08-0243 (SOTB)P.O. BOX 1504',' -44 IQU 46
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 08-0.0000243 - Owner:
Property Address: 79962 VIENTO DR DAVE-HUMPHREY
APN: 609-380-999-33 -293234- 79962 VIENTO DR
Application description: STRUCTURES OTHER THAN BUILDINGS LA QUINTA, CA
Property Zoning: LOW DENSITY RESIDENTIAL— LA QUINTA, CA 92253
Application valuation: 1000
Contractor.
Applicant: Architect orEngineer:. F P D SERVICES INC -
43653 PARKWAY ESPLANADE
LA QUINTA, CA1 92253
(760)772-1111
Lic. No.: 820132
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: C53License No.: 820132
Date: (i Contractor:
.�� _ .. -
WNER-BUILDER DECLARATION
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 70001 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 (5500).:.
(_ 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 f, 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 applyto 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 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:
LQPERAIIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/01/08
tLi
ax j
LOAt
FFR 0 17 2008
iiiia
.PT. E
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.
1 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 DLOS INS Policy Number 01DKRM12000631
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 sh become subject to the workers' compensation provisions of Section
3700 of the Labor de I shall forthwith comply with those provisions.
Date: I air. Applicant:
WARNING: FAILURE TO SECURE WO KERS' COMPENSATION COVERAGE 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.
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, rand 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.
. 1 certify that I have read this application and state that the ab information is correct. I agree to comply with all
-
city'and county ordinances and state laws relating to buildi co struction, and hereby authorize representatives
of this county, to enter upon the above-mentioned proper for i pecticn purposes.
Date: Z (` O%>`Signature (Applicant or Agent):
Application Number . . . . 08-00000243
..Permit. . . . . . . PERMIT
•BUILDING
Additional desc .
Permit Fee- 251._00
Plan Check
Fee
16.25
Issue Date
Valuation.
1000 -
Expiration Date 7/29/08.
Qty Unit Charge Per....
Extension
- BASE FEE
.15.00
5'.00 2.0000 HND BLDG`501-2,000
10.00
Special Notes and Comments
.. FIREPIT PER APPROVED PLANS 31DIAMETER
-
CMU- W/35' V.G. 3/4"'GAS LINE. POOL
UNDER CONSTRUCTION
Other Fees . . . . . . . . ENERGY
REVIEW FEE
1.63
Fee summary Charged Paid
Credited
Due
Permit Fee Total 25.00
.00
.00
25.00
Plan Check Total 16.25
.00
.00
16.25
Other Fee Total 1.63.
.00
00
1.63
Grand Total 42.88
:00
.00
42.88
LQPERMIT ... .. . ' .
- ..
Bin # 77%7""
. .
City of La Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit.#
-�
Project Address: 1g0t VIL wro D12-Lr Q ,
Owner's Name: % At)P ;
A. P. Number:
Address: T11 Lo Z VI e n-rc) ,
Legal Description:
City, ST, Zip: L
CA
Contractor: �R D ✓1 OF5
�aQ(
Telephone: v� `} . b ► �? �J .
Address: 43 (R
Project Description:
City, ST, Zip:
Telephone:
-
State Lic. # City Lic. #:%
Arch., Engr., Designer:
A)� 3 7t k-e',e7ve— C, J
((
V•G . 3C to
u TOOL- VAO&L
Address:
City, ST, Zip:
Telephone:
,to q
Construction Type:
YP : Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: U ys
Sq: Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: ppp
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING . PERMIT FEES
Plan Sets
Plan Check submitted I Item
Amount
Structural Calcs.
Reviewed, ready for corrections Plan Check Deposit
Truss Calcs.
Called Contact Person Plan Check Balance
Energy Calcs.
Plans picked up Construction
Flood plain plan.
Plans resubmitted Mechanical
Grading, plan
2"d Review, ready for corrections/issue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H:O:A. Approval
Plans resubmitted Grading
IN HOUSE:-
''" Review, ready for corrections/issue Fee
Planning Approval
Called Contact Per
Pub. Wks. Appr '
Date of permit issueIll, G & AFSchool
Fees .FOR
teepact
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