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07-0647 (SOTB)CA P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: 07-00000647 81195 LEGENDS WY 762-310-012- (Tf4ih, tt 4 STRUCTURES OTHER THAN BUILDINGS LOW DENSITY RESIDENTIAL 5000 Architect or Engineer: �IA BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: KENNETH MEADOF 81195 LEGENDS LA QUINTA, CA Contractor: VICTORIA LANDS 53725 AVENIDA LA QUINTA, CA (760) 777-1'417 Lic. No.: 801813 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/01/07 ------------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License_jassi C27 C53 r1 (, __Wcense�No.: 801813 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is OWNER -BUILDER DI CLARAT I hereby affirm under penalty of perjury that I am exempt from the Contractor' ate License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or ou y that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issua 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 Codel 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 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: P Ip LQPERMIT 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 -I 3700 of the Labo e, I s I o``�lcomply i�h these provisions. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERA IS WFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP NE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATI ; DA AGES AS PROVIDED FOR IN SECTION 3706 OF, THE LABOR CODE, INTEREST, AND ATTORNEY'S ES. 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 t wilding construction, and hereby thorize representatives of ,Pdthi�cy ter upon th above-mentioned pr a or i s ecti rppses. te:nature (Applicant or Agent): / C> . Application Number . . . . . 07-00000647 Permit . . . BUILDING PERMIT Additional desc . Permit Fee 72.00 Plan Check Fee 46.80 Issue Date . . . . Valuation 5000 Expiration Date 8/28/07 Qty Unit Charge Per Extension BASE FEE 45.00 3.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 27.00' Permit . . . ELEC-MISCELLANEOUS Additional desc . Permit Fee . . 17.25 Plan Check Fee 4.31 Issue Date . . . . Valuation 0 Expiration Date ., :8/28/07 Qty Unit Charge Per Extension BASE FEE 15.00 3..00 .7500 ---------------------------------------------------------------------------- PER ELEC DEVICE/FIXTURE 1ST 20 2.25 Permit . . . PLUMBING Additional desc Permit Fee . . . . 18.00 Plan Check Fee-. 4.50 Issue Date Valuation . . . . 0. Expiration Date 8/28/07 ` 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 .BBQ, PER APPROVED .PLANS ---------------------------------------------------------------------------- Other Fees . . . . . . ENERGY REVIEW FEE 4.68 STRONG MOTION (SMI) - RES .50 Fee summary Charged Paid Credited Due . Permit Fee Total 107.25 00 00 107.25 Plan Check Total 55.61 .00 .00 55.61 Other Fee Total 5.18 .00 .00 5.18 . Grand Total 168.04 .00 .00 168.04 LQPERMIT Bin # f` w� �5 �a�� City of La Qui nta y Building 8Z Safety Division Permit # QD P.O. Boxf 1504, 78-495 Calle Tampico % La Qulnta , CA 92253 -.(760) 777-7012 Building Permit Application and nd Tracking Sheet Project Address L 1� . = D ,i cJ Owner's Name: J<p-x j M mt✓�q-� A. P. Num lr Address: 5 w Legal Description:'-� City, ST,.Zip: Contractor: V (C>W l2/ 4— (✓-�_ w . i 1�f � Telephone: % Address: VA Project Description: . City, ST, Zip:�ZS 3 Telephone: 7 7 - y -7 State Lic. #':-3. City Lic. #: (e j 41 Arch., Engr., Designer: Address: City, ST, Zip: Telephone: Construction Type: Occupancy,: State Lic. #: Project type (circle one): New Add'n Alta Repair Demo Name of Contact Person: {-C_ Sq. FL: # Stories: . Telephone # of Contact Person: #Units: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACKING Pian Sets PERMIT FEES Plan Check submitted Structural Calcs Reviewed, ready for corrections Item 'Amount Plan Check Deposit Truss Calor. Called Contact Person Energy Calcs EEF_Plans Plan Check Balance picked up Flood plain pian Construction S� T Plans resubmitted Grading. plitu ., Z Review, ready for eorrectiowissue Mechanical Subcontactor List'. Called Contact Person Electrical Grant Deed Plans picked up Plumbing S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for. corrections/issue Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr�pfr t A.I.P.P. School Fees L ANG &SAF r t 1 Total Permit Fees DAar S7 RESIDENCE KENNETH MEADOR CITY OF LA QU - GENDS WAY BUILDING & SAFETY DEP , A, CAL. 92253 APPROVED FOR CONSTRUCTION DATE, BY �. { umm