10-0004 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
TO'0-0'000004
Property Address:
55105 OAK HILL .
APN:
775-141-022- -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1000
Applicant: _ / Architect or Engineer:
A
----------------- I
LICENSED CONTRACTOR'S DECLARATION
i
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury tha am licensed under provisions of Chapter 9 (commencing with
Section 7000) of -Division 3 of the Busine nd Professionals Code,. and my License is in full force and effect.
License Class: B License No.: 5940.43
Date: 1000 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 9lcommencing 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 town 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.). ... '
(_) I am exempt under Sec. BAP.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:
LQPER117IT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/04/10
Owner:
GILCHRST,JEAN e
55105 OAK HILL D
LA QUINTA, CA 92253
(760) 564-2594 SAN 053, 210
Contractor: CITY OF LA QUINTA -
7C' S CONSTRUCTION & MAINt FIMAy_ CE 0EPT. _
48236 VISTA DE NOPAL
LA QUINTA,. CA 92253
(760)564-5811
Lica. No.: 594043
------------------
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 whichthis peimit 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 FUND Policy Number 0026211-2008
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 be 'me
subject to the workers' compensation laws of California,
and agree that, if I should b com'subject to the workers' compensation provisions of.Section
3700of the Labor
allbor Code, I hhwith comply withthose provisions.
Date:' Apples icant:3
WARNING: FAILURE TO SECURE WOR ERS' 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 h6ld 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 ve information is correct. I agree to comply with all
city and county ordinances and state laws relating to buil ng onstruction, and hereby authorize representatives
of this countytotoo enter upon the above-mentioned prop e y f spection purposes.
Da f
nt10=SignaturelAppligent):
Application Number . . . . . 10-00000004
Permit . . . . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 15.75 Plan Check Fee
3.94
Issue Date. Valuation . . .
. 0
Expiration Date 7/03/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
------------------------ 1
.75
. . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 25.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 1000
Expiration Date 7/03/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
5.00 2.0000 HND BLDG 501-2,000
10.00
----------------------------------------------------------------------------
Special Notes and Comments
8 IN FT Xt5 FT HT BLOCK WALL CITY
STANDARDS & APPROVED PLANS. RUN SWITCH &
LIGHT FIXTURE TO BBQ AREA APPROVED PER
S.T.
----------------------- ----------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
-------------------=---------------------------
Due
----------
Permit Fee Total 40.75 .00 .00.
40.75
Plan Check Total 3.94 .00 .00
3.94
Other Fee Total 1.00 .00 .00
1.00
Grand Total 45.69 .00 .00
45.69
LQPERMIT
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city Of La Qulnta
Building at•Safety Division
P.O. Box .1504, 78-495 Calle Tampico
L4 Quinta, CA, 92253 -. (760) 777-7012
Bu►Idrng Perrh Application and Tracking Sheet .
Permit #
Project Address: �� O'S dQ �� 1
Owner's Name:' J�qw Gi C r
A. P. Number:
Address: ,.
Legal Description:
City, ST, Zip:.
Contractor. ;� fVC �U/�
Telephone: 562CL
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Address: t•- 1 OA b e / 1% L
Project Description:
City, ST, Zip: AO V 1 p�-!-� -
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Tele honer
State Lie. # :Sq 9 -OU City Lie.
Arch., Engr., Designer.
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Address:
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City, ST, Zip:
,
Telephone:
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Construction Type: Occupancy:
State Lie. #:
-
Protect type (circle one): New Add'n Alter. Repair Demo
Name of Contact Person:Sq.
Ft: '�
# Stories: F
#Units:
Telephone # of Contact Person:
,,Estimated Value of Project: (}
APPLICANT: DO NOTWRITE BELOW -THIS LINE.
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person.
Plan Check -Balance.
Title 24 Cates.
Plans picked up .
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctionstissue
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
Developer Impact Fee
Planning Approval
Called Contact Person
A.1.P.P.
Pub. Wks. Appr
Date of permit issue .
School Fees
Total Permit Fees