BLCK (08-0994)57188 Medinah
08-0994
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application descripti6n:
Property Zoning:
Application valuation:
Applicant:
C0_8—.0.0000994 -
-571.88 MEDINAH
762-110-023- -
WALL/FENCE
.LOW DENSITY RESIDENTIAL
350
T,iht 4 4 Q"
Architect or Engineer:
PI/'f
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTO DECLARATION
I hereby affirm under• penalty of perjury that I am lice sed under visions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Pr essional e, and my License is in full force and effect. -
License C ss: B i nse No.: 863763
ate: { - ractor:
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
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 ($500).:-
(_ 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
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 _ 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.). -
( ) 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:
SNITKOFF MICHAEL H
57188 MEDINAH
LA QUINTA, CA•92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/11/08
Contractor:
-CHAMPION CONSTRUCTION CoLAU
100842331 MILLCREEK WAY
BERMUDA DUNES, CA 92203
(760)835-3234 QUINTiqLic. No.: 863763 EPL
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- STATE FUND Policy Number 0028780-2007
_ I certify that, in the performance of the rk for which permit is issued, I shall not employ any
person in any manner so as to beco subject to orkers' compensation laws of California,
and agree that, if I should become jest to rkers' compensation provisions of Section
37 0 of the L Code, 1 shall with c pl with those provisions.
0 // plicant
WARNING: 'FA URE 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.
1 certify that I have read this application and state that the above infor ation is correc gree to comply with all
city and county ordinances and to laws relating to building cons tion, and he y uthorize representatives
of ' count o ter upon above-mentioned property fo ion purp s.
Date: G S' azure (Applicant or Agentl:17
Application Number . . . . 08-00000994
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 15.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
350 "
Expiration Date 12/08/08
' Qty Unit Charge Per
Extension
BASE FEE
15.00
Special Notes and Comments
1316" L.F. 6' BLOCK WALL TO REPLACE WALL
AT CASITA,. CITY STANDARD
Fee summary Charged Paid Credited
-----------------
Due
------------------------------
Permit Fee Total 15.00 .00
----------
.00
15.00
Plan Check Total .00 .00
.00
.00
Grand Total.. 15.00 _.00
00
15.00
LQPERMIT
Bin #
City .of La. Quinta
Building &-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: _ i P
Owner's Name: I c6 S .f
A. P. Number:
Address:
Legal Description: Y&w.,C S c 1 J I
P&A
.
C44Pic
Contractor: CQ/% S e
Address: i4d 3 3 1 PAJI C W
City, ST, Zip:
G22S
Telephone:
Project Description:
City, ST, Zip: - o, - 9220 .3
/ 3
Telephone: -7(90- 833"•-3
b
< 4
l./61--Ael C „i a
State Lic. # W& b 3
City Lic. #:Ll
Arch., Engr., Designer:
o/
Address:
City, ST, Zip:
Telephone:
r = "
z
Construction Type: /611- k ccu anc
State Lic. #:
hPa (circleone)ect Project New ' Add'n Alter Repair Demo
Name of Contact Person:.. 1nane-Z
Sq. Ft.:
# Stories:
# Units:
Tele hone # of Contact Person: ?
P -$ 3 5 - Jo 3
Estimated Value of Project: 1960 — .
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount.
Structural Cafes.
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 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
z
a•