09-1088 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09.000 i'6 8
Property Address: 78405 `COYOTE CANYON CT
APN: 770 -240 -005 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 20000
T-iht °F 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MICHAEL BALMUTH
78405 COYOTE CANYON COURT
LA QUINTA, CA 92253
Contractor:
MC DERMOTT ENTERPRISES
P.O. BOX 163
PALM DESERT, CA 92261
(760)346-0745
Lic. No.: 306566
VOICE (760) 777-7012'
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/12/09
D OCT 13 zoos
CITY OF LA
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LICENSED NTR aOR'S ECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am 1' eased -der pro ns 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 ro Ass nals Co nd 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 Lice s NO.: 306566 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: W0Contractor: ✓ _ 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 -B DER DECLARATION insurance carrier and policy -number are:
I hereby affirm under penalty of perjury that I am exempt rom the Contractor's State License Law for the Carrier STATE FUND Policy Number 5761 -2009
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of ther for ich this ermit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to beca/ubj to the rkers' 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, ' I should becom su e!ct o the wo ers' mpensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 37 00 of th abor Code, (.shall o Kwit co ply nth se provisions.
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 1$500).: Date:l� 0 pplicant:
1 _ 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 (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKES' COMPENSATION 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 CRIMINAL P NALTIES 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 ($100,000). IN ADDITION TO THE COST 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
(_ 1 1, as owner of the property, am exclusively contracting with licensed 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 Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts 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 License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
1 _ 1 I am exempt under Sec. B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
fI d h kb'ein
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
of La Qwnta, its officers, agents and employees or any act or omission re ate to t e wor g
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 t commenced
within 780 days from date of issuance of such permit, or essation o k r 1 0 days will subject
permit to cancellation.
I certify that I have read this application and state that the abov formatio s corr �.t' I agree to comply with all
city and county o�ignature
d state laws relating to building nstr ctio and h by aut orize representatives
of this Ic'lounty to he above-mentioned property f in ectio pur s.
te:/V (Applicant or Agent .
Application Number . . . . . 09-00001088
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 207.00 Plan Check Fee
134.55
Issue Date . . . Valuation . . . .
20000
Expiration Date . . 4/10/10
Qty Unit Charge Per
Extension
BASE FEE
45.00
18.00 9.0000 THOU BLDG 2,001-25,000
162.00
----------------------------------------------------- ----------------------
Special Notes and Comments
160 L.F. 30" RETAINING WALL @ FRONT
YARD, 192 L.F. 18" GARDEN WALL @ BACK
YARD, 2 161IX16" 8' PILASTERS, ORCO
SYSTEM
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ENERGY REVIEW FEE
13.46
Fee summary Charged
Permit Fee Total 207.00
Plan Check Total 134.55
Other Fee Total 13.46
Grand Total 355.01
LQPERMIT
Paid Credited Due
.00 .00 207.00
.00 .00 134.55
.00 .00 13.46
.00 00 355.01
11
Bin #
Qty of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
A
Project Address:
(;.4-
Owner's Name: I q t 1 ,(,-f vtq
A. P. Number:
Address: --7�-Qoy- (dfe 6/jpivoo Of
Legal Description: (4 77
City, ST, Zip: LA- QL,,10 k-1
Contractor: vY-L
Telephone:
Address: a
Project Description:
escriptior-
City,
City, ST, Zip: ti. zz-(i 1
6012..
Telephone:.
14
..... .
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State Lic. #
City Lic.
Arch., Engr., Designer:
KA) &A-
Address:X---Ue tA I mi.
VIA 1,,J 30 f Wb -1 I f U6
f
City, ST, Zip: Ki
('11A J&-". bt 192VFT
Telephone:
...........
. . .........
. . .... . ............
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): (f�e) Add'n Alter Repair Demo
Name of Contact Person: &0t-1 &�o (007,W 6 h.
Ft.:
["Estimated
# Stories:
# Units:
Telephone # of Contact Person: -1 VD, LJ Z - -7" 1
Value of Project: Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Reqld
Reeld
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss CaIcs.
Called Contact Person
Plan Check Balance.
Title 24 CaIcs.
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 correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees