07-0704 (BLCK)IIIIIII VIII III VIII (III 75
IE
P.O. BOX 1504 --- -- - --- �- -
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07-00000704
Property Address:
80175 AVENUE 52
APN:
772-410-018- - -
Application description:
WALL/FENCE .
-'j Property Zoning:
HIGH DENSITY RESIDENTIAL
i Application valuation:
3447
Tiht 4 4 Q"
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: B License No.: 774293
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
Lhat he or she is exempt therefrom and the basis for the alleged exemptinn. 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 _) 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.
7644, 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 I 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:
LQPERMIT
Owner:
GREYSTONE CLUBHOUSE ASSOC LLC
341 BAYSIDE DR STE 7
NEWPORT BEACH, CA 92660
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/07/07
Contractor:
GREYSTONE MULTI -F $S_ I,1
341 BAYSIDE DRIVE, ��'�•
NEWPORT BEACH, CA 0
(949) 566-9230 MAR 08 2007
Lic. No.: 774293 E
OF
C
F1 NC ;DEPT j
--------------------------------------------
WORKER'S COMPENSATION. DECLARATION
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 ZENITH. INS CO Policy Number Z066293904
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
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: —/ % -V7 Applicant: 4_ .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). 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 state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for 19spection purposes.
>�
Date:3 VZ Signature (Applicant or Agent): '
- 7
Application Number . . . . . 07-00000704-
Permit
7-00000704
Permit . . . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 63.00
Plan Check
Fee
.00
Issue Date
Valuation
. .
3447
Expiration Date 9/03/07
Qty Unit Charge Per
Extension
BASE
FEE
45.00
-t 2.00 9.0000 THOU BLDG
2,001-25,000
-
18.00
------- -----------------------------
f Special Notes and Comments
------
-----------
------
---------------
450 LF WROUGHT IRON Q TWO RETENTION
BASINS
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
1111111111111111111111111
Bin #
76
'E
City of La Quinta
Building U 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: a SZ
Owner's Name: 4W)W,- CL.0pot-YC A-SS� GLC,
A. P. Number: '777 -67b -oz -1 4�
Address: 34/1 1i,9"l F(pf Q �''+-f 1Z At 7
Legal Description:
City, ST, Zip: N J5W PoA J Q f C { ( <A 9U60
(gyp
Contractor: 4 fwfsJD�1.(u(,T/,�j,���`c� ��s
Telephone: %y9� �G-62 45/
Address: 3 r !Of PR
A,fdM `7
Project Description:
City, ST, zip: /�i�6. 667 PE., "�(
cA &O
2 A,574,- f�c4c/r /fr
Telephone:y
�'f E►.i Tlo� p st s
D
City Lic. #:135-b3
State Lic. # : '77Y? -175
Arch., Engr., Designer:
✓
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
1. # 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 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 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 correctionstiissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
GQ' zz
City of La Quinta - PM 10 Project Information (< 1 acre per Lot or Infill Project) Page 1 of 3
Form updated & effective 8/25/2005
Project Information
Project Phase
Project Contractor:
Project Phase
(Check One):
❑ Construction
❑ Demolition
Project Name:
Project Tact
Number:
Lot Number(s):
Anticipated Start Date:
Project Street
Address:
Anticipated
Completion:
Total acres in active
construction (< 1 acre
per Lot):
Project Contact
Information
Please Note: Dust control is required 24 hours a day, 7 days a week,
regardless.of construction status. Person listed below is responsible
for dust control during business and non- business hours.
Name:
Title:
Company Name:
Mailing Address:
City:
State:
Zip Code:
Primary Telephone
Number:
Fax:
24 Hour
Access/Emergency
Phone:
Cell Phone:
PM 10 Certificate
Number:
❖ Expanded PM 10 plans for commercial and residential developments > 1 acre are required by
the City of La Quinta.
CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET
PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT
Form updated & effective 11/17/2006
Green_ Sheet approvals are forwarded to the Building & Safety Department directly by Public Works.
Please DO NOT submit the Green Sheet (Public Works Clearance) Packet to the Public Works Department
until ALL requirements listed below are. complete. Incomplete applications or applications which cannot
be processed will be returned to applicant.
Date:
/07 Developer:. EYS-rC)N F U C-- L�--
Tract No.:?r0 Tract Namg
�,e: LuA0uS. Ac,P i < Lot No.(s): ----�
Address(s).:
The following are the requirements for Public Works Clearance to authorize issuance of a building permit
from the Building & Safety Department:
❖ CUSTOM HOMES: PROVIDE ITEMS #2 #3 #4 AND #5 BELOW
❖ TRACT HOMES:. PROVIDE ITEMS #1 #2 #3 #4 (AS APPLICABLE) AND #6 BELOW
❖ COMMERCIAL BUILDINGS/OTHER: PROVIDE ITEMS .#1 #2 #3 AND #5 BELOW
❖ WALLS: PROV�DEEMS #7 BELOW S j ( FDNC( AJ jr � �. N.�oN+�jp�r,,� J
SIGNS: PROVIDE ITEMS #8 BELOW <,jM'"4 fT- cTr_a, , _
1. Attach Pad Elevation Certificates in compliance with the approved design elevation for building
pad (maximum allowable deviation of .+/- 0.1 foot). Pad Elevation Certificates must be current
(within 6 months -of current date). If a precise grading plan creates the pad for approval, please.
withhold green sheet submittal until a Pad Elevation Certificate can be provided.
2. Attach geotechnical certification of grading plan compliance.
3. Attach recorded final map showing proposed building locations are legal lots.
4. Attach a completed < 1 acre per lot or infill project Fugitive Dust Control project information form,
PM 10 plan .& agreement or provide alternative & valid City approved PM 10 plan set reference
number or hard copy plan. PM 10 plans for commercial & residential developments (beyond 1 lot)
are submitted separately with grading plans & are subject to additional requirements.
5. Attach an approved precise grading plan for the building location(s). AO flood zone developments
will require an approved flood plain development plan.
6. Attach an approved rough grading plan for the building location(s).
7. Attach wall plan & related approved grading plan.
8. Attach sign layout/plan & related precise grading/landscape plan.
I have reviewed and confirmed the requirements listed above as presented and find the improvements to
be sufficiently complete for construction of the proposed buildings/structures/walls/signs on the subject
lot(s). Pursuant to ngs, he ab ve proje t may be released for building permit issuance.
Recommended by: Dated: 3 �D
Public Works Distribution: (_ Green Sheet to Building & Safety counter
(_) Green Sheet to Community Development
Declined for approval for reason(s) as follow(s), please correct and resubmit:
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713)451-6779 HOUSTON.TEXAS 77015
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