09-0101 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: �o9=00000101-1—
..Property
101. Property Address: "57300 PENINSULA LN
APN: 762-150-038- - -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2100
TA04f g It
44Q
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT '•
Owner:
CROWLEY G T 2006 LIVING TRUST
6610 N. PURDY PKWY
APPLETON, WI 54913
Contractor:
Applicant: Architect or Engineer: SOUTHERN HILLS DEVELOPMENT
78150 CALLE TAMPICO STE 101
LA,QUINTA, CA 92253
•l�� (760)771-3497
1" Lic- No.: 838041
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-. LI ENSED CONTRACTOR'S DECLARATION . WORKER'S COMPENSATION D'
hereby affirm under penalty of perjury tha am licen u rovisions of Chapter 9 (commencing with I hereby. affirm under penalty of perjury one of the following declaration
Section 7000) of Division 3 of the Bu_sines and Prof sionals C e, and my License is in full force and effect. _ -I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: 13 tcense No.: 838041 for by Section 3700 of the Labor Code, for the performance of the work'for which this permit is
issued.
ate- -10/ 0 ntr.ctor - 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
OWNER- UILDER DECLARATION insurance carrier and policy number are:
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier OAK RIVER INS Policy Number 2200053408-081
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of work for w ' is permit is issued, I shall not employ any '
• construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to ome subjec o thew ers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that,.if I should becbsubject to ompensation.provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, 1 ' 1 h ly with those provisions.
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 ($5001.: - ate: � plicant: -
(_ 1 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 WARNING: FAILURE TO SEC UR ORKERS' COMPENSATIO VERAGE•IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
.and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). - APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044,.Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) license_ d '11. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). . whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ F I am exempt under Sec. , BAP.C. for this reason - - 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.
.Date: Owner: - 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
• CONSTRUCTION LENDING AGENCY - permit to cancellation.
I herebyaffirm under penalty of perjury that there is a construction lending agency for the performance of the - I certify that I have read this application and state that the above nformation i I agree to comply with all
work for which this permit is issued ISec. 3097, Civ: C.1- - - city and county ordinances and to laws relating to building c ction, d hereb uthorize representatives
of this ounty to enter upon t above-mentioned property f spe i p S.
Lender's Name: ••o
• te: ^ (/-Y I Si ature (Applicant or Agent)' .
Lender's Address: '
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/10/09
LQPERMIT
LQPERMIT
Application Number . . . . 09-00000101
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 54.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 2100-
100Expiration
ExpirationDate 8/09/09
Qty Unit Charge .Per
Extension
BASE FEE
45.00
1.00 9..0000 -THOU BLDG 2,001-25,000.
9.00
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Special Notes and Comments
84 L.F., 6' GARDEN WALL, CITY STANDARD
c�
SOUTH P/L
Fee summary Charged Paid
Credited
'Due
Permit Fee Total 54.00
.00
.00
54.00
Plan Check Total .00
.00
.00
.00
Grand Total 54.00
.00
.00
54.00
Bin #
1
(i Permit #
Project Address:
A. P. Number:
Legal Description: 126--
Contractor: K Du till'
Address: Q
City. ST, Zip:
Telephone: X 7 -
State Lic. #12,5
: x,
Arch.. Engr.. Designer:
Address:
City, ST. Zip:
Telephone:
State Lic. #
Name of Contact Person: X
Telephone # of Contact Person:
# Submittal Req'd
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
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 8t 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
. r
Address:
go 3x o City. ST, Zip: x I
Telephone:
'• /Gp eA Project Description: X
�. 2.f3
Lic. #:
Total Permit Fees
Construction Type:
Occ uc. an �•.
P
. .. ::..
. .. ...
P r J' ect type (circle one):
Newc g1dd'n Alter Repair Dcmo
i
Sq. Ft.:
#
Stories:
# Units:
Estimated Value of Project: X
APPLICANT: DO NOT WRITE BELOW THIS LINE
Rec'd
TRACKING
PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Constriction
Plans resubmitted
Mechanical
"tl Review, ready for corrections/issue
Electrical
Called Contact Person .
Plumbing
Plans picked up
S 111.1
Plans resubmitted
Gradin;
7rd Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A 1 P P
Date of permit issue
Total Permit Fees