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06-4405 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 0-51-3 81622 RANCHO SANTANA DR 767-200-999-3 -312022- WALL/FENCE LOW DENSITY RESIDENTIAL 281 T,iht 4.4 Q" Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury t licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busine and essionals Code, and my License is in full force and effect. License Class: B C29 CS License No.: 455121 ate: Z' ontractor OWNER -BUILDER DECLARATION I hereby affirm under penalty o perjury hat I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, usine s and Professions Code: Any city or.county that requires a permit to construct, alter, improve, demoli 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.). - (_ I 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. , 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.I. Lender's Name: _ Lender's Address: LQPERMIT Owner: NICK THOMAS 81622 RANCHO SANTANA - LA QUINTA, CA 922531D (760)777-9920 IJ Contractor: TOPMAN BUILDERS P.O. BOX 10202 _ PALM DESERT, CA 9225 (760)772-7296 Lic. No.: 455121 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/29/06 u `C 2 9 2006 1 �L C 'Ty OQUTAI w 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. Y -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 CLARENDON Policy Number 01KR-0030-842 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 I shout(bbrome Aject tok the workers' compensation provisions of Section 3700 of the Labor Cbdel I sh ll foytVNith coRply with those provisions. WARNING: FAILURE TO ECURE WOR ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER O CRI MINA PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN DITION O THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LAB COD . 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 ab infor ati is correct. I agree to comply with all city and county ordinances and stat aws relating to buildi constru i ,and hereby authorize representatives of this c ty to enter upon the ove-mentioned property or insp ti purpose e: Z �`'Si ture (Applicant or ent): Application Number Permit Additional desc . . Permit Fee . . Issue Date Expiration Date . . . . . 06-00004405 WALL/FENCE PERMIT 15.00 Plan Check Fee . Valuation . . . . 6/27/07 .00 281 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments 13 L.F. 5- EQUIPMENT BLIND WALL, 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 LQPERMrr 1 Bin # City of La Qu►nta 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: Owner's Name: V�% C K 0,S A. P. Number: Address: Legal Description: City, ST, Zip:L,4,2 Contractor: Telephone: Address:rj(p Project Description: ii -}�1 LtDC n/�� City, ST, Zip: Pt` hn `•i . )12-�SaT= Telephone: -7t,.-,. `7"12 , t{ State Lic. # : L1SSV).,k City Lic. #: Arch., Engr., Designer: Address: IJ--N City, ST, Zip: Telephone: M—M �ff State Lic. #: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: ��a Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project. S6=1 APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Rcq'd Reed TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed ready p�,rections for#b`r Plan Check Deposit Truss Cates. 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