09-1075 (PAT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
09-00001075
Property Address:
53065 AVENIDA VILLA
APN:
774-063-025-5 -000000-
Application description:
PATIO COVER - RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
9576
T4tyl 4 4 Q"
Applicant: p� Architect or Engineer:
�Ok� ko--
L��Vv ` .
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: License No.:
Date: Contractor:
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 signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License L w (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that h r she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.:
(_ 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 ISec. 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.).
I _) 1, ,r ., ro m
Qf tho propoaty, am 0066111;.1W 11411 li cnaed w11LIMwia to wuuu L1111iUiL1111UIUluut t3uu.
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($) licensed
pursuant to the Contractors' State License Law.).
I—) I am exempt under Sec. , B.&P.C. for this reason
Date: 674=i 7 20cr 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.I.
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
HURWITZ, SHARON
300 ARROYO SALADO
SANTA FE, NM 87508
(505)603-1963
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/07/09
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 --- - - - - - - - - - - - - - - - - - - -- Policy Number
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 workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those_ provisions.
Date:l0 -? - or 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 1$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
IMPUN IAN 1 Applittt16h 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 186 days will subject
permit to cancellation.
I certify that 1 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 building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purp ses.
Date: '0(;__)_0t Signature (Applicant or Agent):
Application Number . . . . . 09-00001075
Permit . . . PATIO COVER PERMIT
Additional desc . .
Permit Fee . . . . 117.00 Plan Check Fee
76.05
Issue Date . . . . Valuation . . .
. 9576
Expiration Date 4/05/10
Qty Unit Charge Per
Extension
BASE FEE
45.00
8.00 9.0000 THOU BLDG 2,001-25,000
72.00
--------------------7-------------'------------------------------------------
Special Notes and Comments
PATIO COVERS PER CITY STANDARDS &
APPROVED PLANS TOTAL OF (4) PATIO COVERS
TYPES "A" "B" & "C" TOAL OF 720 SQUARE
FEET. APPROVED BY AJ.
---=------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
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 1.00 .00 .00
1.00
Grand Total 194.05 .00 .00
194.05
LQPERMIT
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTA N
DATFE 4 6m BY Q)
d M f,.+ws •`[IfC3 AiBIG
L' bTttef Axl`( so
RAFTER SIZE AND SPACING
X
-- ----�y II Q. c
ROOF PITCH
SPECIFY ROOFING AND SHEATHDN�
(SEE ROOFING NOTE
CONTINUOUS LEDGER
(SAME SIZE AS RAFTERS)
HEA/D/ER SIZE — _
G �C �-1_ rl
6 AND 'L' STRAPS I
6':6'■t'•t/6" WITH
2 1 (4) 16C NAILS OR BOLT 1
RAFTER SPAN. _— 2 /� I
O.H. �
V POST SPACING --_
�
OVERALL LENGTH: _ I 0CL
I f OVERALL LENGTH.---
POST
ENGTH .------
�—=—� POST SIZE:x__
REAR SETBACK SIDE SETBACK (4':4' MIN.)
I
2000 P.S.I CONCRETE --.� I FINISH GRADE FINISH GRADE
J MIN. 1 T =12 FOOTING I 1
v./ t 2' BELOW GRADE L — J
NOTE
OPEN LATTICE PATI) COVERS MAY BE ATTACHED TO EXISTING FASCIA
VIA ONE 1/4' r S' LAG SCREW THROUGH FASCIA WTO EACH RAFTER TAIL
3/8' : 5 LAG SCREWS INTO STUDS AT 15' O.0
r--- CONTINUOUS LEDGER
i I
JOIST HANGER OR SOLID BLOCKING I —
NAIL RAFTER TO BLOCKING r o +
- —.►d AAAA -... s � �.....-�.3�Yr..�.'-
BUILDING MPARTMEkW4' -AP E)'VAL�
U -STRAP OR AN
NON -CORROSIVE
(4)- 16d NAILS
OR BOLT
io
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE -�
U -STRAP OR ANGLE
(4)- 16d NAILS
OR BOLT
PROVIDE t" CLEARANCE
BETWEEN POST AND
CONCRETE
ANCHOR BOLT (EMBED
7" MIN. INTO CONCRETE)
TYPICAL PATIO COVER
OF LA Q U I NTA DATE OF APPLICATION
BUILDING & SAFETY DEPT. OwNER•S NAME
APPROVEDSTREET ADDRESS
FOR CONSTRUCTION CITY. ST . ZIP
DATE BY TELEPHONE
H.O,I APPROVAL
v%/
RAFTER SIZE AND SPACING
it
----- -------4 f Q, C. -
ROOF PITCH
--- 0 ---
CONTINUOUS LEDGER
(SAYE SIZE AS RAFTERS)
HEADER SIZE
�,VtUfT ROOFING AND SHEATHING O�R{ OPEN ,ATT --E
;SEE ROOFINC NOTE ON REV��
----------------- /
AND •L' STRAPS
w(TH
�� -- Z I 1
(i) 16C NNIS OR BOLT u
f �
J
RAFTER SPAN 2 �
DOST SPACING
LJ/ O.H. u O.N.
