08-1651 (SPIN)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 08-00001651 Owner:
Property Address: 52330 AVENIDA HERRERA ROB STEGMAN
APN: 773-264-004-19 -000000-
Application valuation: 100
Contractor:
Applicant:®� Architect or Engineer: RIVERSIDE DEVELOPMENT
CC//nA 7138 FOXCRSIDE, CA ST
92
RIVERSIDE, CA 92506
(951)334-9657
Lic. No.: 830748
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 Professionals Code, and my License is in full force and effect.
License Class: 13 License No.: 830748
Dater- f 24 Contractor: ✓� �( L
OWNER-BUILDE 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 _ 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 _ 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 riot apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractorls) 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:
LQPERMIT
WORKER'S COMPEN:
I hereby affirm under penalty of perjury one of the following a-...., -
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3706 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
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 forthwik comply with those provisions.
-Date:/0-/'408 (:-Applicant: G
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIONAVERAGE 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.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/01/08
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 1 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 hereb authorize representatives
of this county to enter upon the above-mentioned property for inspe on purposes.
Date: /0-l"'06 Signature (Applicant or Agent):
Application Number
. . . . . 08-00001651
Permit
SPECIAL INSPECTION
Additional desc .
Permit Fee
100.00
Plan Check Fee
.00
Issue Date
Valuation . . .
. 100
Expiration Date
3/30/09
Qty Unit"Charge Per
Extension
BASE
FEE
100.00
Special Notes and
-----------------------------------
Comments
SPECIAL INSPECTION
TO FINAL HOUSEO�p�?D/.3
Fee summary
Charged
Paid Credited
Due
•Permit.Fee Total
100.00
.00 00
1.00.00
Plan Check Total
.00
.00 .00
.00
Grand Total
100.00
.00 .00
100.00
" LQPERMIT
09/18/2008 THU 16:54 FAX La Quinta Builcling/Safty
Z001/001
Bin #
City of La Quinta
Building a Safety Division
Permit # P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: 5 2.330 Owner's Name:
A. P. Number: rSZ6
Address:
Legal Description:
City, ST, Zip: c we
Contractor
Telephone: (
Address:
Project pti
-City, ST, Zip: CA -
Telephone: Gist -
- State Lic.#- 910-7146
Arch., Engn, Designer:
City Lic.
Address:
City, ST, Zip:
Telephone:
State Lic. 4:
ConstructionType: Occupartcy.
Project type (cjrtjc one) -. New Aad'a Alter Repair Demo
—T#Units:
--Name of Contact Persom'
Sq. Ft_: IN stories:
Telephone #-of Contact Person:
Submittil Req1d
Plan sets
Estimated Value of Project:.
APPLICANT: DO NOT WRITE BELOW THIS LINE
PE"
Recd TRACHING pEpj%AU FEES
Plan Check submitted Item Amount
I CRIcs.
Structural
t
Reviewed, ready for Plan Check Deposit
r corrections - _p
rrkcchanical
Truss Calts.
Called Contact Person Pisa Check Balance
Energy CaIcs.
i
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
24 Review, ready for cortrectionslissue Electrical
Subcontactor List
Called Contact Person Plumbing
GrantDeed
Plans picked up S.M.T.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
Review, ready for correctionslissue—_1 Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue.
School Fees
Total Permit Fees