08-0209 (BLCK)49715 Anacapa Cir
08-0209
f!
P.O. BOX 1504 —
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
65
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
08-00000209
---••--- I.E----
P.O. BOX 1504 —
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
65
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
08-00000209
Property Address:
49715 ANACAPA CIR
APN:
646 -210 -024 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
725
Applicant:, Architect or Engineer:
inw-
------------------
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: 13 License No.: 442118
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 sh ' exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
an app n[ 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 sate (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 _ 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.).
1 _ 1 I am exempt under Sec. B.&P.C. for tho reason f
Date:
Owner:
/ KNSTRUCTION LENDING VENCY11
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: 1/29/08
Owner:
NOUSKAJIAN JOHN
49715 ANACAPA CIRCLE
MORENO VALLEY, CA 92553
O
Contractor:
KENNEDY CONSTRUCTION, T.A
48751 SAN PEDRO STREET t?
LA QUINTA, CA 92253 iy 4, . x
(760) 564-4660 c U41
Lic. No.: 442118 I OQ j
----------------------------------------------
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 FUND Policy Number ' 0024567-2007
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 bject to the workers' compensation laws of California,
nd agree that, if I sho _ e sub' ct to the workers' co nsation provisions of Section
3700 of the Labor ode sh rt it y os _...sions.
D te: Applicant:
WARNI F URE TO SECURE ORKER COMPENSATION COVERA IS UNLA FUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI NAL P ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITIO O 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 tion is correct. I agree to mply with all
city and county ordinances and state laws relating to buildi c stru on, and hereby authorizyefffepresentatives
of this c my to enter upon the above-mentioned pro r f I p S.
Date: Signature (Applicant or Agent):
.i
t
LQPERN11T
Application Number . . . . . 08-00000209
.Permit . . . WALL/FENCE PERMIT
Additional desc..
Permit Fee 21.00
Plan Check
Fee
.00
4ti Issue.Date . . . .
Valuation
. . .
. 725
Expiration Date 7/27/08
Qty Unit Charge Per
Extension
BASE
FEE
15.00.
3.00 2.0000 HND BLDG
501-2,000
6.00 .
-----=----------------------------------------------------------------------
Special Notes and Comments
29 IN FT X 6 FT HT GARDEN WALL PER
CITY
t STANDARDS AND APPROVED PLANS
Fee summary Charged
Paid Credited
Due
•Permit Fee Total 21.00
-------
.00
----------
.00
21.00
Plan Check Total .00
.00
.00
.00
Grand Total 21.00
.00
.00,
21.00
LQPERN11T
Bin #
City of La Quinta
Building'& Safety Division
P.O: Box 1504; 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: —7 t - cLk
Owner's Name: 1
A. P. Number:
Address:
Legal Description:
Contractor: FV
City, ST, Zip:
Telephone:
Address:
Project Description:
City, ST, Zip: iy.L 17i i
1
'r
G
Telephone: 2--7S
f.Y
City Lic. #:
State Lic. # : f -t' Zf ( .
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: , , . ...
State Lic. #: a '
:,
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter • Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact -Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for corrections/issue
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.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
y
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U i
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y
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f A
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7C z
" UiLDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
( D. TF BY
by y
y
r
,
o
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' -Compensation Insurance , or a certified copy thereof (Sec.•3800. Lab. C.).
Policy No. Company
O Certified copy is hereby furnished. --r+ • • ,
O Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
0
APPLICANT
A('v MI)
J l eA r 1AII
I
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VIII
III
VIII
IIII 66
PERMIT ALP ICAQuiI NCity
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Department of Building and Safety
• This permit becomes void if work not commenced within 180 days from date of
issuance. OR, if work has been suspended or.abandoned for a.period of 180 days. .
•
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
• LICENSED CONTRACTORS DECLARATION: •I hereby affirm that I am licensed under provisions, of Chapter 9
the permit is for one hundred ($100) o, less. I certify that in the -performance of the work for which this permit is
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
issued, I shall not employ any person in any manner so as to become subject to the Workers'CompensationLaws of
and effect. ,
Lr- G c L
Lic-
California.
License Class. - Num/her
' Oates t _ Contractor r' - -' = ` - ' - '
_Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the'Contractor's- License Law for the
Compensation provisions of the Labor Code, you must forthwith comply with,such provisions or this permit shall
following reason (Sec.,7031.5. Business and Professions Code: Any city or county which .requires. a permit to
be deemed revoked.'
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:.
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
01 hereby certify that no excavationfive(5)orhbrefeetindepth'intowhichapersonisrequiredtodescend,willbe '
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) orthat he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for the alleged exemption. Any violation of Section 7131.5 by any applicant for a permit
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp•2, Art 2, Sec341, Title B,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.) "
❑ 1: as owner of the property. or my employees with wages as their sole compensation, will do the work, and the ,
❑ As owner -builder, I will not employ anyone to do4work which would require a permit from the Division of
structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License
Industrial Safety;•as noted above, unless such person has a permit to do such work from that division.
• Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or '
LOT SZ
through his own employees, provided that such improvements are not intended or offered for sale..lf•, however, the .r
❑ Division of Industrial Safety Permit No.
' building orimprovemnt,issold within one year ofcompletion, the owner -builder will have the burden of proving that
Date Applicant
he did not build or.improve for the purpose,of sale.).