¢
OVERALL LENGTH:
IL OVERALL LiNGTM
� 2– –7 POST SIZE:
REAR SETBACK SIDE SETBACK
1
2000 P.$.1 CONCRETE -+1 I FINISH GRADE FIIISM GRADE I L. __ YIN. 1 T:12 FOOTING1 1
L J I L– J 12" BELOW. GRADE L– -J
PROVIDE I- CLEARANCE
BETWEEN POST AND
OPIi CONCRETE
OPEN LATTICE PATIO COVERS MAY BE ATTACHED TO ExISTING FASCIA
VIA ONE 114' ■ S' LAC SCREW THROUGH FASCIA INTO EACH RAFTER Tul
U–STRAP OR AN
3/8' . 5' LAG SCREWS INTO STUDS AT 16' O.C.7 NON-CORROSVE
r— CONTINUOUS LEDGER /
i 0 -
` JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING `
BUILDING DEP`ARTMET'�AP`R'�/AL'� O�IV
`moi J
. (AlC'. C LA Q i� 4 NTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE BY
(4)- 16d NA7LS
OR BOLT
U -STRAP OR ANGLE
(4)- ,16d NAILS
OR BOLT
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE
ANCHOR BOLI (EMBED —
7- MIN. INTO CONCRETE)
TYPICAL PATIO COVER
DATE OF APPLICAMON
OWNER'S NAME
STREET ADDRESS.
Cm, ST . ZIP
TELEPHONE
H.OA APPROVAL
RAFTER SIZE AND SPACING
2
--------------
_2-�ll o c
--
ROOF
\PITCH
SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE �
#SEE ROOFIN =NOTE ON REVERSE)
- - /
• II • p . I. .
�- CONTINUOUS LEDGER
io
NON -CORROSIVE PLATE
(SAME SIZE SIZE AS RAFTERS)
II II
(4)- 16d NAILS
OR BOLT
U—STRAP OR ANGLE
HEADER SIZE
OR BOLT
PROVIDE t" CLEARANCE
BETWEEN POST AND
CONCRETE
II II II
II I
II III
ANCHOR,BOL- (EMBED
I
AND 'l' STRAPS
DATE OF APPLIC'kTION
OWNER'S NAME
WITH I
STREET ADDRESS
CITY, ST ZIP
(4) 16C NAILS OR BOLT I
RAFTER SPAN:
H.OA APPROVAL
O.H.
a:
'OST SPACING.--LL-
COVERALL
O.H.
LENGTH:
a
J�I,
OVEFVkLl LENGTH._— =--
Zol
CPI
POST SIZE. -4-A zi
REAR SETBACK
SIDE SETBACK
(4'x4' MIN.)
I
2000 P.S.1 CONCRETE —+N I FINISH GRADE
FINISH GRADE
L J
,
L_
I,_. MIN. 12' ■ 12 FOOTING 1 1
I
.J 12' BELOW GRADE L_ J
NOTE:
OPEN LATTICE PATIO COVERS MAY BE ATTACHED TO EXISTING FASCIA
VIA ONE 1/4' 1 5' LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL.
