12-1330 (BLCK)b P.O BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: �12='00001330 _�
Property Address: 81891 SEABISCUIT WY
APN: 767-200-999-40 -312023-
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5100
Applicant: JV Architect or Engineer:
air
-----------------
CENSED CONTRACTOR'S DECLARATION
4 4 Qum& C' VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/09/12
I. hereby affirm under penalty of perjur I am licensed under provisions of Chapter 9 (commencing with
Section 700 cf Division 3 of the Busi s and Professionals Code, and my License is in full force and effect.
Licens ss: B License No.: 916227
ate!// //B ntractor: I.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury tha 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 ($500).:
(_ 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, 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.).
Lender's Name: /�
Lender's Address: K
LQPERMIT
Owner:
DESERT CHEYENNE, INC.
78401 HIGHWAY 111, SUI'
LA QUINTA, CA 92253
(760)777-9920
Contractor:
GJH DEVELOPMENT INC
29207 RIDGELINE CT
TEMECULA, CA 92590
(760)777-9520
Lic. No.: 916227
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 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 EXEMPT k Policy Number EXEMPT
I crtt, in the perfor an a of the work for which this permit is issued, I shall not employ any
person in any manner sc a to become subject to the workers' compensation laws of California,
and agree that, if, I shout subject to the workers' compensation provisions of Section
3700 of the Labor CodeJ,,Jcome
hl forthwith comply with those provisions.
,15-ate:L1/9 ,- icant:
WARNING: FAILURE TO SECURE WORKS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES 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
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 ybuildinnstruction,
r cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state thmation is correct. I agree to comply with all
city and county ordinances and state laws relating to, and hereby authorize representatives
of thiscounty to enter upon the above-mentioned prion purposes.
,p5te: ignature (Applicant or Agent):
Application Number . . . . . 12-00001330
Permit . . . WALL/FENCE
PERMIT ,
Additional desc .
Permit Fee . . . . 81.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
5100
Expiration Date 5/08/13
Qty Unit.Charge Per
Extension
BASE
FEE
45.00
4.00 9.0000 THOU BLDG
2,001-25,000
36.00 .
Special Notes and Comments
204, L.F. 6' GARDEN WALL AT SIDE
& REAR,
ORCO SYSTEM. 2010 CODES.
------------------ ----------------------------------------------------------
Other BLDG
STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total 81.00
.00
.00
81.00
Plan Check Total 00
.00
.00
.00
Other Fee Total 1.00
.00
.00
1.00
Grand.Total 82.00
00
00
_ 82:00
0
LQPERMIT
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city 6f'. La, Q who,
BuiWk Br Uiviuon
P.O. Rox: 1 SP4,78495 Calle Tampico
La -Quinta, CA 92253 -:(760) 777-7012
B011ding Permit Application and Tracking Sheet.:
'Penna # '
00
Project Address:
Owner's Name,.
CL
� e--, C.
A. P. Number.
x
Address:.
Legal Description:
City, ST. zip:
City.
Telephone:''�A
Addressi
Project Description:
City. $T, Zip:
A,1 4411.
Telephone:
State Lie. #: City Lie-, 6,
ArcJL, EW., Designer
Address:
City, ST, Zip:
Telephone: Construction Type:. -
C 0ocupancy:
mr.
State Lia #: Prqject type (Cude one): New Add'n. Alter Repair Demo
.-
Name of ContactPerson: Sq. 4: # Stories: T I Units:
Telephone # Of C Ontact Person: EstimaW Value of Project
.
APPLICANT: DO NOT WRITE BELOW THIS. LINE
#
Submittal
PIqLa Sets
Req9d
--Ree'd'.
TRACENG PERM17IFEES.
Plan Check submitted Item Amount .
Structural calm
Reviewed, ready for correictlons Plan Check Deposit.
Truss Coles.
Called Contact Person Plan Check 1wante.
Mile 24 Wes.
Plans picked up Construction
Flood plain plan
Plans resubmitttd.. Mechafilcal.
Grading plan
2' Review. ready for correctionsJissue Electrical
Subcontattor 1.6t
Called Contact Person Plumbing
Grant Deed
Plans picked up SILL
H.O.A. Approval
Plans resubmitted Grading
Eq HOUSE-
Review; ready for correctlo'nsAssuc Developer Impact Fee
Planning Approval.
Called Contact Person AJ.P.P.
Pub. Wks. Appr
Date of permit Issue
Schoa Fen
Total Permit Fees