CONS7RUCTIOWLENDING AGENCY: I hereby affirm that there is a construction lending agehcy for the performance
❑ I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
of the work for which.this permit is -issued (Sec. 3097, Civ. C.).
7044. Business and. Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Name
' .builds or improves thereon, and who•contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.). _
Lender's Address
O 1 am exempt under. Sec. B. 8 P.C. (Attached Certificate).
I.certify that I have read this application and state that the above information is correct. I agree to.comply with all
' Date Owner
city and county ordinances and state laws relating to building copstruction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for` inspection purposes. .
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' -Compensation Insurance , or a certified copy thereof (Sec.•3800. Lab. C.).
Policy No. Company
O Certified copy is hereby furnished. --r+ • • ,
O Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
0
APPLICANT
A('v MI)
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`ADDRESS f /
CITY/COMMUNITY/STATE/ZIP
JOB SITE ADDRESS LSPACE ,. "
1S N /QL lqra,4
CI TWCOMMUN ITY/STATE/ZI P
LA
BOK
PAG7
PRC
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SB
TRACT NAME - -
_a
OWNER NAME (L. F, M0 _
CONTRACTOR -FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE117 / , 3
.LICNC
711
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC.0
USE OF PERMIT '
BL
ZON
FSB
SSB
SSB
-RSB
OFC
ZONE ORD M
`•
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END
SIDE
Signature of Applicant or Agent n' Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:• I certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a' representative of the City of La ouinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
BLDG. DEPT.
VALUATION
70 e7Z
-TOT u :T
FEE •
. dQ
BLDG. DEPT.
VALUATION
NO.
OPERATION DATE
INSPECTOR
NO. OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set.Back
33 Ventilation System
2
Ftgs & Frms
34 Plenums & Ducts
2A
Slab Grade
35 Furnace Compart:
3
Steel
36 Inlets & Outlets
4
Grout Blocks
37 Combustion Air, . .
5
Bond,Beams
38 Compressor
6
Roof Deck
39 Appl. Clearance
7
Framing.
40- Fire Damper.
8
Vents
41 Smoke Detection Device.
9
Garage Fire Wall
42 Commercial Hood
10
Fireplace P.L.
❑
43 Final
10A
Fireplace T.O.- ❑
NO ADDITIONAL INFORMATION"
zl
SEWAGE SYSTEM SIZE•&. LOCATION
11 Exterior Lath
12 Internal Lathy
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final '
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 *Vents ^
19 Sewage Disposal
20 Sewer
21 Water Heater
22 : "Water Softener
23 Water Service
24 Gas Test
25 Final
Tank. Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE'
PSL P/L
STREET -NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32_ Final
;Of
IIIIIIIIIIIIIIIIIIIIIIIII 67
IE
This permit becomes void if work not commenced within
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class
Lic. Number
)ate Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he 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 live 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 Contractor's License
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
through his own employees. provided that such improvements are not intended or offered for sale. If, however, the
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
❑ I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
O 1 am exempt under Sec.
Date
Owner
B. 8 P.C. (Attached Certificate).
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
0 Certified copy is hereby furnished.
yrI Certified copy is filed with the City Building Inspection Departm oi-Citye Department.
Date N ` %2 .- S Applicant
APgLI, C:AN,T NAME (_* L es
i,i uc J 4iQi[i7`7
A%rX685 Anwapa Circle
CfTY/COMM( gwl*T,LV _a, ZI-P.,. FR 92253
y(•FJ
J SITF- DDRESS/SPACE
B,
CIT,, Y/C M UNITY/STATE/ZIP
.80 V17
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TOTAL
FEE
$2.•5U
Moo
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TRACT NAME
yOWNER AME (L. F. MI)
CONTRACTOR -FIRM NAME
t2irW & LR«r W tG l s
53- is20 Avenida Vil1la
Cy b COQ MMy'N Iryt JTF , 92253 1
( (-
PHONEyP
564-9250
LICNC M
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ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE M
LICNC •
'
t '
USE,.O PE MITy,,., , re=it
` • 1 TFSLB G I
BL
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SS8
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END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred (3100) o. less. 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.
Date
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title8,
C.A.C.)
O As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above. unless such person has a permit to do such work from that division.
❑ Division o1 Industrial Safety Permit No.
Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. Q.
Lender's Name
Lender's Addre
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 county to enter upon the above-mentioned property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMTf4 i tt 8 4 22-8 Carb •
Petit to install solar suer headM
systemsystemper apt/i71+Ji. plan
2 Solar Panels 4.00
l Water SSS Tank 7.50
snit xssumice Fee 10.00
r
CRY of..Lis Qwnta
TOTAL
FEE
$2.•5U
VALUATION pp
Arrow Printing 250/1-83 White: Finance Canary: Assessor Pink: Applicant Tag: Bldg. Dept.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS ,
.
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System '
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel '
36
Inlets & Outlets
4
Grout Blocks
37
CombustiomAir
5
Bond Beams ..
38
Compressor.
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device '
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
fireplace T.O.
❑
NON -ADDITIONAL INFORMATION
/.21—)7/1i l 7 '
SEWAGE SYSTEM SIZE & LOCATION
11. Exterior.Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
• •23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
p/L P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
Ut A'
I
C -i
'7 /lYT
I
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