LAG SCREWS INTO STUDS AT tG' O.C.
r-- CONTINUOUS LEDGER
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING
( BUILDING DEPARTMENT APPROVAL BELOW
CITY OF QUINTA
BUILDING & S" FETY DE
APPR DIED
FOR CONSTRUV N
DATE By
i
Z
PROVIDE 1- CLEARANCE
BETWEEN POST AND
CONCRETE
U—Z�INAF' LIR ANGLE
io
NON -CORROSIVE PLATE
II II I II
II II
(4)- 16d NAILS
OR BOLT
U—STRAP OR ANGLE
(4)- 16d NA_'LS
OR BOLT
PROVIDE t" CLEARANCE
BETWEEN POST AND
CONCRETE
II II II
II I
II III
ANCHOR,BOL- (EMBED
7" MIN. INTO. CONCRETE)
TYPICAL PATIO COVER
DATE OF APPLIC'kTION
OWNER'S NAME
STREET ADDRESS
CITY, ST ZIP
TELEPHONE
H.OA APPROVAL
RAFTER SIZE AND SPACING
ROOF PITCH
SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE
(SEE ROOFING NOTE ON REVERSE) /
--------------------
/ �- CONTINUOUS LEDGER
(SAME SIZE AS RAFTERS)
HEADER SIZE
'L' STRAPS
-
ITAND
6*x6'.I".I/8 WH
=
I(4)
Ll
16C NAILS OR BOLTRAFTER
SPAN:
,
F
OI
POST SPACING._)-_
�
4
a
O.H.
OVERALL LENGTH: _-_
�
a
Z
I
I (/;50)
OVERALL LENGTH _1z o -- �
-�
POST SIZE: 4x/4
�
REAR SETBACK
SIDE SETBACK
-
(4'r4"
I
2000 P.S.1 CONCRETE —+N 1 FlNISH GRADE
FINISH GRADE
L_ JI
L_
J —' MIN. I T x I T FOOTING I I
IT BELOW GRADE L _ J
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE
OPEN LATTICE
VIA ONE /a" xSPATIO_I COVERS MAY BE ATTACHED TO AC SCREW FRAACER
THROUGH FASCIA INTO EACH TAIL
U -STRAP OR AN
3/8" if T LAG SCREWS INTO STUDS AT 16" O.C. NON -CORROSIVE
r—�CONTINUOUS LEDGER 7
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING
BUILDING DEPARTMENT APPROVAL BELOW
CITY OF LA Qk
A
BUILDING
❑& SAFEET.AP R® VFOR CONSTRU
DATE By
(4) 16d NAILS
OR BOLT
U -STRAP OR ANGLE
(4)- 16d NAILS
OR BOLT
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE
ANCHOR BOLT (EMBED —
7" MIN. INTO CONCRETE)
TYPICAL PATIO COVER
DATE OF APPLICATION
OWNER'S NAME
STREET ADDRESS
CITY. ST ZIP
TELEPHONE
H.OA. APPROVAL
RAFTER SIZE AND SPACING
ROOF PITCH
SPECIFY ROOFING AND SHEATHING OR OPEN LATTrE
(SEE ROOFING NOTE ON REVERSE)
--------------- - - - - --
%
CONTINUOUS LEDGER
(SAME SIZE AS RAFTERS)
HEADER SIZEPI
T' AND 'L' STRAPS
WITH I
�)
Z
I
(4) 164 NAILS OR BOLT I
/
RAFTER SPAN. `
—�---
Q
POST $PACING._10
O.H.
W
O.H.
--
OVERALL LENGTH:
4
O /
_
OVERALL LENGTH
POST SIZE:
REAR SETBACK
SIDE SETBACK
(4x4' MIN.)
/
I
2000 P.S.I CONCRETE —+I I F1N15M GRADE
fMrt$H GRADE
`—
J MIN. 1 T x 12" FOOT94G I I
IT BELOW GRADE L - J
NOTE
OPEN
VIA ONE LATTICE PATIO COVERS SCREW T BE ATTACHED TO EXIST*4G HROLIGH FASCIA INTO EACH FASCIA
TAIL.
3/8' x 5 LAG SCREWS INTO STUDS AT 15' O.0
/-- CONTINUOUS LEDGER
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING
BUILDING DEPARTMENT APPROVAL BELOW
CITY OF LA Q II�ITA�
BUILDING & SAF�E/ DEPT.
