13-0710 (SOTB)r r
4 4a
P.O. BOX 1504 "® VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/10/13
Application Number: 13-00000710 Owner:
Property Address: 81290 GOLF VIEW DR SHANNON HEARN
APN: 762-390-013- - - LA QUINTA, CA 92253
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 10000 O
Q
Contractor:
Applicant: Architect.or Engineer: COMMON GROUND SWIMMING POO
72877 DINAH SHORE DR 4103- 72 I
Ifs RANCHO MIRAGE, CA 92270I C,rY . &N%3 \ (760)799-9174 Q�
00 Lic. No.: 745278 F�NA,V Fop/Tri /
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License—Class: D06 C53 Ar Licens� 78
Date:/1-3_
Contracto .
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).:
(_ 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.).
(_ I 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 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:
1.QPF%II IT
WORKER'S COMPENSATION DECLARATION
1 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 EXEMPT Policy Number EXEMPT
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 wXkers' compensation provisions of Section
3700 of the Labor Code, hall forthwith com y with those pr inions.
�f ID
App
lica_
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. `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 property f r inspection purposes.
D. aie:gi ��y / Signature (Applicant or ei
tfi�9 jby r
Fl- a
I- I Application Number . . . . . 13-00000710
Permit . .
. REMODEL 2013
Additional desc .
.
Permit -Fee . . .
. 143.00 Plan Check
Fee
.00
Issue Date . .
Valuation
0
Expiration Date
12/07/13
Qty Unit Charge
Per
Extension
1.00 143.0000
EA MISC.FIREPLACE
143.00
----------------------------------------------------------------------------
Special Notes and
Comments
FIREPLACE (KIVA) PER
ENGINEERED PLANS
AND 281611LF OF GAS
LINE. 2010 CALIFORNIA
BUILDING CODES.
----------------------------------------------------------------------------
Other Fees
. . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, REMODEL
214.50
Fee summary
-----------------
Charged Paid Credited
------------=---------------------------
Due
Permit Fee Total
143..00 .00
.00
143.00
Plan Check Total
.00 .00
.00
.00
Other Fee Total
215.50 .00
.00
215.50
Grand Total
358.50 .00
.00
358.50
LOPE"11T
RE,
...OLIN IN 0S.2013
Bla #
OtY Of. b Who cil Y k
-Bu11d1ng&,.S3reiyDivision COMMUNITY DEVEL
P.O. Box 1504,78-495 Calle Tampico
LaQuinta, CA 92253 -:(760) 777-7012
Building Permit -Application and Tracking Sheet
ME
Perm lt #
Project.Address:
44
Owner's Name: .
A. P. Number.
Address:
Legal Description:
City, ST, Zip:
Contractor.
Contracto
telephone: rw
Address:
Project Description:
Pmj
City, ST, Zip:
Telephone: 741
9,2-9 7/9.
'1 l
clI pt)� A
State Lic. # :
,R.�o I City Lic.
Arch., Engr., Designer. 6L
Address:.
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'a. Alter Repair Demo
Name of Contact Person. <&&,)
Sq. Ft.:
# Stories:
nits;
Telephone # of Contact Person: -
Estimated Value of Poject:)e1b"
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Reqld
Reed
TRACMG PEPJ4rr FEES -
Pian Sets
Plan Check submitted item Amount
Structural Calm
Reviewed, ready for corrections Plan Check Deposit.
Truss Cales.
CAIJcd Contact Person Plan Check Balance.
Title 24 Calci.
Plans picked up Construction
Flood plain plan
Plans resubmitt.ed Mechanical
Grading plan
2'! Review, ready for correctionstissueEltenical
Subcoutactor List
..... .....
Called Contact Person 11 Plumbing
4
Grant Deed
4EI
Plans picked up SALL
S
K.O.A. Approval
Grading
Plans resubmitted G
1T( HOUSE:-
Review; ready for correctionslissue Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit Issue
School Fees
1.32�x nx: I A g- 11N rA
Total Permit Fees
S-4EEly DE
APPROVED.
FOR CONSTRUCTION
DAM By
SIT
CITY OF LA QUINTA'SUB-CONTRACTOR LIS
JOB ADDRESS PERMIT NUMBER OWNER BUILDER�"
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized t
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building Dermit. For each aDDlicable trade. all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade /Classification
Contr actor, :.::..::.:::..:•....,..State::ContractorsLicense :.......:.
Wotkeis Com e'lsation:rsurance: `-6.City
4
Business License`:{:::::
.
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, Calcomp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp, Date
Ixx/xx/xxl
EARTHWORK (C712)
CONCRETE (C-8.)':-.'��--t-
FRAMING .(C-5) .
STRUCT. STEEL (6-51)
�1
Al
MASONRY (C•291
�f c
2pp
l
PLUMBING (C-361
a
A
34&7 b S
A R
d/
LATH; PLASTER (0-35)
DRYWALL (C-9).::,.
HVAC. (C-201'
ELECTRICAL. (C=10)
ROOFING` IC.=
:SHEET -METAL
FLOORING lCr:151:.
GLAZING (C-17)
INSULATION' (C72).w
SEWAGE DISP (C-421'`:
PAINTING (C-33)'-:
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C=27).-:,"',
POOL (C-53)