04-6370 (GRES)BUILDING & SAFETY DEPARTMENT
„P.O. Box 1504760)"777-7012
('.. OF94`+' 78-495 CALLS TAMPICO - FAX (760) 777-7011
LA QUINTA, CALIFORNIA, 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Numberf0.4-00006370 Date •2/14/05
Property Address . . . 80851 VISTA`LAZO
APN: 762 -250 -,012 -
Application description GARAGE-- RESIDENTIAL
Property Zoning LOW.DENSITY RESIDENTIAL
Application -valuation . . . 16327
Owner ` Contractor
• - - - - - - - - - - - - - - - - - - - - - - . .. -------- - -- - - .- - �- - -
TAMI./ ROBERT STOWE OWNER D
79-914.DANDELION DR.
41910 BOARDWALK NO A10 SEP.
LA QUI NTA ' f =CA 92253-'
} ----- CITYDF.LA�1UINtA -----
Structure Information- 833 =SQ.. FT.' GARAGE AD I.TIO IpIANCEDE
-
Cons ruction Type TYPE'V - NON'RATED '
Occupancy Type. GAR, CARPORT;'SHED, AG
Flood Zone NON -AO FLOOD ZONE ,
Other struct,info . . CODE EDITION 2001 CBC
FLOOD ZONE NO
GARAGE SQ FTG 833.00 111611
---=----------------------------- - ------
Permit CARPORT/GARAGE
Additional de`sc
Permit Fee, 180.00. Plan Check -Fee. 11.7.00
Issue Date Valuation 1632-7
r- Qty ' Unit CYiarge "Per Extension
. BASE FEE 45.00
15.00 9.0000. THOU BLDG 2,.001-25,,000.
001-25 000. .4 r 135.00
--------------- -------------- - - - - ----- - - -__ -- `- - - - - - - - - - - - - - - - -
Permit 'GRADING PERMIT
Additional desc
Permit Fee 15.00 Plan Check Fee .00
Issue. Date Valuation f. 0
Qty Unit Charge Per. Extension
BASE FEE 15.00
---------------------------------------------------------------------
Special Notes and'Comments
FREE'.STANDING 833 SQ. FT. GARAGE,.2/14/05
3':28:44 PM JJOHNSON .`
Other Fees STRONG MOTION .(SMI) - RES 1.63
•
Fee summary Charged .,Paid', Credited ,Due
----------------- ------ 7----- - `-- - -- ----------
Permit Fee Total 195.00 .00 .00 195.00'
i'
P.O. Box 1504 • VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Numbers- �37p Dater"2�- °5'
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
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 License No.
Date 11 li F r ! Contractor `
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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 fora permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 or 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.).
U 1 am exempt under Sec. , BA P.C. for this asory�
Date 9 ( Dw
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury o e o 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 work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier Policy Number
�d 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'
7� compensation laws of California, and agree that, if I sh uld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date D Applicant
WARNING: FAIL RE TO SECURE W EN ION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRE TH A OLS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR C DE, I ST, AND ATTORNEY'S FEES.
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
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 160 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. a to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to enter upon the a ve- tioned property for inspection purposes.
tel Signature (Applicant or Agent).?
.i
Page 2
Application Number",.
04-00006370
Date 2/14/05
Plan Check Total
117.00 .00
.00 117.0.0.
Other.Fee Total
1.63 .00
.00 .1.63
Grand Total
313.63 .00
.00 313.63
r�
•
City of. La Quinta
Bin #
>;
r
�
Building 8i Safety Division
P.O. Box 1504, 78-495 Calle Tampico
ermit #
La Quinta, CA 92253 (760) 777-7012
3 �(�
Building Permit Application and Tracking Sheet
Owner's Name: �TQwE RO CRT TA
Project. Address:
Address: ?19 1 JDAKIDELIN,
A. P. Number:
City, ST, Zip:) A t CA a
. Legal Description:
Contractor:
Telephn _ � 1p
o:(dD
o Project Description: _ E •
Address:
City, ST, Zip: s✓ %3 (, ��5 r Q1i
e:
Telephone:
P hon
City Lic. #: No?E G4A;Nu"�.. 1 It ti3
State Lic. # :
,.
� I � � e 0 GOV&/
Arch.; Engr., Designer:
-S"'A
Address:
Cqv /f*s �/L
City, ST, Zip:
'fele P ho ne:
ct ion e: Occupancy:
construction tru Type:
Project a circle one New Add'n Alter Repair Demo
J type
State Lic . #: :::::::::::::::............
...........
A Qw Sq. Ft.:
Name of Contact Person:" 1, A M
# Stories:
# Units: (�
Telephone # of Contact Person: %(oU
Estimated Value of Project.
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd RecdTRACKING
PERMIT FEES
PI he s Item Amount
Plan Sets
Structural Calcs.
eviewe dy for corre Plan Check Deposit
ailed nt Plan Check Balance
Truss Calcs.
`t7�1 Construction
k p
Title 24 Calcs.
p
Mechanical
Flood plain plan
Plans resubwAUed__—
Grading plan
2"" Review, ready for correcti issu Electrical
Subcontactor List
Called Contact Person OS Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
•
Srd Review, ready for corrections/issue Developer Impact Fee
IN HOUSE:-
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue y
Fees Q S
SCR
School
Total Permit Fees
/ /
I D
P.
CITY OF LA QUINTA'SUB-CONTRACTOR LIST -
JOBADDRESS I V 15 7_A LJZc7 PERMIT NUMBER o,1-4,7 -7(7 OWNER BUILDER .
This form shall belJosted on the job with the Building Inspection Card at all.times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job.Any changes to this list must be-approved_:by_the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work.and/or the voidance
of building permit. For each applicable trade, all information requested below must be -completed by applicant. "On File" isnot an acceptable response.
Trade /Classification
Contractor
....:.....
:::.:.::...._:. State..Contractor.s License.., .,, ..;.:.•; ::.:;:;
Woikeis.Com ensatio�:ansurance:° ;` ' ;. ::::;:.:.
:. City Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
.(Format Varies)
Exp. Date
(xx/xx/xx1
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
`
CONCRETE (C-8)
FRAMING. :.'
LA Al }/ I AA,:
STRUCT.`STEEL (C-51)
MASONRY (C•29)
PLUMBING (C -36j
LATN; PLASTER (C=35)
f
V
DRYWALL (C-9)
HVAC. (C-20)::.:'
ELECTRICAL. (CA 6)-:.' ,
it
ROOFING`,ICr391';:.:.;>:`:'` :
O
SHEET.METAL (C-43)`
FLOORING (C=:151;
GLAZING (C1!17):-.'-'
INSULATION `(C-2) .
u
SEWAGE DISP (ib-4i)-
C-42)
PAINTING
PAINTING (C=33)
CERAMIC TILE (C-54)
i,
CABINETS (C-6)
r
FENCING (C-13)
LANDSCAPING (C=27)...::
POOL (C-53)