05-3624 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:0.5_0,0.0.0.3624
Property Address: 51200 CALLE PALOMA
APN: 770-143-004-104 -000000-
Application description: WALL/FENCE D
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: , 2875
Applicant: Architect or Engin er:
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BUILDING &SAFETY DEPARTMENT
BUILDING PERMIT.
Owner:
ROPER MORRIS
51200 CALLE PALOMA
LA QUINTA, CA 92253
AUG 1 5 2005 U
Contractor:
VINTAGE DEVELOPMENT GROUP INC
CITY PF LA oil
47601-MANTECA COURT
FINANCE DEPT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: . .8/15/05
_
INDIO, CA- 92201
(760)272-9292
LiC. No.: 830222
All
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LICENSED CONTRACTOR'S DECLARATION
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.WORKER'S COMPENSATION DECLARATION
r
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declara{ions:
+?
---Section 7000). 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:corisent to self -insure for workers' compensation, as provided
Class: B - License No.: 830222
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
_License
'
issued. - —
Date: Contractor:
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of *the Labor
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Code, for the performanceof the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number.are: '
' v+
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the -
Carrier EXEMPT "' Policy Number EXEMPT-
XEMPT"following
followingreason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
I certify that, in the performance of the work for which this p it 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 anymanner so. as to b subject to w ers' compensation laws of California,
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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 be m jeCt to th ar s'" pensa i rovisions of Section
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
3700 abor Cod I orthwithco y h t se provision
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any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
ate' 9 •� p scant:
(_ 1 .1;•as owner of the property, ori my employees with wages as their sole compensation,'will. do thework„and
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the structure isnot intended or offered for sale (Sec. 7044; Business and Professions Coder The
WARNING: FAILURE TO SECU WORKERS' COMPENSATION COVERAGE 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
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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 thepurposeof sale.;.. -:
APPLICANT ACKNOWLEDGEMENT
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 fo the projects with a contractors) licensed
1. - Each person upon whose behalfthisapplication is made, each person at whose request and for
pursuant to the Contractors' State License .1.
whose benefit work is performed under or pursuant to any permit issued as a result of -this application,
(_ 1 1 am exempt under Sec. , B. this reaso
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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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: �(� her:
2. Any permit issued as a result of this application becomes null and work is not commenced
within 180 days from date of issuance of such permit, or atio work for 180 days will subject
- CONSTRUCTIO CY
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 abov ation is correct r comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). �
city and county ordinances and state laws relating tobuilding ruction, and here a repres atives
Lender's Name:
of this c unty jo epi�nt3on the above-mentioned property ins s
�_�'
�
,\
Date nature (Applicant or Agent;:
Lender's Address: �/ A
LQPERMIT
LQPERMTT -
Application Number . . . . . 05-00003624
Permit. . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 54.00
Plan Check
Fee
.00
Issue Date.
Valuation
28.75
Expiration Date 2/11/06
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
ts
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_ 116 L. F.. COMBO WALL, 2' RETAINING,
6'
GARDEN, CITY STANDARD
Fee: summary, ,, Charged
Paid Credited
Due
Permit Fee Total 54.'00
.00
..00
54.00
.
Plan Check Total 00
:00
.QO:
00
Gravid Total 54.00
.00 '.
00
54.0-0
LQPERMTT -
Bin #
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City of La Quinta
Building 8t 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: j 'Z v� . Cul �epOwner's
Name:
A. P. Number: V3 ooL4
Address: Z%%6 o l /Y1`rr/'rG'Cyr e!
Legal Description: 7)�§6g Cfab
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City, ST, Zip: _
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Contractor: t/.•
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'Tele hone: one
P. . � . < R
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Address: y%�Q� M J-144 irl� �
Project De scriPtion: >:<:»:........
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Telephone: h
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State Lic. # : 09D 2,7,-Z—
City Lic.
Arch., Engr., Designer:
Address:
ry
City., ST, Zip:
Telephone:
P hon e.
:'•>:
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'.,Cod structi on Type: •c
P O P. c Y
Stat e Lic
ct �`
oe ' c rcl e on e.
. J .. New Add'n
h' P � Alter Repair air Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project::
APPLICANT: DO•NOT WRITE BELOW. THIS.; LINE
#
Submittal
Rewd ..
.
Rec'.d:
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed; ready for corrections..
Elan Check Deposit
Truss Calcs.
Called Contact Person '
Plan Check Balance
Title 24 Calcs:
Plans picked u.p
Construction
Flood plain plan
Plans resubmitted,
Mechanical
Grading plan
2nd Review, ready for correctionsrssue
Electrical •
Subcontactor List
Called Contact Person
Plumbing'
Grant Deed
Planspicked up
S.M.
H.O.A. Approval
Plans r`•esubmitted
Grading
IN HOUSE:-
''d.Review, ready for corrections/i'ssue
Developer,Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
.
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