08-1144 (BLCK)444 P.O. BOX 1564
78-495 CALLE TAMPICO
LA QUINTA,'CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT.
BUILDING PERMIT
Application Number: `08-00001144 Owner:
Property Address: 55293 RIVIERA ROD MINKLER
APN: .775-153-009- - - 55293 RIVIERA
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 346
Contractor:
Applicant: Architect or Engineer: BRYAN INVESTMENTS GROUP INC
P.O. BOX 1804
PALM SPRINGS,•CA 92263
'1 (760)345-8483
r+ Lic. NO.: 552140
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: BpC53 Lice�nsse'No.: 55572140
ate. 6 tractor:
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 70001 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).:
(_) 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 or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.). -
I _ 1 1 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:
LQPER1111T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/03/08
D Q D
JUL 0 3 2000
CITY OF LA QUINTA
FINANCE DEPT.
l
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
A' issued.
\� I have and will maintain workers' compensation insurance, as required by Section 3700 of.the Labor
Y� Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier NORTHERN INS NY Policy Number WCO281765000
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 become subject to the workers' compensation provisions of Section
37000 of the Labor ode, I shall forthwith comply with those provisions.
�ate: 3 a z+ plicant:
WARNING: FAI URE TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI AL 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 information is correct. I agree to comply with all
city and county ordinances and ate laws relating to building construction, and hereby authorize representatives
of this my to enter upon above-mentioned prope for inspection purposes.
te: nature (Applicant or Agent):
Application Number 08-00001144
Permit . . . . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee 15.00
Plan Check
Fee
.00
Issue -Date.,..
Valuation
. . .
. 346
Expiration Date 12/30/08
Qty Unit Charge Per.
Extension
BASE
FEE
15.00
-------------------------------------
Special Notes and Comments
------------------
------
---------------
16'L.F. 5' EQUIPMENT WALL, CITY
STANDARD
-Fee summary Charged
Paid Credited
Due
Permit Fee Total 15.00
.00
.00
15.00
Plan Check Total .00
.00
.00
.00
Grand Total 15.00
.00
.00
15.00
LQPL'R11IT
JUL-03-2008 11:36 AM P.01
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#
City of La Quints tippllocfim
Building 8t Safety Division 0 $ q y
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1`
Address:
F
4
Owner's Narne:'Woe
A. P. Numbei:
Address: A 9 3 1� j U I e r 6L
Legal Description:
Contractor: ad Q L►1'f'/ � S
Address: r O Q / Q
City, ST, Zip: il 1 h
Telephone: s
Project Description:
City,ST, Zip:342C i a
Telephone: % _ a r. 8
State Lic. #: 55a I J10 City Lic. l9
Arch., Engr., Designer:
^' 1 /'�l OfttA)�7 CrQ e
4t9
Address:
City, ST, Zip:
Telephone:
State Lie. !l:
Name of Contact Person: G,.Oen"anSq.
Construction Type: -Occupancy,
Project type (circle one): New Add'n Alter Repair Demo
FL:
# Stories:
4 Units:
Telephone Il of Contact Person: 7 — — 2b419
Estimated Value of Pmject:•
APPLICANT: DO NOT WRITE BELOW THIS LINE
Req'd.
Rtc'd
TRACMG
PERMIT FEES
ffOSubmittal-
Plan Check submitted
Item
Amount
al Cales.
Reviewed, ready for corrections
Plan Check Deposit
Trun CRlcs.
Called Contact Person
Plan Check Bilance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
j
II
Grading plan
2"" Review, ready for oorrecdonsAssue
Electrical
9ubcontactor List
Called Contact Person
Plumbing
Grant Deed
Pleas picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSEt-
"' Review, ready for correctlondlisue
Developer Impact Fee
Planning Approval
Called Contact Person
A.f.P.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
1
Total Permit Rees