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07-0138 (SOTB)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T,dy 4 4 Q" Application Number: 07-00000138 Property Address: 61063 IRE_B- - REL DR APN: 764-280-999-67 -300235- Application description: STRUCTURES OTHER THAN BUILDINGS Property Zoning: MEDIUM HIGH DENSITY RES Application valuation: 6000 Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that 1 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 Cl s: 53 License No.: 866518 Date; Contract 'r OWNER -BUILDER DECLARATION I hereby affirm der 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.). (_) 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 1 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 Owner: STEVE BALMUTH 61-063 FIRE BARREL LA QUINTA, CA 92253 ( VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/16/07 Contractor: GARY & SONS PFFZ::6 67657 CLUBHOUSE DRIV DESERT HOT SPRINGS,(760)251-8945 AN 1 9007 Lic. No.: 866518 L I OF LA -U NI A.- __ 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 STATE FUND Policy Number 1837911-06 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 bec a subject to the workers' compensation provisions of Section 3700 of the Labor Code, forthwith comply with those provisions. bate: 3 ,� nt: WARNING: FAILURE TO SECURE W RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIM AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDIT N TO THE COST OF 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 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 ' formation is correct. I agree to comply with all city and county ordinances and state laws relating to build' g trusion, and hereby authorize representatives off t�his,c/�o1�u t enter upon the above-mentioned prope r' spection purposes. Date: -1% 6 Signature (9pplicantor Agent): Application Number 07-00000138 y Permit BUILDING PERMIT Additional desc ., Permit Fee . . . . . 81.00 Plan Check Fee 52.65 Issue Date . . . . Valuation 6000 Expiration Date 7/15/07. 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 7/15/07 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 .7500 -----------------------------------------------`----------------------------- PER ELEC DEVICE/FIXTURE 1ST 20 2.25 Permit . . . PLUMBING Additional desc.. . Permit Fee . . . . 18.00 Plan Check Fee 4.50 Issue Date . . Valuation . . . . 0 Expiration Date 7/15/07 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special Notes and Comments BBQ/FIREPIT PER APPROVED PLAN. Fee summary Charged ----------------- Paid Credited Due ---------- Permit Fee Total ---------- .116.25 --------------------- .00 .00 116.25 Plan Check Total 61.46 .00 .00 61.46 Grand Total 177.71 .00 .00 177.71 LQPERMIT 389 � Fi¢f�ir By SSP. '�+ cRM cr,pq- 1,,'011 01vQ ( &,6 IA) 0 Y.6 Bi" # City of La Quinta Building a Safety Division P.O. Box 1.5041 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit'# Project Address: rG �-/� Owner's Name: A. P. Number: '51--eynV Address: 06 3 L Legal Description: City,'ST, Zip: Contractor: n Telephone: Address: (1b ' �S �� . ProjectDescription: City, ST, Zip:b S P,10 Telephone '7 .� - SMon State Lic. # : S City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Construction Type: `✓ Occupancy: Project type (circle one): New. Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person:Estimated Value of Project:' Q ()00 • Uv APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACK NG PERMrr FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. .x Reviewed, ready fo oFrectiona Plan Check Deposit Truss Calcs. Called Contact Person IZ Plan Check Balance Energy Calcs. Plans picked up Construction OT f5 Flood plain plan Plans resubmitted Mechanical Grading.plan god Review, ready for correctionstissue Electrical FIXYJQ�S Subcontactor List Called Contact Person Plumbing OU (�Y Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted r g O IN HOUSE:- ''' Review, ready for. corrections/issue A"MrM& S, WETY DEP Planning Approval Called Contact Person I.P.Y. A Pub. Wks. Appr Date of permit issue School Fees DA Total Permit Fees AAF&aep Few a6m1f� i4PB•,l/.orvc6S 3� Gas aPJR Sizes �k%qi grrr rvs >FS 4J/rClaEt FB/d� S'f�K otl�P/v�rlBiat� � -SE•cA2EC ,t&T Slyd"A&