05-3347 (BLCK)iv `Ilk
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA;. CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:_
Property Zoning: �.
Application valuation:
Applicanf;; .
O17
S-0000334'7
57591 SANTA ROSA TR
762-240-013-14 -30487
WALL/FENCE
LOW DENSITY RESIDENTIAL
3200
t.; --. a
Architect or
'.
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
..SANTA ROSA DEV
40847 SANDPIPER CT
PALM, DESERT, CA 92260.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
I, Contractor:
CASA VERDE LANDSCAPE MAINT COR"
_78341 DARBY! ROAD
A
BERMUDDUNES, CA 92201--0
(760)320-8755
Lid. No.: 624647
Date: 8/02/05
" .:LICENSEDCONTRACTOR'S DECLARATION -
I hereby affirm underperialiy. of perjury than am licensed untler provisions of: Chapter :-9=lcommencing-.with
WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of peijury one of the following declarations:
Section 70001'of:Division 3 of the Business and Professionals Code, 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..- C-2:7 - License No.: -62'4647, -
-. for by -Section 3700 of the Labor Code, for the'performance o£the.work for.which this permit is
.issued.. •• :. '' rs.
ontractor: M •� -� xBt7E� -
/�.'
1; have and -will maintain workers' compensation insurance, as required by Section 3700 of the Labor
TTT -
F.-',• _^,�:. _
OWNER•BUILDER.DECLARATION
r Code, for the performance-of.the work -for which.this`permit is issued. My worker' compensation
insurance carrier and -policy number:are:-
I herebyaffirm.under penalty of -perjury tgat I am exempt from the Contractor's State License Law for the
Carrier'GRANITE. - Policy Number . 954'9987 -
following reasoni(Sec. 7031.5, Business and Professions Code: Any city or county that requires,a permit to
L ' .1 certify that, in'the performance of the work -for which this permit is issued,) shall not employ any
construct, alter;`improve, demolish, or repair any structure, priorto its issuance; also requires the applicant for the
person in any manner so as to become subject to the workers',compensation laws of California,
rm
peit 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 become subject to the workers compensation provisions of Section
-License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and,Professions Code) or
3700 of th bor Code, I shall forthwith comply 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 the applicant to a civil of not more than five hundred dollars ($500).:
te: • �•" Applicant: �y��
permirsubjects penalty
O �1, as owner of the property; or my employees -with wages as their sole compensation, will do the work, and
- "
-.thestructure is not intended or offered forsale (Sec. 7044, Business and Professions Code: The -
" WARNING: FAILURE TO-SECURE.WORKERS:. COMPENSATION.'COVERAGEIS UNLAWFUL, AND SHALL
• . Contractors' statiNL cense LaW does.r of apply to amown'& of,property who 6uiias or -improves thereon,
SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES -AND CIVIL FINES:UP TO ONE HUNDRED. THOUSAND
.'and whodoes;the work himself`or herself through his or her own" employees,'provided that'fhe
DOLLARS (5100,000) `IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
. improvements are not intended;or.offered for sale: If, however, the building;or.improvemerit is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND'ATTORNEWS FEES. "
- one.year of _completion; the owner -builder will Have the -burden of proving that'he orshe did.not build or
" improve forahe purpose of'saleil. -' -
- APPLICANT ACKNOWLEDGEMENT
I ). I; as owner of the property, am exclusively contracting with licensed contractors:to construct the project (Sec.
IMPORTANT Application is hereby made to the"Director of Building and Safety for a permit subject to the
7044;,.Business'and Professions Code: The Contractors' State License -Law does notapply'to an owner of
conditions and restrictions set forth on this application:
" property who builds or improves thereon, and Who contracts for the projects with a contractor(s) licensed
1 . Eich person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.)-'
- whose:benefit work is performed under or pursuant to any.permit issued as a result of this application,
I_). I am exempt under Sec. , B.&P.C. for this reason -
the$wner, 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 ofthis 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 hereby affirm 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 information is correct. I agree to comply with at;
work for which this permit is issued (Sec. 3097; Civ: C.).
city and county ordinances and state laws relating to building construction, and h by authorize representatives
"
. of this cou y t enter upon th above-mentioned propert or ins tion
Lender's Name:
' -
e: ignature (Applicant or Agent): ,
Lender's Address:
LQPERitfIT
Application Number 05-00003347
Permit WALL/FENCE PERMIT
Additional desc .
Permit.Fee 63.00
Plan Check
Fee
.00
Issue.Date . . . .
Valuation
. . .
. 3200
Expiration Date 1/29/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
2.00 9.00.00 THOU BLDG -2,001-25,000
18.00
,. - - ---- -. -- -- - -- --------------------
pecial Notes and Comments
------------
------
---------------
128 L..F. 6''GARDEN WALL,. CITY STANDARD
-
:Fee summary. Charged Paid
Credited
Due
Permit. Fee:Total,.., 63.0.0
00 ..00
7 7
63.00
Plan -Check Total ' .0"0
:0.0
00
00
- Grand',TotaT 63.00
:00
00
63.00
LQPERAIIT.
70, 00'
Ok
Bin # City Of La uinta
Building a Safety Division
Permit # P.O. Box''1504, 78-495,Calle Tampico
La Quinta, CA 92253,- (760) 777-7012
L�',Lj Building Permit Application and Tracking Sheet -
Project Address: S 'S'1 SAAAA . k&A IV l l Owner's Name: x 5 1N A iOI i S 1 �,'O
A. P. Number: Address: X 4�
Legal Description:
City, ST, Zip:
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Contractor:�( S C' I3t—
Ajb&Crj j0
Telephone,:,. 7`(s0MQ _
Address: _3u ( "�
City. ST, Zip:)( Q U��, AJ i
Project Description:
Telephone: 3S —7
d �
...................................:.:..::::::
C
State Lic. # : K
Citv Lic. #:
Arch.. Engr., Designer:
Address:
City. ST, Zip:
Telephone:
Construction - T
Type: e: Occupancy:
c
'State e Lic. #
Pr
.oJect hPe (circle o ) N e Add' n Alter Repair ar Dcmo
Name of Contact Person:
OA1 OS ISq.
Ft. I # Stories: # Units:
+ Estimated Value orProject: X —
• Telephone # of Contact Person: %
P'� _ ;
APPLICANT: DO NOT,.WRITE,BELOW THIS LINE
k Submittal Itcq'd Recd :TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cnlcs.
Rev7ewed, ready for correctionsflan
Check Deposit
Truss Calcs.
Called Contact Person
PIan,Check Balance
Title 24 Calcs.
flans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"a Review, ready for correction's/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SAI.1.
11.0:A. Approval
flans resubmitted
Grading
IN IIOUSE:-
''' 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
(O 3