05-5078 (AR)ry ,
P.O. BOX 1504
78.495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
• —8-00'0'5078
78590 FORBES CIR
604-221-001-43 -23268 -
ADDITION - RESIDENTIAL
LOW DENSITY RESIDENTIAL
17389
. T-,iht 4 4 Q"
Architect or Engineer:
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.: E FOOTAGE
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 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, 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.).
Imm's, 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 LicenseJLAw1.
1 _ 1 I am exempt under Sec. , B:&P.0 or his reason
I —,S 0
- CORSTRUCTION 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:
LQPERi1IIT
Owner:
EGGERS ROGER C
78590 Forbes Circle
LA QUINTA, CA 92253
Other struct info
Contractor:
Owner
DITION 2001/
Lic. No.: E FOOTAGE
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/30/05
p . C LQ
JAN 05 2006
CITY qF l A QUINTA
FWAPIOE DEPT.
2005
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
Co�or the performance of the work for which this permit is issued. My workers' compensation
I'll
carrier and policy number are:
Carrier / 1.00 Policy Number NO
Itcertify 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 shr
a subject to the workers' compensation, provisions of Section
3700 of the Labor Corthwith comply wi dse provisions.
t�Ob Applicant.WARNING: FAILURE TO SECURE WO PENSATION'CER E 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 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 information is correct.' I agree to comply with all
city and county ordinances and state laws relating to build!w7onstruction, and hereby authorize representatives
of this county to enter upon the above-mentioned properW fof inspection se
Application Number . . . . . 05-00005078
Permit . .
. . . . BUILDING PERMIT
Additional
desc . .
Permit Fee
. . . .
189.00
Plan Check Fee
122.85
Issue Date
. . . .
Valuation . . . .
17389
Expiration
Date
6/28/06
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
16.00
----------------------------------------------------------------------------
9.0000
THOU BLDG
2,001-25,000
144.00
" Permit
. . . ELECT - ADD/ALT/REM
Additional
desc . .
Permit Fee
. . . .
25.64
Plan Check Fee
6.81
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
6/28/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
304.00
----------------------------------------------------------------------------
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
10.64
Permit
. . . . . MECHANICAL
Additional
desc . .
Permit Fee
. . . .
39.50
Plan Check Fee
9.88
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
6/28/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00
9.0000
EA MECH
FURNACE <=100K
9.00
1.00
9.0000
EA MECH
B/C <=3HP/100K BTU
9.00
- 1.00
----------------------------------------------------------------------------
6.5000
EA MECH
VENT FAN
6.50
Permit
. . .
PLUMBING
Additional
desc . .
Permit Fee
. . . .
61.50
Plan Check Fee
15.38
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
6/28/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
3.00
6.0000
EA PLB
FIXTURE
18.00
1.00
15.0000
EA PLB
BUILDING SEWER
15.00
1.00
7.5000
EA PLB
WATER HEATER/VENT
7.50
1.00
3.0000
EA PLB
WATER INST/ALT/REP
3.00
LQPERAIIT
J
"F f
r
LQPERA1IT
Application Number . . . . .
05-00005078
Permit . . . . . . PLUMBING
Qty Unit Charge Per
Extension
1.00 3.0000 EA PLB
GAS PIPE 1-4
OUTLETS
3.00
----------------------------------------------------------------------
Special Notes and Comments
-------
304 sq. ft.CASITA ADDITION.December
30,
2005 7:39:30 AM jjohnson
----------------------------------------------------------------------------
Other Fees . . . . . . . .
ENERGY REVIEW
FEE
12.29
STRONG MOTION
(SMI) - RES
2.00
Fee summary Charged
---------------------------
Paid
Credited
Due
Permit Fee Total 315.64
--------------------
.00
----------
.00
315.64
Plan Check Total 154."92
.00
.00
154.92
Other Fee Total 14.29
00
.00
14.29
Grand Total 484.85
..00
.00
484.85
#
City of La Quinta
Building & Safety Division 56
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
�S�7�;uilding Permit Application and Tracking Sheet
Permit #
Project Address: -% a6
Owner's Name:
A. P. Number: �� - 2 2 _ �G _ L�' 3
Address: 2 0 pePS
Legal Description:
City, ST, Zip: 44 4pu/
Contractor: 0L,0N•e,2_ 134Ul Gw-e/
Telephone: -
Address: a{J v&S
,Project Description:
City, ST, Zip:
Telephone:
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip: k-A-
Telephone: 26 o - �2-7 2
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: '?o # Stories: # Units:
State Lic. #:
Name of Contact Person: G P� (� �,� S
Telephone # of Contact Person: %
Estimated Value of Project: 00
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal
Req'd
Rec'd
TRACKING. PERMIT FEES
Plan Sets
ZAtii!
