08-0777 (SOTB)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICQ FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
-- --- Date: 5/06/08
Application Number: .___--08-00000777._ Owner.
Property *Address: 80769-VIA PESSARO' JACOBSEN DAVE
APN: 772-500-069- - 80769 VIA PESSARO
Application description: STRUCTURES OTHER THAN BUILDINGS LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL: "
Application valuation: 8000
Contractor:. .
Applicant: Architect or. Engineer: MONARCH HOMES DESER"DIV N
T C a te'®
pHq
73290 EL PASEO, SUITE "#4 ALJ
PALM DESERT, CA.92260
(760)568-3905 �.
tt
'
�J- - LiCNo'457228 l/f� llaf�A
B
-
------- -----------'--------------------------- - - - - --------- - -=- --- - - ---- •-------- - -- - -—
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION "
1 hereby affirm under penalty of perjury that`I. am licensed under provisions of Chapter 9 (commencing with I hereby affirm under pen altypf perjury one of the following declarations:
Section 70001 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 forworkers' compensation, as provided
-License Class: B - License.No.: 457228 for by Section 3700 of the labor Code, for the performance of the work for. which this permit is
issued. ,
, - ,
ntractor: • - - _ 1 haveandwill 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:
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number -3015506-08
following reason (Sec. 7031_5, Business andProfessions 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 repairany 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 Icommencing with Section 7000) of Division 3 of the Business and Professions. Code) or ' -3700 of the Labor ; I shall forthwith comp) with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
a`ny'applicant-for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: D ^ - A'pp'- nt:
( 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 WARNING: FAIL TO SEC WORKERS' COMPENS ON 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 T RIMINAL 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 ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN ..
improvements are not intended or offeredfor 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-
. I, as owner of the property, am exclusively contracting with licensed contractors to construct. the project (Sec. IMPORTANT Application is hereby made to the Director f 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 person at whose 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 LaQuinta, its officers, agents and employees for any act, or omission related to the work being
J y - performed under or following issuance of this permit. '
,�ate:
D-�_ / - 0 - -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 1.80 days will subject -
CONSTRUCTI LENDING AGENCY _ permit to cancellation.
I hereby affirm under penalty of peri y that there is a construction lending agency for the performance of the 1 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 buil ing construction, and hereby authorize representatives
of this county to enter upon the ove-mentioned grope ,y or inspection purposes.
Lender's Name: _ _._ . _ ur
Lender's Address: - te" (� Si ure (Applicant"or.Agentl: -
.alp
fes;
LQPERMIT -
Application Number 08.-00000777
Permit . . . BUILDING:PERMIT
Additional desc .
Permit Fee ... 99.00 Plan Check Fee .,
64.35
Issue Date Valuation
8000
Expiration Date 11/02/08
Qty Unit Charge Per
Extension
BASE FEE
45.00
6.00 9.0000 THOU. -BLDG 2,001725,000
54.00
Permit . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee, : 16.50 Plan Check Fee
4.13
Issue Date Valuation
0
Expiration Date _. 11/02/08
- Qty Unit Charge Per
Extension
BASE FEE
15.00
2'.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
1 50 11.
Permit PLUMBING _.
Additional desc
Permit Fee 18.00 'Plan Check`Fee
4.50 ,
Issue Date Valuation
0
Expiration Date 11/02/08 .>
f Qt Per
Unit_Char e
Y g. :
Extension -
BASE FEE.
1.5.00
1.00, 3.0000 EA PLB GAS PIPE 1-4.,OUTLETS ,.
3.00
----------------------------------------------------
Special Notes and Comments
REMOVE BBQ AND INSTALL NEW FIREPLACE
- ---------------------------------------------
' Other Fees ENERGY REVIEW FEE
6.44
STRONG MOTION "(SMI) -,RES
:80
Fee summary Charged Paid '" Credited
-Due
-------------------------------------
Permit Fee Total 133.50 .00 ,,00
133.50 -
Plan Check Total 72.98 .00 .00
72.98
Other Fee Total 7.24 .00• .00
7.24
Grand Total 213.72 .00 .00,•
213.72
LQPERMIT
Bin
City of La. Quinta
''Building a Safety Division
Permit # P.O. Box 1504,. 78-49S Calle Tampico
La Quints, CA 92253, (760) 777-7012
Building Permit Application and Tracking Sheet'
Project Address.`*o 7 4 9 V A P d Owner's Name:. L� eoaSe.,�J
A. P. Number: Address: so
Legal Description: City, ST, Zip: [,� `
QtJ AS 74
Contractor: Telephoner
LAdess: 3 _ •Z 9a L /HS Project Description: �rDv7�
ST,Zip: Z�90hone: "7(06 L/Z.3
State Lic. #: 'IS - 'City Lic. #:. �
Arch., Engr., Designer:. ,
Address:
City,' ST, Zip:
Telephone: Construction Type: Occupancy:
. P cY:
State Lic. #: Project type (circle one): New Add'n Alter. Repair Demo
Name of Contact Person: C S Ft #tories:#Units
.
