06-2642 (BLCK)t. =�. - IIIIIIIIIIIIIIIIIIIIIIIII 46
P.O. BOX 1504 IE
-
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
06-00002642
81475 AVENUE 52
767-206-003- -000000-
WALL/FENCE
LOW DENSITY RESIDENTIAL
21900
c&-ty/ 4,4 Qu&&
Architect or Engineer
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
------ ------------------------------------------
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: B License No.: 820821
Date: a 21 UC 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 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 (5500).:
(_ 1 1, 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 ISec. 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.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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 _ I I am exempt under Sec. , B.&P.C. for this reason
Q e:yr�9a 106 OXer:
//\` 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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
I,QPI;R\f IT
Owner:
EAST OF MADISON LLC
80955 AVE 52
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153.
Date: 8/21/06
Contractor:
MCD CONSTRUCTION
49881 29 PALMS HIGHWAY 11A
Q r
MORONGO VALLEY, CA 92256 III
(760)363-7740
Lic. No.: 820821 IU I AUG 2 12006
C17Y OF LA Q NIUQ NIU q
-------------- - - - - -----------•r.nnvlCU�P�:- --
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 0442271205
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 theworkers' compensation provisions of Section
3700 of the Labor Code, 1 shall forthwith c ovisions.
Date O' < Applicant:
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 ($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 stale that the above information is correct. I agree to comply with all
City and county ordinances and stale laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Dater IDL Signature (Applicant or Agent)
Application.Number
06-00002642
Permit WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . .225.00 Plan Check Fee 00
Issue Date . . . . Valuation 21900
Expiration Date 1/07/07
Qty Unit Charge Per Extension
BASE FEE 45.00
20.00 9.0000 THOU BLDG 2,001-25,000 180.00
----------------------------------------------------------------------------
Special Notes and Comments
876 LF 6' BLOCK WALL PER CITY STANDARD
AND CDD & PW'S APPROVED ROUGH GRADING
PLAN.
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Grand Total
LQPERNIT
Charged Paid Credited Due
225.00 .00 .00 225.00
.00 .00 .00 .00
225.00 .00 .00 225.00
Bin #
- 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 #
0(0 Zb�
Project Address:' �J 1gU� S
Owner's Name: East of Madison, LLC
A. P. Number: 767-200-003 1
Address: 80955 Avenue 52
Legal Description: Portion of Lots 72 and 83 of
Contractor: Owner—Builder t_�
Address:
City, ST, Zip: La Quinta, CA 92253
Telephone: (760) 393-5288
1
Project Description:tLj
1 P 6. standard precision
City, ST, Zip:
block wall/stucco 876 l.f.'
Telephone:
Desi n pursuant to Planning Commission
approval of Item 2006-012
State Lic. # : , City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
P
State Lic. #:
Name of Contact Person: MQ.r-ez
Perimeter
Construction Type: Occupancy: n/a
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL: 8 7 6
#Stories: n/ a
#Units: n / a
Telephone # of Contact Person: ( 760) 393-5288
Estimated Value of Project: $61, 320
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACIUNG.
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
2ad 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 correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Al
Total Permit Fees
zZs ea
J'
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
`4 ntil ALL requirements listed below are complete. Incomplete applications or applications which cannot
be processed will be returned to applicant.
Date: a 1 0-7 Developer: F otj
Tract No.: U Tract Name:MA-D] SbAl Lot No. (s): —7
Address(s): �o [-N A I ��
1rn
f��c
The following are the requirements for Public Works Clearance to authorize issuance of a building permit
%om 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: PROVIDE ITEMS #7 BELO
❖ SIGNS: 8 BELOW
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,
PM10 plan & agreement or provide alternative & valid City approved PM10 plan set reference
number or hard copy plan. PM10 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 to do es)
Attach wall plan & related approved grading p
8. Attach sign layout/plan related precise grading/landscape plan.
have reviewed and confirmed the requirements listed above as presented and find the improvements to
be sufficiently complete for construction of th propose(T buildings/structures/walls/signs on the subject
lot(s). Pursuant to findings, e a ve p 'ect may be released for building permit issuance.
7
Recommended by: Dated: /6-7Z
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:
IIIIIII VIII III VIII IIII 47
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 Tract
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.
r.