08-0921 (BLCK)P.O. BOX 1y504 VOICE .(760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA,'.CALIFORNIA 92253. :' BUILDING & SAFETY DEPARTMENT INSPECTIONS (.760) 777-7153
BUILDING PERMIT
��r-- Date: 5/23/08
Application Number: 108-.0-0000921 Owner:
Property Address: 53300 AVENIDA NAVARRO:. KATHY GRIBIN
-APN: .774-095-002-23 000000- 53-300 AVENIDA NAVARRO
Application description: WALL/FENCE ' c LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL (760) 564-4104 - �� a
Application valuation:' 1535 D /A\
Contractor: Ln� p
Applicant: Architect w Engineer: WHITLEY' S REMODELING MHI 2 3 2008
74804 JONI DRIVE, STE 7A
PALM DESERT, CA 92260 CIN�FLAgUINTA
(76 0) 341-9480 FINANCE DEPT.
(
Lic. No.: 805021
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
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 consent to self -insure for workers' compensation, as provided
License Class: B License N .: 805021 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
4 Q issued.
Date: -S —7,7.- Hontractor: �� r•% _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
s Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION insurance carrier and policy number are: -
I hereby affirm under penalty of pe y that I am exempt from the Contractor's State License Law for the Carrier GRANITE INS Policy Number 6923463
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 the work for which this 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 become subject to the workers' 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 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 3700k the Labor Code, 1 s forthwith plcwith 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 ($500).: _ Date: , Applicant:
(_ 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 intendd or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE RKERS' CO ENSATION 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 CR NAL PENALTI S 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 (5100,0001. IN ADDI ON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building 6r 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 1, as owner of the.properiy, 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) licensed 1 . 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,
`�. 1 _) I am exempt under Sec. , BAP.C. for this reason - 'A 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 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 all
work for which this permit is issued (Sec. 3097, Civ. C.). - city and county ordinances and state laws relating to building c [ruction, and hereby authorize representatives
of this county to erlier upon the above-mentioned property foV c[io�urposes.
Lender's Name: -'
Date: Signature (Applicant or Agent
Lender's Address: - -
LQPERMIT . -
Application Number 08-00000921
"Permit . . . WALL/FENCE PERMIT
Additional desc .
• Permit Fee 37.00 Plan Check
Fee ."
00
Issue' -Date - . . . . Valuation
1575
Expiration Date
Qty Unit Charge Per
Extension
BASE :FEE
15.00
11'`.00 2.0000 HND BLDG 501:2,000
22,OQ
Special Notes and Comments
- 63.LN FT X 6 FT HT GARDEN BLOCK WALL PER
CITY STANDARDS AND APPROVED PLANS
Fee summary Charged - Paid Credited
Due
Permit Fee Total 37.00 .00
.00
37.00
Plan Check Total .00 .00
.00
.00
Grand Total 37.00 .00
.00
37.00
LQPERAI IT - -
- -
Bin #
City of - La Quinta
Building U Safety Division
P.O. Box 1.504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
..Building Permit Application and Tracking Sheet
Permit #
Project Address:' 7r�
Owner's Name: �.
A. P. Number:
Address: 3 49-0
Legal Description:
Contractor: sC
OC(;A4�
City, ST, Zip: �,¢ �pQ . �a a �'3
Telephone:
Address: 17 96 L/ opi 1
Project Description: Ir �/ � �� n>, to L �S.
/-
City, ST, Zip: - o+Z K� 0
/--
%
Telephone: 40
State Lic. # : :. "CityLl
Arch., Eng., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person: �—�C�
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories: -T
# Units:
Telephone # of Contact Person: 9,&0 `-7
Estimated Value of Project:*�j 0 , co
APPLICANT; DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit"
Truss talcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2"u Review, ready for corrections/issue .
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permtt Fees