12-0242 (SOTB)4
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: 3/16/12
Application Number: 12-00000242_ Owner:z
Property Address: 44575 VIA TERRA NOVA JOHNSON & MARIA PELAYO U; U
APN: 604-032-999-2 -305212- 44575 VIA TERRA NOVA
Application description: STRUCTURES OTHER THAN BUILDINGS LA QUINTA CA ((��!
Property Zoning: LOW DENSITY RESIDENTIAL LA QUINTA, CA 92253 ''t 2012 r
Application valuation: 4500
CI`rY or �aSsN I '
Contractor:
Applicant: Architect or Engineer: UNITED BROTHERS CONCRETE INC
PO BOX 756
THOUSAND PALMS, CA 92276
r (760)343-2861
Lic. NO.: 800402
-------------------------
LICENSED C NTRj
I hereby affirm under penalty of perjury that 1 ani licens d un(
Section 7000) of Division 3 of the Business and Profen 'onal;
Lic se Class: B C8 C22z Li
Date:ctor: �'I
ll
2�. Chapter 9 (commencing with
my License is in full force and effect.
800402
/IiceinspLedeU�pou(rsuant
ILDER DECLARATION
I hereby affirm under penalty of perjury thatfrom the Contractor's State License Law for the
following reason (Sec. 7031.5, Business anCe: Any city or county that requires a permit to
construct, alter, improve, demolish, or repaiprior to its issuance, also requires the applicant for the
permit to file a signed statement that he ors 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, 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:
LQPERMIT
WORKER'S COMPENSATION DECLARATION
I 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 w for which this permit is issued. My workers' compensation
insurance carrier and policy numbere:
Carrier GRANITE POI�cl
Number UNWC102569
I certify that, in the performance ftheork for which tis permit is issued, I shall not employ any
person in any manner so as to , ecom subject to workers' compensation laws of California,
and agree that, if I should beco, a su ect to t workers' compensation provisions of Section
3700 of the Labor Code, I shall rthv 'th c ply with those provisions.
te: L - A icant:
WARNING: FAIL E TO SECURE WORKERS'
SUBJECT AN EMPLOYER TO CRIMINAL PENS
DOLLARS 15100,0001. IN ADDITION TO TH
SECTION 3706 OF THE LABOR CODE, INT
fPENSATION COVERAGE IS UNLAWFUL, AND SHALL
S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
iT OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
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 defendq�nd
indemnify and hold her �s the City
of La Quinta, its officers, agents and employees for any act orjmission related to th ork being
performed under or following issuance of this permit. II
2. Any permit issued as a result of this application becomes null void if work ' not commenced
within 180 days from date of issuance of such permit, or ces tion
or 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above informatioagree to comply with all
city and county ordinances and state laws relating to building constr ctio thorize representatives
oft county tto enter upon the above-mentioned property for inspe io �I
ate: —/U_ nature (Applicant or Agent): 11YY '
12"–
r
Application Number . . . . . 12-00000242
Permit . .
. BUILDING PERMIT
Additional desc .
.
Permit Fee . . .
. 72.00 Plan Check Fee
46.80
Issue Date . . .
. Valuation . . .
. 4500
Expiration Date .
. 9/12/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
27.00
Permit . .
. PLUMBING
Additional desc .
.
Permit Fee . . .
. 18.00 Plan Check Fee
4.50
Issue Date . . .
. Valuation . . .
. 0
Expiration Date
9/12/12
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 - INCLUDES 13
L.F. 1/2" GAS LINE,.NO
SINK, NO ELECTRIC.
STRUCTURE NOT TO
TOUCH BLOCK WALL.
2010 CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
4.68
STRONG MOTION (SMI) - RES
.50
Fee summary
Charged Paid Credited
Due
-----------------
Permit Fee Total
----------------------------------------
90.00 ..00 .00
90.00
Plan Check Total
51.30 .00 .00
51.30
Other Fee Total
6.18 .00 .00
6.18
Grand Total
147.48 .00 .00
147.48
LQPERMIT
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CA 9 z 9-53
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE J•
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Bin. #
Permit
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Buf[0g 8L Safety DiM&i . .: .
P.O. Box. '1504; 78-495 Calle Tampico
La.Qufnta, CA 92253 -:(760) 7774012
Building Permit Application and Tracking Sheet
Project Add=:
0"Ws Name: Vl on
A. P. Number.
Address: 44 A10 va
Legal Description:
Contractor. a
rt) CrL/
ST. Zip-
City. -
T
Address: n
Project Description:.
City, ST, Zip: n ✓1
Telephone:[b l _
State Lie. #: City Lic. fk
L- 2 !f
Arch, Bag., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Construction Type:. Occupancy:
Project type (circle one): New A�dd'n Alter Repair Demo
Sq. FL: # Stories: #Units:
Name of Contact Penson: �, .. � 6
Telephone # of Contact Person: Q 8 - 33 T
I Bstimatod Value of Project
APPLICANT: DO NOT WRITE BELOW THIS. UNE
#
Submittal
Plan Sets
Req'd
Reed
TRACENG PERMIT FEES
Pian Check submitted Item Amount
Structural Cale&
Reviewed, ready for corrections Plan Qwck Deposit. .
Truss Calcs.
Called Contact Person Pian Check Mance
Tide 24 Cates.
Plans picked up Conateactiou
Flood plain plan
Plans resubmitted.'.
Grading plan
Z'! Review, ready for correctionsrasue Fdeetrdul
Subeoatactor List
Called Contact Person Plumung
Groat Deed
Pians picked up ML
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE-
''• Review; ready for correetionsAssue Devebper Impact Fee
Planning Approval
Called Contact Person A.LP4.
Pub. Wks. Appr
Date of permit issue
School Fees
Tota. Permit Fees