06-0358 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant: .
06-OOnnn'cQ
7815E
770-1
PLUME
LOW I
Tilq.4 4Q"
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 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.).
(_) 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.).
( ) I am exemptunderSec. , B.&P.C. for this reason
Date: D-r`� 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: 1/24/06
Owner:
RUSSELL SIDNEY & LARRY
78-155 CALLE FORTUNA
LA QUINTA, CA 92253
---------------------------------
Contractor:
Owner
----------------------------------------------—
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
�o 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 forth 'th comply ith those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORK RS' 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 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. 1 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 prope g for inspection pur oses.'
Date:—2� Signature (Applicant or Agent)'
Application Number . . . . . 06-00000358
Permit PLUMBING SEWER
Additional desc .
Permit Fee . . . . 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 3000
Expiration Date 7/23/06
Qty Unit Charge Per
Extension
BASE FEE
----------------------------------------------------------------------=-----
30.00
Special Notes and Comments
SEWER HOOK-UP/SEPTIC ABANDONEMENT
Fee summary Charged Paid
Credited
Due
----------------- ---------- ----------
Permit Fee Total. 30.00
I ----------
.00
----------
.00
30.00
Plan Check Total .00
.00
.00
.00
Grand Total 30.00
..00
.00
30.00
I
t
,a
LQPERMIT
f
Received From: l
Address:
ACHELLA VALLEYA7E8 DISTRICT CASH RECEIPT DETAIL . 1x.223 ,
Date.
�� 07.
(rl 7 C
Account No.
Lots) Tract
`
Service Address - %
- GA. Code
❑ Meter(s)
❑ Service(s)
❑ Backtiow(s)
❑ House Lateral(s)
❑ Detector Check(s)
❑ Meter Surcharge
❑'lankation Capacity Charge
❑ W.S.B.F.C.
❑ S.I.W.S.C.
❑ Temporary Construction Meter
❑ Tum on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check .Fees Water / Sewer -
Tract -
❑ Bond Payment- A.D. - Bond
Assort
❑ Customer Deposit
❑ Other
TOTAL 3_,
Remarks:
spy to:
Cash Water Service
Check - L .ti
/
Money • ` Cashier
Order CVWD-438 (1/05)
aV 3
I
APPUCANt:
DO NOT WRITE"BELOW-THIS UNE
Bin # `
Permit #
City of La Quinta
Building U Safety Division
P.O. Box. 1504, 78-495 Calle Tampico
La Quinta, CA 92253 -.(760) 777-.7012
Building Permit Application and Tracking Sheet
Project Address:'.Owner's
Name: Y - _5P (11 a SS c t -L
A. P. Number:
Address: S .66 C
Legal Description:
Contractor:
City, ST, Zip: Z�
Telephone: ,,, "•
Address:
Project Description:
City, ST, Zip:
P
Telephone:
State Lid. # :
Arch., Engr., Designer:
City Lie. #:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Construction Type: Occupancy;
Project type (circle one): New Add'n Alter 'Repair Demo
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Pro` xg
Flood plain plan
APPUCANt:
DO NOT WRITE"BELOW-THIS UNE
#
Submittal
Plan Sets
Req'd
Recd.
TRACMG • PERMrr FEES
Plan Check submitted . Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss'Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans. picked, up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading.plan"
21' Review, ready [or correctionsrssue
Electrical
Subcontactor List
Caned Contact Person
Plumbing"
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctioWissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date orpermit Issue
School Fees
Total Permit Fees