07-1819 (SOTB)P.O. BOX 1504 4 4
Qum&
78-495 CALLE TAMPICO
LA QUJNTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 07-00001819
Property Address: 78421 DEACON DR W
APN: 770-210-019- - -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2500
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I a 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.
LicenseClases::C8 C27 C29 LicenseNo.: 656128
Date:L'" ontractor:
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 _ 1 I, as owner of the property, or my employees with wages as their sale 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 _ 1 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 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
Owner:
TRADITION LOT 5
78-421 DEACON DR W
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/21/07
Contractor:. rI
TESERRA AN 21
P.O. BOX 1280
COACHELLA, CA 92236 ��
(760) 398-9222 Cljy®pl�IPLA
Lic. No.: 656128
------------------------------------------------
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 SEA3RIGHT Policy Number BB1070510
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 b come subject to the workers' compensation laws of California,
and agree that, if I should be subject to the workers' compensation provisions of Section
3//7700 of the Labor Cod , sh 11 hwith co ply with those provisions.
Date: !T'�Applicant:
WARNING: FAILURE TO SECURE WO ERS' 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. I agree to comply with all
city and county ordinances and state laws relating to building cons uction, and hereby authorize representatives
of this`co/u/�rJ'ty/t{o' en7te�r upon the above-mentioned property �p tion purposes.
}
Dale: I y / G elignature (Applicant or Agent):
Application Number
. . . 07-00001819
Permit . . . BUILDING
PERMIT
Additional desc .
` Permit Fee . . . .
54:00 Plan Check Fee
35.10
Issue Date . . . .
Valuation . . .
. 2500
Expiration Date
12/18/07
Qty Unit Charge
Per
Extension
BASE.FEE
45.00
1..00 9.0000
------------------------------------------------------
THOU BLDG 2,001-25,000
----------------------
9.00
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . .
15.75 Plan Check Fee
3.94
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
12/18/07
Qty. Unit Charge
Per
Extension
BASE FEE
15.00
1.00 .7500
PER ELEC DEVICE/FIXTURE 1ST 20
.75
---------------------------------------------
Special Notes and Comments
-------------------------------
COURTYARD WATERFEATURE
PER APPROVED PLAN
Fee summary Charged
Paid Credited
Due
---------------------------
Permit Fee Total
------------------------------
69..75 .00 .00
69.75
Plan Check Total
39.04 .00 .00
39.04
Grand Total
108.79 .00 .00
108.79
11
LQPERMIT
Bin #
City of La Quinta
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 #
Project Address: ,V� A) DR
Owner's Name:
A. P. Number:
Address:
Legal Description:
Contractor:
City, ST, Zip:
Telephone:
Address: 0 9 O • ' 2-5(p
Project Description:
City, ST, Zip: e oA-c1• L1-4 CA 7i3 (a
P
Telephone: 5( — L Z Z
State Lic. # : City Lic. #:
Arch., Engn, Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person: `JSL N,4tJL>GZ
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:(
Estimated Value of Project:E::2: QQ
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
1
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Constructs
Flood plain plan
Plans resubmitted
anica
Grading plan
2nd Review, ready for corrections/issue
Elect 1
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
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
r