13-0923 (SPIN)1 �
P:O. BOX 1504 4^ VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA.QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/24/13
Application Number: 13-00000923 Owner:
Property Address: 78360 HERITAGE WY CARRINGTON REAL ESTATE SERVICE
APN: 643-170-999-39 -31348 - LA QUINTA, CA 92253
.Application description: SPECIAL INSPECTION (
Property Zoning: LOW DENSITY RESIDENTIAL ---------------------------------
Application valuation: 0 a
Contractor: D e
.Applicant: Architect or Engineer: Owner- A 201
JUL 2
�&,l'\ ---------------'------------
1 WY OF LA QUINTA
NFINANCE DEPT,
LICENSED. CONTRACTOR'S DECLARATION
I heretiy effirrn under penalty of, ;perjury 'that I am licensed under provisions of Chapter 9•(commencing with
Section 7000) of Division 3 of the. Business and Professi k COrfe—d5d-my License is in full force'and effect.
License Class:, Ucense,No.:
Date: Contractor:
OW NER-BUILDER: DECLARATION
I hereby affirm under penalty ofperjury that I am'exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Businessand.Professions Code: Any city;or county thatrequires a permit -to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also- requires the applicant for the:
permit.fo,file a signed, statement that,he or she is'licensed pursuant to;tfie 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 orshe 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, 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,Lioense Law does novapply to an owner of property who builds orimproves 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:orrimprovement is sold within
one year of�completion, the owner -builder will have the,burden;of provingthat..he or she,did not build or
improve for the:'purpose of. sate.).
1 _ 1 I, as owner of the propertyi am exclusively contracting with licensed contractors to constructthe project (Sec.
7044, Business and Professions Code:: The Contractors' State License Law does not apply town owner of
propertywho builds or improves thereon,, and who contracts for the projects with a contractor(s) licensed
pursuant tothe'Contractors' State. License Law.).
1 _) Lam exempt under Sec. B.&P,C..for, this• reason
Date:, Owner:
CONSTRUCTION G' ENCY
I hereby, affirm under penalty of perjury that there is a con aro le di ,agency for the_ performance of, the
work: for which this.permit is issued (Sec. 3097, Civ..C.).
Lender's,Name: - _
Lender,'s'Address:
LQPEIUIIT
WORKER'S • COMPENSATION DECLARATION
I hereby'affirm'under, penalty of perjury one of the following'dolaiations:
_ I have and will maintain a certificate of; consent to self4nsure 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.
rcertify
ill maintain workers' compensation insurance, -as required bySeaion3700 of the Labor
the:performance of theworkfor which.this permifis issued. My workers' compensation_
carrier and policy number are:
Carrier i yNumber
, imthe perfo an of ork for which this permit is issued, I shall:noremploy any
any.manner as o c e;subject to the workers' compensation laws otCalifornia,
,thet; if Lsli ub' ct.fo the workers' compensation provisions of Section
A 370oof the Labor Cod Is
h ithcomply w) ose provisions.
Date:' ` Applicant:
WARNING:' FAILURE TO�SECURE WO MRS' MPENSATION COVERAGE IS UNLAWFUL, AND SHALL.
SUBJECT AN 'EMPLOYER TO CRIMINAL PENAL Its AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (8100,000). 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'thjs application is made, each persomat whose,request.and for
whose benefit workis performed under or pursuant to any.permit'issued asa result of this application;
the owner,, and the applicant, each, agreesto,.and shall defe emnify.and hold harmlesstheCity
of La Quints; its officers, agents and employees for arty oro ission related to the work being
performed. under or following issuance of this permit.,
2. Any permit;issued as.a result of -this epplicstio becam s ull and void if•work is not commenced
within 180 days from date;of issuance -of su rmi , cessation of work for 180 days will subject
permit cancellation.
I certify that I have read this application and state, that t i or ation.is correct.
.1 agree to complywith all
city and coup ordinances -and state laws relating to buil ' u n,. end hereby authorize:representatives
of this cc my o tet upon the above=mentioned prope„- r t purposes.
Date:° fr tiV VN Signature (Applicant or Agent):
^l
Application Number 13-00000923
Permit . . . SPECIAL INSPECTION
Additional desc
Permit Fee . . . . 71.50 Plan Check_ Fee 00
Issue Date Valuation . . . . 0
Expiration Date . . 1/20/14
Qty Unit Charge Per Extension
1.00 71.5000 EA MISC SPECIAL INSPECTION 71.50
----------- ------------ -------------------------------------------
Special
-- ----
Special Notes and Comments
SPECIAL INSPECTION - INSPECTION FOR IID
RELEASE.
Fee summary Charged Paid Credited Due
Permit Fee Total 71.,50 .00 .00 71.50
Plan Check Total .00 .00 .00 .00
Grand Total 7.1:50 .00 .00 71.50
LQrERMrr
Bin #
CityOf Qulnta
Budding 8r SafetyDiidsion
P.O. Boz. 1504, 78-495 Calle Tampico
La Quinta, CA 92253- (760) 777-7012
Building Permit Application and Tracking Sheet
Permit
Project. Address:
Owner's Name:
A -P. Number.
Address: 36 0
Legal Description:
City, ST, Zip:
Contractor:
Telephone: % - c
Address:
ProjectDDeseription:
City, ST„Zip:
C! i
Telephone:
State Lic. #: City Lic. k
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 ContactPerson: VAft,—"
Sq. Ft:;
# Stories:
# Units:
Telephone # of Contact Person: -
Estimated'' Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Set
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed,,ready for corrections
Plan Che&Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance •
T do 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°!Aeview, ready for correctioustissue
Electrical
SubcontactorList
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
kd Review, ready for eorrectiong/issue .
Developer LnpactFee
Planning Approval
Called'Contact Person
A.IP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Totat,Permi(Fees