....._.
Telephone # of Contact Person: " Z 37 Estimated Value.of Proj
APPLICANT: DO NOT WRITE BELOW THIS LINE ..
# Submittal Req'd - Reed TRACKING PERMIT FEES
Plan Sets Plan Check submitted D Item Amount
StructuralCalcs• Reviewed; ready for correctionsPlan Check Deposit
Truss Calci. Called Contact Person Plan Check Balance
Energy Calcs.. Plans picked up Construction
So .
Floodplain plan,, Plans resubmitted Mechanical
Grading. plan Review, ready for correctio issueElectrical
` o�-Filtt�etl
Subcontactor.List ' Called Contact Person 5 5�(p og Plumbing
diAS e u lE 45
Grant Deed Plans. picked up S.M.I.
H.O.A. Approval Plans resubmitted 4 Grading
1N HOUSE: Review, ready for correctionsrissue Developer Impact Fee
Planning Approval ' Called Contact Person A.I.P.P.
Pub. Wks. Appr Date of permit issue
School Fees
SCALE. 1"= 10'
lb io so
NOTE:
DRIVEWAY APPROACH REQUIRES A SEPARATE
PERMIT & INSPECTION FROM CITY OF LA QUINTA
PUBLIC WORKS DEPARTMENT
N —
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06
100 .99TC
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60,29
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35:
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0 0 3
0
ix Lu
0
0
0- 0
0
(A- 5 N 5-60TC
3.60INV
wm
1005 48TC
I APPROVED FOR PERmnNG: 11
y
CONSTRUCTION NOTES
QUANTITIES
(D
CONSTRUCT 6-X22-1/2' BEND (SDR -35).
I
EA
O
CONSTRUCT YARD, DRAIN. NDS #50* 6' DIA. GREEN
13
EA
I J
COLOR GRATE OR'EQUAL,
... .......
.............
CONSTRUCT 6X46 BEND (SDR -35).
2
EA
DRAFT:
CONSTRUCT 6' PVC PIPE, (SDR -35). SLOPE AT 47.
400
LF
UNLESS OTHERWISE 'NOTED ON PLANS,
DATE:
/83
ESSI
CONSTRUCT BUBBLER Box WITH GRATE TOP. NYLOPLAST
12", 1
EA
PG895009
DRAIN BASIN PER DETAILON SHEET 1. %
CONSTRUCT WALL PER SEPARATE PLAN AND PERMIT.
245
LF
HEIGHT AS SHOWN ON PLANS.
CONSTRUCT 4" MIN. THICKNESS STAMPED P.C,C DRIVEWAY.
1840
SF
CONSTRUCT 10, DEEP DRYWELL PER DETAIL ON SHEET 1.
1
EA
CONSTRUCT MEARIN 100--S;. SLOTTED DRAIN W/GAL VANIZED
41
LF
SLOTTED GRATING OR EQUAL.
10
CONSTRUCT 6'X6' TEE (SDR -35).
1
EA
SCALE. 1"= 10'
lb io so
NOTE:
DRIVEWAY APPROACH REQUIRES A SEPARATE
PERMIT & INSPECTION FROM CITY OF LA QUINTA
PUBLIC WORKS DEPARTMENT
N —
fiZ�C% O--
f ! _
06
100 .99TC
)wy
7
q0)
60,29
>
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La zi
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35:
uj Of
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0 0 3
0
ix Lu
0
0
0- 0
0
(A- 5 N 5-60TC
3.60INV
wm
1005 48TC
I APPROVED FOR PERmnNG: 11
y
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r.
........
... .......
.............
--- ------
DESIGN:
DRAFT:
ESSI
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CHECK:
DATE:
/83
ESSI
APR.- 04
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