07-2030 (BLCK)7.
P.O. BOX 1504 ^�
78-495'CALLE TAMPICO
LA QUI NTA, CALIFORNIA 9.2253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 000002030 Owner:
Property Address: 5,16-85"AVENIDA OBREGON DOUG PETERS
APM 773-123-01977 000000- 52540 AVENIDA
Application description: WALL/FENCE "y LA- QUINTA, CA
Property Zoning: COVE RESIDENTIAL
Application valuation: 3 516
Applicant: Architect or Engineer:
NAVARRO
92253
Contractor:
ROADRUNNER CONSTRUCT:
52540 AVENIDA NAVARR(
LA QUINTA, CA 92253
(760)578-6842
Lic. No.: 620456
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/11/07
-------------------------------------------=-----------------------------------------------------
• -LICENSED CONTRACTOR'S DECLARATION -
' WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed:under'provisions of Chapter 9 (commencing with,
I hereby affirm under penalty of perjury one of the.following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
I have and will maintain a certificate ofconsent,to self -insure for workers' compensation, as provided
Livens lass: B ,L`y o.: 620456
_
for by Section 3700 of the Labor.Code, for the performance of the work for which this permit is
ate:/_/Il:�l`% ontractor:
issued.
_ I have and 'will maintainworkers' compensation insurance, as required by Section 3700 of the Labor
-/ F -
Code, for the performance of the work for which this permit is issued. My workers' compensation
' OWNER -BUILDER DECLARATION
insurance carrier and policy number are: :p
I hereby affirm under penalty of perjury that I am exempt from tfie Contractor's State License Law for the
Carrier ST TE FUND Policy Number . 0036842-2006
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requiresa-permit to
I certify that, in the;performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure; prior'to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
. permit to file a signed statement that he of she is licensed pursuant to the provisions of the'Contractor's State.
'and agree that, if I should become.subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of theLabor Code, 1 shall forthwith'oompl ith•those provisions.
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 toa civil penalty of not more than five hundred dollars 155001.:
ate: C, plicant:
•(_) 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE -IS UNLAWFUL, AND SHALL
Contractors' State License -Law doesnot apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees,'provided that the
DOLLARS (5100,000). IN ADDITION TO.THE COST. OF COMPENSATION'; DAMAGES AS PROVIDED:FOR IN
' improvements are"not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST; AND ATTORNEY'S FEES.
' one year of completion, the owner -builder will hive the burden of,proving that he or she did.not build or
- improve for the purpose of sale.)..
APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby'made to the Director of Building and Safety for a permit subject to the
' 7044; Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
- property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon, whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
1 _) I am exempt under Sec. B.&P.C. for this reason
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
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: s '
Lender's Address: �V
LQPERMIT
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 construction, and hereby authorize representatives
of this unty to enter upon above-mentioned, property for inspection pur s.
e: ignature (Applicant or Agent):
Application Number . . . . . 07-00002030
Permit . .
. WALL/FENCE
PERMIT
Additional desc .
.
Permit Fee . . .
. 63.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 3516
Expiration Date .
. 1/07/08
Qty Unit Charge Per
Extension
BASE
FEE
45.00
2.00 9.0000 THOU BLDG
2,001-25,000
18.00
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Special Notes and
Comments
80 L.F. 6' GARDEN
WALL & 70 L.F.
5'
GARDEN WALL, CITY
STANDARD
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
63.00
.00
.00
63.00
Plan Check Total
.00
.00
.00
.00
Grand Total
63.00
.00
.00
63.00
LQPERMIT
I 1
'' -'.-' '-- ` `f.-~
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATELT 0_1 13Y-:2
'rl
i
Bin f
City of La Quinta
Building u Safety Division
Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
0'%0
a
Project Address: .� �d✓J e ,
Owner's Name:
A. P. Number: -7-73* /9-301 q I
Address: 5 "
Legal Description:
City, ST, Zip: qW3
Contractor: o
Telephone &Q SW-LQFsLt -�L
Project Description:
Address: S () ,,., k ' .
City, ST, Zip: _ 6
100
4 eqadw WGA
Telephon : —7U 578 —6 7 'Lf dL
(�
State Lic. # : S(p City Lic. #: ; n i 8
Arch., Engr., Designer:
S J .(,
Address:
n,
City, ST, Zip:
Telephone:
Construction Type: 81 jXVGuzG Occupancy:
P cY=
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. FL:
#Stories.
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE 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.
Energy .Calc#.
Plans, picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading,plan
2" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
$.M.I.
H.O.A. Approval
Plans resubmittedEcorrectEionstisAsue'
Grading
[N HOUSE:-
'`"Review, ready
Developer Impact Fee. ;
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue,
School Fees
.77
Total Permit. Fees,.. ..�-3
W�
4 