08-0816 (SOTB)#4 TIE
STEEL AT- 36" DIAM.
TOP COURSE
GAS. FIRE RING: NSIDE DIMENSION WATERPROOF
I.C. B.O. # MEMBRANE
ANSI #_�lh I3G�t"4 (TYP. INTERIOR
SURFACES)
BTU #4 BAR
U.L. APPROVED. VERT AT
32" O.C.
(TYP.)
7A
LENGTH OF GAS PIPE LF-•-
OR
DIAM. OF GAS PIPE ` �` 8x8X8 CMU
OUTDOOR FIRE RING SOLID GROUT
GAS LINES SHALL BE INSTALLED
PER CPC FOR DEPTH,
COVERAGE, AND PLACEMENT.
GAS SHUTOFF
VALVE
LOCATED
WITHIN 36"
OF UNIT
(TYP.) -
METAL GAS opa
RISER
GRAVEL
SUMP
O'FOOTING'='!'' 1 ROCK
I
OUTDOOR
r RING -BOULDERS
@ 11211=1
1-011
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tjht 4 4 4"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
rApplicatilin Number: J_ 08-000008161 Owner:
`Propei:ty Address: 81419 GOLDEN POPPY WY WOOD RESIDENCE
APN: 764-280-999-113 -300236- 81-419 GOLDEN
Application description: STRUCTURES OTHER THAN BUILDINGS LA QUINTA, CA
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 1000
POPPY WY
92253
Contractor:
Applicant: Architect or Engineer: TESERRA
P.O. BOX 1280
�. CO60)398- 22 92236
1760)39.:656
y� Lic. No.: 656128
LIC EN D 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 ofthe Busi and ofessionals Code, and my License is in full force and effect.
License Cla s: C C27 C29 License No.: 656128
. Date: Contractor:
NE -B ER -DECLARATION
I hereby affirm under penalty of perjury t am ex pt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business an o .ss
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).:
(_ 1 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 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 1 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: 5/08/08
WORKER'S COMPENSATION DECLARKION
I hereby affirm under penalty of perjury one of the following declarations:
1 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 SEABRIGHT Policy Number BB1080510
I certify that, in the *ast
of he work for which this permit is issued, I shall not employ any
person in any mab come subject to the workers' compensation laws of California,
and agree that, io e subject to the workers' compensation provisions of Section
700 of the Laball orthwith comply with those provisions.
Date1 .6 Applicant:
WARNING: FAILURE TO SECUR' C MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CAL ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS(S 100,000). IN ADDIST 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 i ormation is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin const uction, and hereby authorize representatives
of this cou �tyttto/e)�njter upon the above-mentioned propert is
npe tion purposes.
Date: l/.gnature (Applicant or Agent))
r
a
LQPERMIT
Application Number . . . . . 08-00000816
Permit . . .
BUILDING PERMIT
Additional desc . .
Permit Fee . . . .
25.00 Plan Check Fee
16.25
Issue Date
Valuation . . .
. 1000
Expiration Date
11/04/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
5.00 2.0000
----------------------------------------------------------------------------
HND BLDG 501-2,000
10.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . . .
15.75 Plan Check Fee
3.94
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
11/04/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 .7500
----------- ----------------------------------------------------------------
PER ELEC DEVICE/FIXTURE 1ST 20
.75
Permit
PLUMBING
Additional desc . .
Permit Fee . . . .
18.00 Plan Check Fee
4.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
11/04/08
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
FIREPIT, GAS & ELECTRICAL
STUB OUT,
WATER & ELECTRICAL STUB OUT PER APPROVED
PLAN.
Fee summary Charged
---------------------------
Paid Credited
--------------------
Due
Permit Fee Total
----------
58.75 00 .00
58.75
Plan Check Total
24.69 .00 .00
24.69
Grand Total
83.44 .00 .00
83.44
Bill #
City of La Quinta
Building & 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: _!9 QQQ�mZ fYDDFy W"
Owner's Name: 19
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Tele hone:W
'
Address: 96,-100 AV&7 _5q
Description:
City, ST, Zip: ZZ3 6
Telephone:
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: J isL
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: ?
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
5/�
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
2°d Review, ready for correcti n .ssue
8
Electrical
1 ?�
Subcontactor List
Called Contact Person
Plumbing
— po E2J
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`d 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