09-0501 (BLCK) IIIIIIIIVIIIIIIVIIIIIII 57T4ht 4
P.O. BOX 1504 IE ___ .__ _-/ VOICE(760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING &SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
D 6/09
Application Number: 09-00000501 - Owner: !
Property Address: 79300 AVENUE 48 SANTA ROSA DEVELOPMENT INC t
APN: 649-030-069- - - 46753 ADAMS ST
Application description: WALL/FENCE LA QUINTA, CA 92253 aC �<
Property Zoning: HIGH DENSITY RESIDENTIAL (760) 771-3345 P
Application valuation: . 1200 to {�
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Contractor:
Applicant: Architect or Engineer: CONSOLIDATED CONTRACTING, INC. �� coo t
46753 ADAMS STREET
LA QUINTA, CA 92253
(760)771-3345
Lic. No. : 824183
- - -- - - - - - - - ---- - - - ------ - - -- - - -- - - ---- - - -- - - -- --- --- -- -- -- --- - - ------- - - -- - -- -- ------ - - -- -- - - -- --
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 of consent to self-insure for workers'compensation,as provided
License Class: B C8 License No.: 824183 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued.
Date: Contractor: 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
OWNER-BUILDER DECLARATION insurance carrier and policy nu rare:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Po'cy Number 0010415-2008
following reason ISec.7031.5,Business and Professions Code: Any city or county that requires a permit to _ I certify that,in thete
f th work for which this permit is issued,I shall not employ any
construct,atter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the person in any mbeco a subject to the workers'compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, meujecttothe 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 the Lall fo hwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 byr�.ggany applicant for a permit-subjects the applicant to a civil penalty of not more than five hundred dollars($500).: ate Z?' "7 App' m:I,as owner of the property,or my employees with wages as their sole compensation,will do the work,andthe structure is not intended or offered for sale(Sec.7044,Business and Professions Code: The WARNING: FAI E TO SECUCOMPENSATION COVERAGE IS UNLAWFUL,AND SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CLTIES 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 1$100,000). IN ADDCOST 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 have the burden of proving that he or she did not build or
improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT
(_) I,as owner of the property,am exclusively contractin icensed 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 actors'State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon,' ho cont acts 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 Lice .I. 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. this rem/n 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.
at 0 / Owner: 2. Any permit issued as a result of this application bec es null and void if work is not commenced
within 180 days from date of issuance of such p mit,or ce sation of work for 180 days will subject
CTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury tha ere is a construction lending agency for the performance of the I certify that I have read this application and state that[he a inform ion is correct. I agree to,comply with all
work for which this permit is issued(Sec.3097,Civ.C.). city and county ordinances and state laws relating to buil g constructi n,and hereby authorize representatives
of this cou ty to mi upon a above-mentioned prop f inspecti purposes.
Lender's Name:
D e: .a nature(Applicant or Agent):
Lender's Address: 01 Dc
LQPERMIT
Application Number . . . . 09-00000501
Permit . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 29.00 Plan Check Fee .00
Issue .Date . . . Valuation . . 1200
Expiration Date 11/15/09
Qty Unit Charge .Per Extension
BASE FEE 15.00
7.00 2 .0000 HND BLDG 501-2, 000 14 .00
----------------------------------------------------------------------------
Special Notes and Comments
48 L.F. 7' GARDEN WALL TO COMPLETE
PERIMETER WALL & CLOSE OFF CONSTRUCTION
ACCESS, ORCO SYSTEM, PER P/W APPROVAL
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- -----
-----
Permit Fee Total 29.00 .00 .00 29.00
Plan Check Total .00 .00 .00 .00 .
Other Fee Total . 1.00 .00 .00 1.00
Grand Total 30.00 .0.0 .00 30.00
LQPERMIT
s
Bin#
City Quint*aof La
Building 8i Safety Division
Permit# P.O. Box 1504, 78-495 Calle Tampico
Q La Quinta, CA 92253- (760) 777-7012
D� Building Permit Application and Tracking Sheet
Project Address: �tg- ji'rIS Owner's Name:
A.P.Number: Address:
(,,
Legal Description: City,ST,Zip: 6
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Contractor:
Telephone: -33�� �•'r:`F >�.;>:» :::::>::>::»>;:<zs>:>
..4•:
Address: A*dDe3cription:
City,ST,Zip: L
Telephone: >1>%><'s'::'a':>".a': f'>< »>?
State Lic.#: City Lic.
Arch.,Engr.,Designer: _
Address: —0 C o
City.,ST,Zip:
Telephone:
P Construction Type: Occupancy:
r:........ YP
....:...........
State Lic
#:
Project
Pe c
ir�e one): New Add,
n Alter Repair
Name of Contact Person: LIGE Sq.Ft.: #Stories: #Units:
f Telephone#of Contact Person: 2'SQ3Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd TRACKING PERMIT FEES
Plan Sets Plan Check submitted /�8 Item Amount
Structural Calcs. Reviewed,ready for corrections Plan Check Deposit
Truss Calcs. Called Contact Person Plan Check Balance
Title 24 Calcs. Plans picked up Construction
Flood plain plan Plans resubmitted Mechanical
Grading plan rd 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
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