BSPN2014-003178-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: BSPN2014-0031
Property Address: 78155 CALLE FORTUNA
APN: 770155002
Application Description: WORK CONDUCTED WI
Property Zoning:
Application Valuation:
Applicant:
CHRISTIAN NOIROUX
78155 CALLE FORTUNA
LA QUINTA, CA 92253
To � D VOICE (760) 777-7125
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/9/2014
Owner:
CHRISTIAN NOIROUX
78155 CALLE FORTUNA
FERMIT/C9ODELA QUINTA, CA 92253
C I 01DEPW-MEta
Com MUMI f DEVE►A Contractor:
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 Professions 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.).
(_) 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.).
(� I am exempt under Sec. B.&P.C. for this reason
Date: .1 wner:
CONST CTION LENDING A
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:
Llc. No.:
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:
Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALLSUBJECT 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 Building Official 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 building
construction, and hereby authorize representatives of this city to enter upon the above.
me Ione property for inspection purposes.
Date: Signature (Applicantr Agent):
Bin #
Permit #
Project Address: 7g S f
City of La Quinta
-Building 81: Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777 7012.
Building Permit Application and Tracking -Sheet
7v^ eL Owner's Name: Q f ST/ �v Ivo 4 uA Le,,17-e
A. P. Number:
TRACKING
Address: 7 g f j',('
Legal Description:.
City, ST, Zip: 6a 3
Contractor: OG�NC�
[ �UJfi
Telephone:
a.•.
Address:
oo
Project Description:
City, ST, Zip:
Plan Check Deposit
Telephone:
Truss Cala.
State Lic. # :
City Lie. #;
Arch., Engr., Designer.
Address:
N
Construction
City., ST, Zip:
Flood plain plan
Telephone:
Plans resubmitted
Construction Type: Occupancy: Q�p.
itatc Lic. #:
Grading plan
Project type (circle one): New Add'n Alter Repair Demo
lame of Contact Person: t,' CS 7' /,1 N 4/o / tl UK
Sq. Ft.:'
# Stories:
# Units:
Celephone # of Contact Person:
Estimate4.,Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal
Rcq'd
Rcc'd
TRACKING
PERMIT FEES.
Plan Sets
Pian Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance.
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
tad Review, ready for corrcctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
I-Y.O.A. Approval
Plans resubmitted
Grading
IN IfOUSE: -
1rd Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue.
School Fecs
Total Permit Fees
DESCRIPTION .
FINANCIAL •R
ACCOUNT `
•
QTY
AMOUNT
PAID
PAID DATE
SPECIAL INSPECTION
101-0000-42404
1
$72.52
$72.52
10/9/14
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
CALLE FORTUNA TRUST
CHECK
R1903
1009
MFA
DESCRIPTION :..
- ACCOUNT
QTY;
AMOUNT , ..
PAID
PAID DATE
SPECIAL INSPECTION PC
101-0000-42600
1
$181:29
$181.29
10/9/14
:-. PAI0.6Y
METHOD, : _
RECEIPT #
-CHECK #
CLTD BY
CALLE FORTUNA TRUST
CHECK
R1903
1009
MFA
Total Paid forCOMPLIANCE SURVEY/SPECIAL INSPECTION:
TOTALS:
$253.81
$253.81
Description: WORK CONDUCTED WITHOUT A PERMIT/CODE CASE
Type: SPECIAL INSPECTION Subtype:
Status: SUBMITTED
Applied: 10/9/2014 MFA
Approved:
Parcel No: 770155002 Site Address: 78155 CALLE FORTUNA LA QUINTA,CA 92253
Subdivision: DESERT CLUB TR UNIT 1 Block: 6
Lot: 2
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $0.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
CHECK #
Details:
PAID BY
CLTD.
ADDITIONAL SITES
FINANCIAL•R
•
l DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD.
BY
SPECIAL INSPECTION
101-0000-42404
1
$72.52
$72.52
10/9/14
R1903
1009
CHECK
CALLE FORTUNA
MFA
TRUST
SPECIAL INSPECTION PC
101-0000-42600
1
$181.29
$181.29
10/9/14
R1903
1009
CHECK
CALLE FORTUNA
MFA
TRUST
Total Paid forCOMPLIANCE SURVEY/SPECIAL INSPECTION: $253.81 $253.81
Printed: Thursday, October 09, 2014 12:27:24 PM 1 of 2
SYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
FINAL**
Printed: Thursday, October 09, 2014 12:27:24 PM 2 of 2
SYSTEMS