06-3846 (AR)48850 Avenida Anselmo
'.' IIIIIIIIVIIIIIIVIIIIIII 42
P.O. BOX 1504 _ _ IE I Fa VOICE (760) 777-7012
ll
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT .
Date: 11/06/06
Application Number: 06-00003846 Owner:
Property Address: 48850 AVENIDA ANSELMO CHARLES COULTER
APN: 658-300-009- - - 48850 AVENIDA ANSELMO
Application description: ADDITION - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL Other struct info . .
Application valuation: 4176
Contractor: D
.Applicant: Architect or Engineer: Owner FEB 12 2007
- - J
CITY OF LA QUINTA
FINANCE DEPT.
nl
------------------------------ -----------=---------------------------------------------------
. 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: Contractor:
OWNER -BUILDER DECLARATION
I 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 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.).
(_ 1 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 op improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_) I am exempt under Sec. , B.&P.C. for this recon
0
CONSTRUCTION LENDING AGENCY
1 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:
LQPER.N1IT
WORKER'S COMPENSATION DECLARATION
I hereby affir nder 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
JA insurance carrier and policy number are:
Carrier ,r . AW Policy Number .
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 should beco a subject to the workers' compensation provisions of Section
3700 of the Labor Co I s fort h com with t ose provisio
bate y of
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 Quints, 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construct' and hereby authorize representatives
of this co my to enter upon the above-mentioned property f pe of pur es.
_Ba0 Signature (Applicant or Agent),
r
Application Number . . . . . 06-00003846
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
72.00 Plan Check Fee
46.80
Issue Date
Valuation
4176
Expiration Date
5/05/07
Qty Unit Charge
Per
Extension
BASE FEE
45.00
3..00 9.0000
----------------7-----------------------------------------------------------
THOU BLDG 2,001-25,000
27.00
Permit . . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
17..56 Plan Check Fee
4.39
Issue Date . . . .
Valuation
0
Expiration Date
5/05/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
73.00 .0350
----------------------------------------------------------------------------
ELEC NEW RES - 1 OR 2 FAMILY
2.56
Permit MECHANICAL
Additional desc .
Permit Fee
26.00 Plan Check Fee
6:50
Issue Date
Valuation
0
Expiration Date
5/05/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00.
1.00 4.5000
EA MECH VENT INST/ DUCT ALT
4.50
1.00 6.5000
--------------------------------------------
EA MECH VENT FAN
-------------------------------
6.50
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . .
81.00 Plan Check Fee
20.25
Issue Date . . . .
Valuation
0
Expiration Date
5/05/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
3.00. 6.0000
EA PLB FIXTURE
18.00
1.00 45.0000
EA PLB SEPTIC
45.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
---------------------------7-------=---------------------------------7------
Special Notes and Comments
73SF BATHROOM ADDITION/V-NR/RES-3.
LQPERNIIT
LQPERDIIT
Application Number . . . . .
06-00003846
----------------------------------------------------------------------------
Special Notes and Comments
750 GAL. SEPTIC TANK ADDITION,
APPROVED
BY HEALTH DEPARTMENT. THIS PERMIT DOES
NOT INCLUDE BLOCKWALLS, POOL AND SPA, OR
DRIVEWAY APPROACH. November 6,
2006
4:04:21 PM AORTEGA
-----------------------------------------------------------------------------
Other Fees . . . . . . . . .
ENERGY REVIEW
FEE
4.68
STRONG MOTION
(SMI) - RES
.50
Fee summary Charged
Paid
Credited
Due
---------------------------
Permit Fee Total 196.56.
--------------------
.00
----------
.00
-196.56
Plan Check Total 77.94
.00
.00
77.94
Other Fee Total 5.18
.00
.00
5.18
Grand Total 279.68
.00
.00
279.68
LQPERDIIT
IIIIIII
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VIII III VIII IIII 51
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-
City of La Quinta
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit ff
Project Address: fi 4A1.r eC A7 p
Owner's Name: C'>f1441 tC S C occ L T
A. P. Number: �$ — 300 — OQ 9
Address:
O rt • G ala o
Legal Description: Lta T y Z
City, ST, Zip:
Contractor: O wNC X st4 / LQ ,fc
Telephone: ,
Address: Zy A.
Project Description: f.*;-.A1
City, ST, Zip: QUIMEa yg 3
Telephone: -7 (p Q x(701 J.
0A1 S) 714 owc/ r-A
State Lie. # : N
City Lie. #:
Arch, Engr., Designer: fJ�j �Ll S tote L72�Q
Address: � � . S L /Yl A
�,�� %'� •• �",
City, ST, Zip: 4 �t'.tt�tTll 9LZr3
Telephone:�ivlb N(#D
State Lie, #: WA
Construction Type: Occupancy:
Project type (circle one): NewAdd' Alter 'Repair Demo
Name of Contact Person:
�-e �1
Sq_ Ft-: �.3
# Stories:
# Units:
Telephone # of Contact Person: J.
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd.
Recd
TRACKING.PERMIT
FEES
2
Plan Sets
Pian Check submitted
'L7 Ob
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Z•,
Truss CAlcs.
Energy Calcs.
Called Contact Person
Plans Picked up
/
Plan Check Balance
Construction
Flood plain plan
Pians resubmitted114echartical
Grading.plan
2"' Review, ready for correctio issue
Il a1
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
$.M.I.
H.O.A. Approval
Plans resubmitted.
Grading
IN HOUSE:-
Review, ready for correctionstissueDeveloper
Impact Fee. ;
Planning Approval
Called Contact Person
A.I.P..P.
Pub. Wks. Appr
Date of permit issue,
School Fees
,.........,.
, .
Total Permit Fees
1012-P
7% - ? 0,�J 0CAtZ_0
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