
200.00
Plan Check Total
.00
.00
.00
.00
Grand Total
200.00
.00
.00
200.00
' LQPERMIT
Bin #
City of La Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
t' • 0, �. I-
Project Address:
Owner's Name:2
A. P. Number: %
Address: GJ �(D T �% l r �Ct 1.
Legal Description: S Z 04-C /ZL--:S7 I-oT Q: -T --Z.-
Contractor:�,/
Lt U ~Pile I � t'TJSG G( �1�
City, ST, Zip: L< Ock I n A -c-, g2 3
Telephone: � � �c7
Project Description:
Address: %S �] L4-7 J eS
City, ST, Zip: ` IYY� C
L
Tele hone:r`'''':`::>>;;>:y.,
State Lic. # : -7
City Lie. #.: q q 7
Arch., Engr., Designer: Re h {!
Address: 7 S
City, ST, Zip: L(
Telephone: 7 (1 77/ Cl
„�r .;;•:.�,:
?;;k "?;:v??:`:><`:>'<
Construction Type: Occupancy:'o(n S [
State Lic. #:
Project type (circle one): ew Add'n Alter Repair Demo
Name of Contact Person: -
Sq. Ft:: 9� J
# Stories:
# Units: ,
Telephone # of Contact Person: 5-,] 9,1 -,�-tio<p Estimated Value of Project: / % "/, ✓/ia^,
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
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
Title 24 Calcs.
Pians picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan2°'
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 correctionsrtssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees,
r'
16�+*-% � 0*94 -C.0 % 4wr