11-1353 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&tr 4 44"
Application Number: 11=00003353y
Property Address: ,� 6.1'2-7-5-�FfiRE�'`BARREL DR
APN: 764-280-999-131 -300235-
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 7800
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
PIP
-----------------=------------------ r---—
Wsd
ED CONTRACTOR'S DEC TIONI,
I hereby affirm under penalty of perjury licensed under rovision f hapten (commen ng with
Section 7000) of Division 3 of the Busirofessio Is ode, and icen e i in full for and effect.
LLii/cyennnsee j;lasss:. C27 Lic se No.: 794
/date!/ �iJl /� Contractor: 0 ,4
r OWNER -BUILDER DECLARATION
I hereby a irm 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).:
(_ I 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 1, 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/21/11
Owner:
JIM & JAN KEATING
61275 FIRE BARREL DRIVE
LA QUINTA, CA 92253
Contractor: 1 i
ARTISTIC LANDSCAPE ,� C . 20 20
78206 VARNER RD, #D: -M 244 }4
PALM DESERT, CA 92211 rte"
11 0, �aCS.",:�iEbvd,la
(760)360-1:39.5 F
LiC. NO.: 379421
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 work rs' compensation
insurance carrier and policy number are: .
Carrier DELOS INS CO Policy Number 04DKRM1200 5 4
I certify that, in the performan f the work for w ich this per it is i u , I sh II not employ any
person in any manner so a t become subject the worke ' co p satin laws of California,
and agree that, if I shoul b ome subjy,(;�` tot workers' mp ns ion pr isions of Section
3700 of the Labor Cod . I hall forthWUS co Iv with th vi ons.
WARNING: FAIWRE TO SECUROrWORKERS' 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 THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.-
APPLICANT
EES:
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 no mmenced
within 180 days from date of issuance of such permit, or cessation of work for 1 ays will subject
permit to cancellation.
I certify that I. have read this application and st a hat the above information i corre I a o comply with all
city and county ordinances and state laws rel in to building on ruction, a her y a o ze representatives
of is c my to nter upon the above -men ' n property f in coon p p se
//}�,,tttfi {9 //fie r J
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Application Number . . . . . 11-00001353
Permit BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 15.00 Plan Check Fee
9.75.
Issue Date . . . Valuation
3.72
Expiration Date 6/18/12
Qty Unit Charge Per
Extension
BASE FEE
----------------------------------------------------------------------------
15.00
Permit ELEC=MISCELLANEOUS
Additional desc . .
Permit Fee . . . . 18.00 Plan Check Fee
4.50
Issue Date . . . . Valuation . . .
. 0
Expiration Date:. 6/18/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
4.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
----------------7-----------------------------------------------------------
3.00
Permit ... . PLUMBING
Additional desc .
Permit Fee . . . . 18.00 Plan Check Fee
4.50
Issue Date . . . . Valuation . . .
. 0
Expiration Date 6/18/12
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
12 L.F. 5' MASONRY FOUNTAIN, 7 L.F. 4'
AC ENCLOSURE, 4 ELECTRICAL OUTLETS, GAS
LINE TO FIRE PIT & FIRE BOWL AT FOUNTAIN
& TO BBQ. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
.98
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 51.00 .00 .00'
51.00
Plan Check Total 18.75 .00 .00
18.75
Other Fee Total 1.98 .00 .00
1.98
Grand Total 71.73 .00 .00
71.73
LQPERMIT
Bin
City of La Quin to
Building at Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253.- (760),777-7012
Building Permit APPlication and Tracking Sheet
Permit #
I i3�3l
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Project Address:�->
Owner's Name: � yyl
A. P_ Number:
Address: '� ) Z7 Y 1 -y-L Y
Legal Description:
; City.; ST, Zip: Z n l at
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Contractor: ` , o
�lS�l L L-/ S
•:::.,.:.:.
T6Iephone: u J : �'�a•`^
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Address: Z d.6 vaC✓�
City, ST, Zip: G( �1/y) n��,/� c -off 7-2-1
Project Description:
10,Zt vl . �Z -7Y lti�
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Telephone:
/%7
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State Lic. # : Z City Lie.
Arch., Engr., Designer.
Address:
692,
A C_ LlLi
City, ST, Zip:
Telephone:..;"?sa�
State Lic. #: 7 N Z/��,u/4fcYyrf;
Name of Contact Person:2�
.Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft: #Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project DU
APPLICANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cities.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cities.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plata plan
Plans resubmitted
Mechanical
Grading plan
Subcontactor List
2"' Review, ready for corrcctionsrssue
Called Contact Person
Electrical
Plumblag';
•
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/inue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
ETotalPermit
Fees
ED
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