06-0263 (BLCK)• IIIIII�III�IIIIIIIIIIIIII 38
P.O. BOX 1504 _ IE
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-00000263
Property Address:
81123 AVENUE 54
APN:
767-320-001- -
Application description:
WALL/FENCE
`. Property Zoning:
VERY LOW DENSITY RES
Application valuation:
45465
Applicant:
wptl�`�
Architect
T-it!t 4 XP Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
�p
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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 N : 701039
ntractor: j/ k.
l
OWNER -BUILDER DECLARATION
C"Or. I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law fo e
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
lW 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 155001.:
(_) 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.).
(_ 1 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/17/06
Owner:
MCCOMIC GRIFFIN LLC
7979 IVANHOE AVE #550
LA JOLLA, CA 92037
Contractor:
TRANS WEST HOUSING, INC.
9968 HIBERT STREET, STE #102
SAN DIEGO, CA 92131
(858)653-3003
Lic. No.: 701039
------------------
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 1648813-2005
_ 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.Lilber Code I shall forthwith com ly ie provi ions.
te: pplicant: /
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE I UNLAW7FUL,SHALL
S
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNSAND
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 sta laws relating to building construction, and hereby authorize representatives
of thi =nty to ante upon t ave -mentioned property r 5inspelgio!p2ses
ate: nature (Applicant or Agent):
Application Number . . . . . 06-00000263
Permit WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 388.50
Plan Check
Fee
00
Issue Date . . . .
Valuation
45465
Expiration Date . . 7/16/06
Qty Unit Charge Per
Extension
BASE
FEE
252.00
21.00 6.5000 THOU BLDG
25,001-50,000
136.50
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Special Notes and Comments
2100 L.F. 2'-5' RETAINING WALL,
ORCO
SYSTEM
Fee summary Charged
----------------- =
Paid
Credited
Due
----- ---- ----------
Permit Fee Total 388.50
----------
.00
----------
.00
388.50
Plan Check Total .00
.00
.00
.00
Grand Total 388.50
.00
.00
388.50
,.c
Y
LQPERMIT
Bin #
City of La Quinta
Building u Safety Division
Permit # ��P.O. Box 1504, 78-495 Calle Tampico
(�J La Quinta, CA 92253 -.(760) 777-.7012
Building Permit Application and Tracking Sheet
Project Address:
L� Owner's Name:
A. P. Number:1 i vi 3
S Address:
Legal Description:
�J City, ST, Zip:
CoRtritctUr:
Telephone:
Address: 1,47 —lW
Project Description:
City, ST, Zip: LZZ53 c2—
Telephone: 7 7
State Lit. # : City Lie. #:
-17Arch., Engr., Designer:
Address:
-------------
City, ST, Zip:
Telephone: Construction Type: Occupancy:
State Lic. #: p .
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:# Stories: #Units:
Telephone 4.0f Contact Person:
7-7-6 3 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 Cales. 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 I10USE:- 3" 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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