10-0175 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
q
1_
10-00000175
54838 OAK TREE A 33
775-081-064- - -
REMODEL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
6000
Architect or Engineer:
/J4__
1
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
IICENS CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am I ensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and fessionals Code, and my License is in full force and effect.
License C ess: B License No.: 466572
Date: 4�w Contractor:
OWR- ILDER DECLARATION
I hereby affirm under penalty of perjury that I am exampt 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 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 _ 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 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/09/10
Owner:
POWERS ROBERT
175 KENWOOD WAY ;
SAN
F FRANCISCO, CA 94127
0445
!!
Contractor: APP � Q r9 1010 �1
JERRIS CONSTRUCTION INC
713 EUGENE ROAD bra l Y (fir !Si�lF jl� j!<
rp" .n
PALM SPRINGS, CA 92264
(760)327-3974
Lic. No.: 466572
-----------------------------------------------
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 work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FLTND Policy Number 2290003740
I certify that, in the performance of t work for which this permit is issued, I shall not employ any
person in any manner so as to W a subject to the workers' compensation laws of California,
and agree that, if I she )oco s bjact to the workers' compensation provisions of Section
3700 of the Labor Code, rt Ith comply with those provisions.
Date- i«% Applicant:
WARNING: FAILURE TO SECURE WORKERS' 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, 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 infor tical is correct. I agree to comply with all
city and county ordinances and state laws relating to bui ing constru 1 , and hereby authorize representatives
of thls coy to enter upon the ebovefmamioned property - s -on urposes.
Date: Signature (Applicant or Agent}:
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Bin #
0140
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
—
Permit #
11j
' ` 1
Project Address: ;j
Owner's Name: t� M r—t--(u
A. P. Number: 775 Oe l t,)64-
,)6
Address:
Legal Description:Utu fr 13 Ile 10% 17 "2
Contractor:
City, ST, Zip: I&47;&
Telephonex`' "`°=•'`''? «'
Address:
Project Description:
City, ST, Zip:
Telephone: 760
State Lic. # :
City Lic. #:
Designer: Pi
Address: 7 74 Z,Z C00&k!n4 G[r(
City, ST, Zip:.{
Telephone Q _ "' '' `�' Y •`'
7onstruction
State Lic. #: ?'._ ? ?
Name of Contact Person: C t
C Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:#Stories: # Units:
2r�~
Telephone # of Contact Person: 7 ��j Z -L,35 f�
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
I Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cales.
21-
Reviewed, ready for corrections;
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2id Review, ready for correttio ssue
Electrical
Subcontactor List
Called Contact Person f 70
r ,
Plumbing
Grant Deed
Plans picked up
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
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
9
�'C1rl:� G �.NGIAT�'ERING ,�'�I?T,'j(7E www.valJlQiIC]r_i<�Iil--
-- 71-780 San Jacinto Dr. Ste. E2. Rancho Mirage, Ca 92270 ph (760) 834-8860 fax (760) 834-8861
Letter of Transmittal
To: City of La Quinta Today's Date: 3-31-10
78-495 Calle Tampico City Due Date 3-31-10
La Quinta, CA 92253 Project Address: 54-838 Oak Tree
Attn: Phillip Plan Check #: 10-175
By: John W. Thompson
Rancho Mirage Office: ® (760) 834-8860
Other: 7
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®
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Structural Plans
®
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Revised Structural Plans
❑
Struct. Calcs
❑
Revised Struct. Calcs
❑
Truss Calculations
❑
Revised Truss Calcs
❑
Soils Report
❑
Revised Soils Report
®
1
Structural Comment List
❑
—
Approved Structural Plans
N
1
Redlined Structural Plans
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Approved Structural Calcs
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Redlined Structural Calcs
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Approved Truss Calcs
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Redlined Truss Calcs
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Structural content is approvable.
APR
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By: John W. Thompson
Rancho Mirage Office: ® (760) 834-8860
Other: 7