08-0964 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08-00000964
Property Address:
57720 BALLYBUNION
APN:
762-360-005- - -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
4250
Applicant: Architect or Engineer
`1> /
L
---------------Aln
-
ENSE
I hereby affirm under penalty of perjI licKo
Section 7000) of Division 3 of the Bd Pr f
License Class: B
i
Date: Contractor:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
nder provisiorp of Chapter 9 (commencing with
Is Code, an my License is in full force and effect.
LicenseNo/ 838041
O NER-BUILDER DECLARATION
I hereby affirm under penalty of perjury Jat I am empt from the Contractor's State license Law for the
following reason (Sec. 7031.5, Business essions 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, 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 fSec. 3097, Civ. C.I.
Lender's Name: —
Lender's Address:
LQI'ERAI IT
Owner:
KANJI KIRIMA
57720 BALLYBUNION
LA QUINTA, CA 92253
Contractor:
SOUTHERN HILLS DEVELOPMEN'
78150 CALLE TAMPICO STE 1
LA QUINTA, CA 92253
(760)771-3497
Lic. No.: 838041
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/05/08
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 wor s' compensation insurance, as required by Section 3700 of the Labor
Code, for the performanc f the work for which this permit is issued. My workers' compensatio
insurance carrier and poli number are:
Carrier STATE FUND Policy m / 8396 'z-2007
_ I certify that, in the perXrfnpnce of the o rLich this permit s issued, 1 shall not employ any
person in any man er as to be a ubl t to the workers' mpensation laws of California,
and agree that, if sh I beco sub c the workers' com enation provisions of Section
{ �/.../3'7)0�%0 of the Lab r Co e I shat orthw with those ovisions.
Date: lV ✓ 4 Applicant:
WARNING: FAILURE TO SECURE WORKER CO PENSAT N COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL P ALTI —AIVD CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO E COS OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INT ND ATTORNEY'S FEES.
n
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 o any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and 11 defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees fo ny act or omission related to the work being
performed under or following issuance of this per
2. Any permit issued as a result of this application omes null and voi rk ' ornmenced
within 180 days from date of issuance of suc r it, o i1 c for 180 da will subject
permit to cancellation.
I certify that I have read this application and statethat e a e i io ect. I agree to com y with all
city and county ordinances and state laws relating to uildi g on ructio er orize repr entatives
ofthis►/�p,o, unty to enter upon the above-mentioned pro erty o spe pu os
Date: I w Signature (Applicant or Agent):
Application Number . . . . . 08-00000964
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee 72.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 4250
Expiration Date 12/02/08
Qty Unit Charge Per
Extension
BASE
FEE
45.00
3.00 9.0000 THOU BLDG
2,001-25,000
27.00
----------------------------------------------------------------------------
Special Notes and Comments
170 LN FT X 6 FT HT PER CITY STANDARDS
AND APPROVED PLANS
Fee summary Charged
-----------------
Paid
Credited
----------
Due
---------------------
Permit Fee Total 72.00
----------
.00
.00
72.00
Plan Check Total .00
.00
.00
.00
Grand Total 72.00
.00
.00
72.00
LQPLRAIIT
Bin #
Permit #
Project Address:
A. P. Number:
Legal Description:
Contractor.
Address: —/5769
Cin. ST. Zip: /u
Telephone: X 711—Stl!
State Lic. # : x,
Arch.. Engr.. Designer:
Address:
City. ST. Zip:
Telephone:
State Lic. Of:
Name of Contact Person: x
Telephone # of Contact Person:
w
K Submittal Req'd
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 C21e5.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
//
City 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
Owner's Name: X
Address: y.
City. ST. Zip: K
Telephone:
Project Description: X
9Z2S3 1161 /;�
Lic. #:
Construction Type: Occupancy:
P P .
P ro1ectOPe
cimle one): Ne
Add'n Alter Repair Demo
Sq. Ft.: tt Stories: FV Units:
1 Total Permit Fees -
Cmunatcd Value ol'Prolect: X
APPLICANT: DO NOT WRITE BELOW THIS UNE
Rec'd
TRACKING PERMIT FEES
Plan Check submitted Item Amount
Reviewed. read} for corrections Plan Check Deposit
Called Contact Person Plan Check Balance
Plans picked up Construction
Plans resubmitted Mechanical
Y' Review. rcadv for correctionsfissue Electrical
Called Contact Person Plumbing
Plans picked up SAM.
Plans resubmitted Grading
" Review. rcadv for correctionsftssue Developer Impact Fee
Called Contact Person A.1.P.P.
Date of permit issue
1 Total Permit Fees -