06-2816 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht aF 4 Q"
Application Number: 06-00002816
Property Address: 80340 VIA PESSARO
APN: 772-550-001- - -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5500
Applicant: .
Architect or Engineer:qgOF
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. -
License Class: C53 License No.: 878400
Date' Io t actor. =-
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 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.).
(_ 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 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:
LQPERAIIT
X
Owner:
PEDERSON HOMES INC.
80-340 VIA PESSARO
LA QUINTA, CA 92253
. O�Xr-1Q 74A
Lic.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
WORKER'SCOMPENSATION DECLARATION
Date: 7/27/06
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 EXEMPT Policy Number EXEMPT
`ertify that, in the performance of the work for which this permit is issued, I shall not employ any
�r-�I'cperson 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
3700 of the Labor o e I shall forthwith comply with those provisions. ,
+-Date:%'�'%---Applicant:~
WARNING: FAILURE TO SECURE 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 THECOSTOF 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 isnot 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 comply with all
city and county ordinances and state laws relating to Tin constuction, and hereby authorize representatives
of this county to enter upon the above-mentioned prop ty fo i perct n purposes.
Date!is6?9�?^_Sig nature (Applicant or Agent .
Application Number . . . . . 06-00002816
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 81.00 Plan Check Fee
52.65
Issue Date Valuation . .
5500
Expiration Date 1/23/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
4.00 9.0000 THOU BLDG 2,001-25,000
36.00
Permit ELEC-MISCELLANEOUS
Additional desc .
Permit Fee 17.25 Plan Check Fee
4.31
Issue Date Valuation
0
Expiration Date 1/23/07,
Qty Unit Charge Per
Extension
BASE FEE
15.00
3.00 7500 PER ELEC DEVICE/FIXTURE 1ST 20.
- 2.25
•Special Notes and Comments
BBQ & FIREPIT PER APPROVED PLAN
Fee summary Charged Paid Credited
Due
----------------- ----- - ---- ----- -_---------
Permit Fee Total 98.25 :00 .00
98.25
Plan Check Total ;° 56.96 .00, __ .00
56.96
Grand Total 155.21- .00 .00,
• s -
155.21,
LQPERAIIT
Bin #
C, of Lauinn
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.#
6 CO- n
Project Address:" D -, vo 77-557Apo
Owner's Name: = G
A. P. Number:
Address: �4 d`6
Legal Description:
City, ST, Zip: �-4U +
Contractor: I— S k —e e,` P C^ - 5pA
Address: y8� ,.
Telephone:
Project Description: r i
City, ST, zip: , CA ;4 -D -b3
Telephone: )moi -
City Lic.
5 TO
State Lie. #:
Arch., Engr., Designer: "
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person: AltiTS S [�ee,�J
Construction Type: ;_ Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft-:
# Stories:
# Units:
Telephone # of Contact Person:— ? _5 �s
—I—Estimated—Value of Project: SQA e
APPLICANT:
DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACIONG .
PERNM FEES
Plan Sets
Plan Check submitted
��
Item
Amount
Structufal Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cales.
Plans picked up
Construction
so" r�
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
SALL
H.O.A. Approval `
Plaas resubmitted
Grading
IN HOUSE:-
'"' Review, ready for correctionslrssue
Developer Impact Fee .
Planning Approval
Called Contact Person
A LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
,m