05-4960 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
0A QUINTA, CALIFORNIA 92253
Application Number: 05=00004-9.60_
Property Address: 78965 HIGHWAY 111
APN: 643-020-999-6 -30903
Application description: WALL/FENCE
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 1797
T4&t 4 4 Q"
Applicant: Architect or Engineer:
P (A
\ f
�i; 0/& G*
Off,-`, I
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 LicenseNo.: 397892
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
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.:
(_ 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 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. , BAP.C. for this reason
/9
ate: - wner:
CONSTRUCT( 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 L„
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/07/05
Owner:
WASHINGTON 111 LTD
C/O JACK TARR
30240 RANCHO VIEJO RD. STE. B
SAN JUAN CAPISTRANO, CA 92675
Contractor:
MOOREFIELD CONSTRUCTION, INC.
3415 S. SEPULVEDA BLVD STE 550
LOS ANGELES, CA 90034
(310)390-9400
Lic. No.: 397892
-----------------------------------------------
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 1686016-2005
1 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
37000 the L r Code, I shall forthwit comply with tho a provisions.
ate: _ plicant: `
WARNING: FAILURE TO SECURE WORKERS' COMPENSA41ON 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 state that the above information is correct. 1 agree to comply with all
city and county ordinances and stat ws relating to building construction, and hereby authorize representatives
of this county to enter upon th ove-mentioned property for iinnsspp%ection pu ses.
D J' O 'nature (Applicant or Agent):
v
Application Number . . . . 05-00004960
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee 41.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 1797
Expiration Date 5/06/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
13.00 2.0000 HND BLDG 501-2,000
26.00
---------------------------------------------------------------------=------
Special Notes and Comments
83 L.F. RETAINING WALL RANGING FROM
2'-51, CITY STANDARD & AND APPROVED C/D
PLANS AND APPROVED PRECISE GRADING
PLAN(CONFIRMED WITH PAUL GOBLE 11-7-05).
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 41.00 .00 r.00
41.00
Plan Check Total .00 .00 .00-
.00
Grand Total 41.00 00 .00
41.00
01
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 #
LA R(OO
Project Address: g _ 9
Owner's Name: G
A. P. Number:
Legal Description:
Contractor:
r
Address: 3411S
Address: O ZY
City, ST, Zip: „
�c. : �A 92675
Telephone:
Project Description:
City, ST, Zip:444
Telephone: 3!e _ 3 96 _ F yea a
ere, A / l
State Lic. # : City Lic. #:
Arch., Engr., Designer:
p J 1
Address:
City, ST, Zip:
Telephone: ��'alln
State Lic. #:Project
Name of Contact Person:
Construction Type: Occupancy:
type (circle one): (105:> Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: '� v°
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
2n' 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:-
''d 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