05-4451 (SOTB)P.O. BOX 1504 ^�
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: ,O.5- 04451 Owner:
Property Address: 58569 QUARRY RANCH RD QUARRY RANCH
APN: 766-060-999-5 -30651 - 41865 BOARDWALK NO 214
Application description: STRUCTURES OTHER THAN BUILDINGS- PALM DESERT, CA 92211
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6000
Applicant:
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I m licensed under provisions of Chap�in
mencing with '
Section 7000) of Division 3 of the Business d P fassionals Cod nd y Licenforce and effect. -
License Class* is s o.:
ate: 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 (5500).:
I _ 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
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 i am exempt unser 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:
L,QPERMIT
Contractor:'
C & G CONSTRUCTION COMPA"
WCC: STATE 'FUND
WC: 1799267-2005
CSLB: 692234
VOICE (760) 777-7012 -
FAX (760) 777-7011
INSPECTIONS (760) 777-71.53
Date: 10/04/05
-- - ---------------- - - - - -- --f ��Ql�lRq—
WORKER'S COMPENSATION DECLA jg�+pr
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 or
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 B ' Policy Number - - - - - - - - -- - - - - -
I certify that, in the performanceof the work for which thispermitis issued, I shall not employ any
person in any manner so as to become subject to thew ers' ompensation laws of California, _
and agree that, if I should become ubj ct to the rk s' co ensation provisions of Section
3700 of the Labor Code, 1 s II f h th c wi thos rovisio '
Da Applicant:
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
v:haaa hana8t wod,;5 vu. fvnneJ u.06i ui Vwsuain to any permit Issuea as a r65Ult 6t 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 corre I agree to comply with all
city and county ordinances and state laws relating to buildin tru ion, an ' e auth ize representatives
of this county to enter upon the above-mentioned property f on pos -
Dat ef `� Signature (Applicant or Agent):
LQPERMFr ?
Application Number . . . 05-00004451
Permit BUILDING PERMIT
Additional desc .
Permit Fee 81.00 Plan Check Fee
52.65'
Issue Date . . . . Valuation . . .
. 6000
Expiration Date 4/02/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
- 4.00 9.0000 THOU BLDG•2,001-2'5,000
36.00.
Permit . . ELEC-MISCELLANEOUS
Additional desc
Permit Fee 18.60 Plan Check Fee
4.65
Issue Date . . . Valuation . . .
. 0
Expiration Date .. 4/02/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
8.00 .4500 EA ELEC DEVICE/FIXTURE >20
-----------------------------------------------------------------------------
3.60 .
Permit PLUMBING
Additional desc
Permit Fee 1.8.00 Plan Check Fee
4.50
Issue Date Valuation
0
Expiration Date 4/02/06
Qty Unit Charge Per
Extension
BASE .FEE
15.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00
----------------------------------------------
Special Notes and Comments
---------------
BARBEQUE ONLY. ANSI #Z21-58-1995.
-----------------------------------------------------------------------------
Other Fees . . . . . ENERGY REVIEW FEE
5.,27
Fee summary Charged Paid, Credited
Due
Permit Fee Total 117.6.0 .00 _.00
117.60
Plan Check Total 61.80 .00 .00
61.80
Other Fee Total 5.27 .00 .00
5.27
Grand Total 184.67 .00 .00
184.67
gin a!
City -of La Quinta
Building U Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: o ��',
Jdd•�W �q.r) Owner's Name:
A. P. Number: Address:
Legal Description: TX4 cr- '306S ( r
City, ST, Zip: L4_
Contractor: C 0 tfjS�JLn Telep hone
s
Q S
Address: (b S %(
S � • Project Description: =�
City, ST, Zip:CA
Telephone:,?O l el� 7 - q4G r ........ _
APPLICANT: DO NOT WRITE BELOW THIS LINE
4 Submittal Req'd Rec'd T
Plan Sets Plan Check submitted
Structural talcs. Reviewed, ready for co
Tiruss"Calcs. Called Contact Person
Title 24 talcs: Plans picked up
Flood plain plan Plans resubmitted
Grading plan
Subcontactor List
Grant Deed
II.O.A. Approval
IN IIOUSF:-
Planning Approval
Pub. INTS. Appr
School Fees
2"' Review, ready for r
Called Contact Person
Plans picked up
Plans resubmitted
BY
RACKING 9y 'ERMIT FEES
O p Item Amount
rrection4 Plan Check Dgrosit
Plan Check BaAance
Construction Ore
Mechanical
urrections/issue Flectrical
rlumbing� SAS ' OvJ'L6*T
Grading
Developer Impact Fee
TA 77
A.I.r.r.
TY_DE—"
Cil
Total 1'crmit fres
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fd'r1hft
_- 849
3 ewsw ales
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s Q.,u,ab
;F&M /AJ5#0e .,7?d +.:S
fd'r1hft
_- 849
3 ewsw ales
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T >`
(th an)
(lZ-0A)
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4 $'",S
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