07-2850 (BLCK)A.
r
-P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
"Application description
Property Zoning:
Application valuation:
Applicant:
0-7---0-0.0-0 2 8 5 0
7948-5—HIGHWAY 111
600-020-027- -
WALL/FENCE
REGIONAL COMMERCIAL
850
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:� A -B License No.: 650389
/ 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).:
(_) 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 _ 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 I am exempt under Sec. , BAP.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:
LQPERAIIT
Owner:
STAMKO DEV CO
10345 W OLYMPIC
LOS ANGELES, CA
Contractor:
JACOBSSON ENGINE
P.O. BOX 14430
PALM DESERT, C
(760)340-0194
Lic. No.: 6503 9
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BLV 2 FL
90064
55 N.Oi,
Jr 6 ZD07
CIy'�•OF
�q�,L� �Ui A
Date: 11/05/07
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 765310106
_ 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 1 should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith ompl with those provisions.
Date:PJ'9 A ant: `lam✓
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 state that the above information is correct. 1 agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to to enter upon the above-mentioned property for i'nspp�pe tion proses
91- " Signatur (Applicant or Agent): ��'t�L
LQPERI%IIT
Application Number . . . . . 07-00002850
Permit . . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 23.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
850
Expiration Date 5/03/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
4.00 2.0000 HND BLDG 501-2,000
8.00
-----------------------------------------------------------------=----------
Special Notes and Comments
34 L.F. 6' BLOCK WALL -. TRASH ENCLOSURE,
PER APPROVED PLANS & P/W APPROVAL
Fee summary Charged Paid Credited
---------- ------ -
--- ----------
Due
----------------- ----------
Permit Fee Total 23.00 00
.00
23.00
.Plan Check Total .00 .00
.00
.00
Grand Total 23.00 .00
.00
23.00
,Bin#
-Moo--- IMP"Wftow—
City oAa Quinta.
Building u Safety Division
P.O. Box ' 1504, 78-495 Calle TampicoLaQuinta,CA922SI-(760)777-7012
..Building Permit Application and Tracking Sheet
Permit.#
Project Address:'
":1 L L'i Q j l 1.
J
Owner's Name:
A. P. Number: 5 Fe'-.r cc_
Address:
Legal Description:
Pity, ST . , Zip:
Contractor:J qt 0 o, i ri
Telephone: (76 o) 77 7 6 q&
Project Description:
J V-
Address: g 0
City, ST, Zip: P61( �-Y'n
.TeldphoneY'76o) %0'o 1'el
State Lic. # 0 City Lic. #:
Arch., Engr., Designer:
2— PI-V4-
LS
ZAIMA CW=. *0 U I WD L ge%Ss Gmy
Address: J I I W 61 V
City, ST, Zip: �-o 0_ CIO x.02:
Telephone: (56�) .00
State Lic.
Name of Contact Person: 6L�- SS b
t
$A. WC-LOSUkE 0&L,
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
—Stories:
Sq. FL:
#
# Units:
Telephone # of . Contact Person: (,-760)
Estimated Value of Project .
APPLICANT: DO NOT. WRITE BELOW THIS LINE
N
Submittal
Reqld
Rec.1d
TRACKING
PERMIT FEES
Plan Sets'
Plan Check submitted
l tilItem
Amount
S.tructural.Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called'contact*Pcrson
Plan Check Balance
Energy Calcs..
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
21d Review, ready forcorrectionsfissue
Electrical.
Subcontactor List
Called ContactPirson
Plumbing
Grant Deed,
Plans picked up
S.M.A.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for c'orrcctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
4
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P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760)777-7012
FAX (760) 777-7011
To: Greg Butler, Building & Safety Manager To PW: 10-29-07
From: PAUL GOBLE; SENIOR ENGINEER Due Date: ASAP
Permit #: Status: 1ST REVIEW
Building Plans Approval
(This is an approval to issue a Building Permit)
The Public Works Department has reviewed the Building Plans for the following
project:
Description: TRASH ENCLOSER WALL./ REVISION(
Address or General Location: 79485 HIGHWAY 111
j Applicant Contact: MICHEAL KRUS 760-275-5571
pc L 'r�°� �Sc-a✓��
The PUBLIC WORKS DEPARTMENT finds that: A4>
'IT- Sft vxV
❑ ...these Building Plans do not require PUBLIC WORKS Department() 7-
ap aI. '-TW
a�d�
ij"" ..these Building Plans are approved by the PUBLIC WORKS Department.
❑ ...these Building Plans require corrections. Please forward a copy of the
attached corrections to the applicant. When the corrections are made
please return them to the PUBLIC WORKS Department for review.
a7
PAUL GOBLE S044R NGINEER Date •
Permit #:
. f��ftiCv
P.O. BOX 1504 BUILDING & SAFETY DEPARTMENT
78-495 CALLE TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
Butler, Building & Safety Manager
Johnson, Director -PDD
To PD: 10-29-07
Due Date: ASAP
Status: 1ST REVIEW
Building Plans Approval.
i (This is an approval to issue a Building Permit)
f The Planning Department has reviewed the Building Plans for the following
" project:
Description: TRASH ENCLOSER / REVISION
Address or General Location: 79485 HIGHWAY 111
Applicant Contact: MICHEAL KRUS 760-275-5571
The Planning Development Department finds that:
❑ ...these Building Plans do not require Community Development
Department approval.
2'�- ...these Building Plans are approved by the Community Development
Department.
❑ ...these Building Plans require corrections. Please forward a copy of the
attached corrections to the applicant. When the corrections are made
please return them to the Community Development Department for
review.
Les Tohnsgfn, Director -PD
�t :F/0 7
Date