06-3671 (SOTB)P.O. BOX 1504 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: 10/16/06
Application Number: 0'0.003.6.7:1—Z Owner: '
Property Address: 51620. VIA ROBLADA PETERS
APN: 772-270-010-234, -311231-. "51620 VIA ROBLADA
Application description: STRUCTURES OTHER THAN BUILDINGS LA QUINTA, CA 92253
Property Zoning: LOW. DENSITY RESIDENTIAL
Application valuation: 3000
eApplContractor.
tTY
icant: Architect or Engineer: MCINTYRE POOLS & SPQ83695"AVENUE45INDIO, CA 92201 (760)342-3612T IH 2006Lic'. No.: 614611
OF U► QlJIMT'AANCF new.,
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penaltyof perjury that I am licensed under provisions of Chapter 9 (commencing with 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 Class: C53 License No.: 614611 - - for. by Section 3700 of the Labor Code, for the performance of the work for which this permit is
—�- issued.
ntractor:_.C.--�yZ _ ar.»��—(' jJf3�I-have-and-will-maintain-workers-compensation-insurance,-as-required-by-Section 3200-of-theL-abor
J Code, for the performance of the work. for which this permit is issued. My workers' compensation,. -
OWNER-BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I'am exempt from the Contractor's State License Law for the Carrier HRH INS - Policy Number 020060333601
following reason (Sec. 7031.5. Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the - person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compen ation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 3700 of the Labor Code, I shall forthwi h comply with those pr, (_ions.
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).: tem v A cant' ellk
(_ I 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 WAR ING: FAILUR TO SECURE WORK RS' COMPENSATION COU RAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, - SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000): IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN ,
improvements are not intended or offered for sale. If, however, thebuilding or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S' FEES.
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.). APPLICANT ACKNOWLEDGEMENT
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. - - IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of - conditions and restrictions set forth on this application. - property who builds or improves thereon, and who contracts for.the projects with acontractor(s)licensed 1. .Each person upon whose behalf this application is made, each person at whose request and for "
pursuant to the Contractors' State License Law.). -whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason - 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.. - -
Date: Owner: 2. Any permit issued as a result of this application becomes null and void if work isnot commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY - permit to cancellation.
-I hereby affirm under penalty ofperjury that thereis a construction lending agency for the performance of the I certify.that I. have read this application' nd state that the above information is correct. I.agree to comply with all
work for .which this permit is issued (Sec. 3097; Civ. C.). city and county dinances and. state s relating to building construction, and hereby authorize r presentative_
. - of this coun to enter upon the a ye-mentionedproperty for ' �peaion ei poses.
Lender's Name:
_ Date: igna a (Applicant or Agent):
Lender's Address:
LQPERMIT. _
Application Number 06-0000301
Permit . . . BUILDING PERMIT
Additional desc
Permit Fee 54.00 Plan Check Fee
35.10
Issue Date Valuation
3000
,Expiration Date : 4/14/07
Qty Unit Charge Per;
Extension
BAS E'FEE
45.00,,
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
---------------------------------------------------------------
-------------
Permit . . ELEC-MISCELLANEOUS."
Additional desc .
Permit Fee . . . . 17..25 Plan Check Fee
4.31
Issue Date Valuation
0
Expiration Date .' 4/14/07 -.
Qty Unit Charge Per
Extension
BASE FEE
15.00 _
3.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
2.25
------------------------------------------------------------------
Special Notes.and Comments
BBQ - REQUIRES HAANDRAIL FOR STEPS <'
-------------------------------_----------------------.----------
--------------
Other Fees . . . ENERGY REVIEW FEE
3.51
. . �:,.
STRONG.MOTION (SMI) - RES
.50.
Fee summary Charged Paid Credited
Due t.
----------------------------------------=----------------
Permit Fee Total 71.25 .00 00
7125.
Plan Check Total 39.41 00 .00
39.41
Other Fee Total 4.01 .00 .00
4.01
Grand Total 114.67 .00 .00
114.67
LQPERDIIT" - ..
Bin #
V
City
La
of Q uinta
Building u Safety Division
Permit # ^ t
P.O.
Box 1504, 78-495 Calle Tampico
La Quilnta, CA 92253 - (760) 77777012
Building Permit Application and Tracking Sheet
Project Address: U/
Owner's Name: 7
A. P. Number: _.
3
Address:
Legal'Description:
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City, ST, Zip-
Contractor: � _
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Telephone:
Address:
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Project Description:
City, ST, Zip:
Telephone:
State Lic. # : / y��
City Lic. #:
�G l LJ ?�S
Arch., Engr., Designer:
A
Address:
i�V • c r a2E s s � �cla.,r�
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
4
State Lic.#:
Project type (circle one).Add'n Alter Repair Demo
Name of Contact Person:
Sq: Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
I
Estimated Value of Project: •—�
APPLICANT:
DO NO.T WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready.for corrections
,
Plan Check Deposit
Truss Cl
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans -resubmitted
Mechanical
Grading, plan*god
Review, ready for correctionsrssue
10140 Electrical
3 t`
Subcon.tactor List
Called Contact Person
Plumbing
Zv61d�
.
Grant Deed
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted I
Grading
IN HOUSE:-
"'Review, ready for eorrections/issue
Developer Impact Fee.. .
Planning Approval
Called Contact Person
:A.L"P. .
Pub. Wks. Appr
Date of permit issue
s
School Fees
BUILDI
G & S
NV_
A
.Total Permit Tees
..
C •, f� l � �_
..
.v R -Q- .
a� (38 .
. , .
DATE