APRO V
FOR CONSTRUCTI `4
DATE_ By
U—STRAP OR AN
NON —CORROSIVE
(4)— 16a NAILS
OR BOLT
PROVIDE 1" CLEARANCE
BETWEEN POST AND
CONCRETE —�
U -STRAP OR ANGLE
(4)- 16C NAILS
OR BOLT
PROVIDE i" CLEARANCE
BETWEEN POST AND
CONCRETE
ANCHOR BOLT (EMBED —
7" MIN. INTO CONCRETE)
TYPICAL PATIO COVER
DATE OF APPLICATION
OWNER'S NAME
STREET ADDRESS
CITY. ST ZIP
TELEPHONE
H -OA APPROVAL
RAFTER SPAN TABLE
GRADING RULES
PS 20-70
(FEET & INCHES)
NOTES:
1. 32" RAFTER SPACING IS ALLOWABLE
FOR OPEN LATTICE PATIO COVERS ONLY.
2. FOR SOLID PATIO COVERS (NOT LATTICE)
RAFTER SPAN IS LIMITED TO 10'-0" USING
THIS STANDARD.
LATTICE ROOF BUILT-UP ROOF
--------------
HEADERS HEADERS
DOUGLAS FIR NO. 1 DOUGLAS FIR NO. t
51-7 SPAN
4r.4
j•_0"
4x6
8'_0.•
4x8
1 1'-0"
4x10
14'-0"
4x 12
17'-0"
6x8
14'-0"
6x 10
17'-0"
SIZE SPAN
4x4
4'-0"
4x6
6•_0"
4x8
8'-0..
400
10'-0"
4x12 12'-0"
6x8
600
14'-0"
�)UNNLLMENTAL NOTES:
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE BY.
ROOFING NOTES
A. BUILT-UP. ROLLED ROOF: SLOPE TO DRAIN.
B. ROCK ROOF: 311%1 2 MAXIMUM PITCH.
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(7 60) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner.
An. application—for- a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at _ 5306 5—)�y t LLA- R Z s3
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or -verify this information.
-d_ 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
1-2. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
i3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. i understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
/"'4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
32-=5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
5*'L'6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
risk.
P —7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot .legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
t8' I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held Liable for any
financial or personal. injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
�I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
I am aware of and consent to an.Owner-Builder building permit applied for in my name, and understand that I am the
arty legally and frnanciaHy responsible .for proposed construction activity at the following address:
I agree that, as the party legally and financially responsible for this proposed. construction activity,.l will abide by all
pplicable laws and requirements that govern Owner -Builders as well as employers.
2. I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information I
ave provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a License, the Contractors' State License Board may be unable to assist you with any financial loss .
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in'civil court. It is also
important for you to. understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property; you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuiing; the. permiL Note: A copy of the property owner's driver's.l'icerrsei form notanzatir n; or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner Date: OCL, 71 -20of
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, .the execution of which I understandis my personal responsibility, l hereby authorize
the following person(s) to act asmy agents) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required'to be presented when the permit is issued to verify the property owner's signature..
Property Owner's Signature: Date:
Bin #
City of [a Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
,-1
Project Address: 5-3 06P 5 104- VtLL,E
Owner's Name:
A. P. Number: 2 7 S-- _
Address: 300
Legal Description:
Contractor: �
City, ST, Zip: JA -A1 -1A- FE
Tele phone: o
e. S
P g.f/ 6
6 39 3
Address:
Project Description: 17� cc S AAJ
City, ST, Zip:
Telephone:
u
State Lic. # :
City Lie. #;
Q
Arch., Engr., Designer:
�' S^ 2 0: f
Address:
City, ST, Zip:
Q' b C� � -7 ZO
Telephone:
State Lic. #.
Construction tion T e: anc
Type: 0 Y•
D Occupancy:
Project type (circle one Acd' n Alter Repairair Demo
Name of Contact Person:
Sq. Ft.: 7-2) 0#
Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: G'
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
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 Chcck Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrica.l
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Develop -!r Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
%.
ted - i