Plan Check submitted Item
Amount
Structural Calcs.
Reviewed, ready fo corrections ,2 Plan Check Deposit
Truss Cafes.
Called Contact Pe son ii plan Check Balance
E rgy Calcs.
Z
Plans picked up VConstruction
Flood plain plan
Plans resubmitted I i Mechanical
Grading plan
2"" Review, ready for correctio s/issue Z �3 Electrical
Subcontactor List
Called Contact Person �L 3 iumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''" Review, ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
p(Atis Q6Woc(
8q(00< I -W S
10 PS5 D G- 1J F -Ib (L—
�A(o-- pV- r -Y-06
.SVd CIC7— <DK f -Y-"
78-590 Forbes Circle CITY OF LA QUINTA SUB -CONTRACTOR LIST C. Blankenship
ADDRE;8 PERMIT NUMBER OWNER'Roger Eggers BUILDER
an shat be posted on the job with the Building Inspection Card at All times In a coWs—nIcuous place. Only persons appearing on this list or their employees are authorized to work
job. ply changes to this list must be approved by the Building Division prior to commencement
ncement of work. Failure to comply .will result In a stoppage of work and/or the voidance aw::
-ding pe -nit. For each applicable trade, all information requested below must be completed applicant. 'On File is not an acceptabld response.
J
a.
X
TO
,Q_1f
Company Name
0
clowrleation Liceme Number
(e.g. A. R. C78) lXXXXX9.)
T W, u nee*..
Exp. Date Carder.Name May Number
(=Ixx/xxl (e.g. State Fund, CdComp) (Format Vanes)
Exp. Date
twxxlx.l
tune Number Exp. Date
(xXxx) lxxhmtJL4
**WORK 2') •
Owner
ttg� (q r,
C. Blankenship
B.C-61,D-30
610821
1-31-07
N//A
LING t. 6
-.
C. Blankenship
Owen's Contracting
C-36 C-54
517172
9-30-07
N/A
P ASTE f '35)
TBD
TBD_
i. P)-
Electrical Installation Co.
C-10 B
249022
8-31-07
State Comp
229-00-0018518
1-1-06.
1191 Z15
.71o6
TBD
RING I
TBD
ATION4(.-21,-
OJ Insulation Company
C-2*
783472
Virginia Surety Co.
ICW50180800 .3-15-06
%IN 83)
C. Blankenship
181416 Tucsm
Owen's Contracting
.JErs JC -f
TBD
No (C-12
J
a.
X
TO
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At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Detached Casita
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.24 X 304 S.F. or $680.96 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By OC/Washington Mutual Bank - Mr Eggers Check No. 710773711
Name on the check Telephone 772.7556
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected
Signature e
ilvrey Payment Recd
Al $680.96
NOTICE: Pursuant to Government Code Section 66020(d)(1), thig will serve to notify you that the 90 -day approval period in which you may protest the fees o
r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy -Accounting
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
C.
47950 Dune Palms Road
< BERMUDA DUNES O
Date
1/3/06
La Quinta, CA 92253
Cr RANCHO MIRAGE 0
INDIANWELLS
No.
27997
(760) 771-8515
d PALM DESERT
LA QUINTA y
°'�oINDIO
Owner
M/M Eggers
APN #
604-221-001
Address
78-590 Forbes Cir
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
Tract #
Study Area
Type
Detached Guest House/Casita No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1
78590 Forbes Cir
304 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Detached Casita
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.24 X 304 S.F. or $680.96 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By OC/Washington Mutual Bank - Mr Eggers Check No. 710773711
Name on the check Telephone 772.7556
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected
Signature e
ilvrey Payment Recd
Al $680.96
NOTICE: Pursuant to Government Code Section 66020(d)(1), thig will serve to notify you that the 90 -day approval period in which you may protest the fees o
r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy -Accounting