08-1577 (BLCK)•4��
P.O. BOX 1504 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
Date: 9/17/08
Application Number: (0 0000001.5_72- Owner:
Property Address: 80855 PASEO DE ROSARIO R.T. HUGHES
APN: 766-110-016-56 -,33597 - 78900 AVENUE 47
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (760) 771-8890
Application valuation: 4700
Contractor:
Applicant: Architect or Engineer: GHA ENTERPRISE, INC.
30875 DATE PALM DRIVE, SU C
CATHEDRAL CITY•, CA 92234 SEP(760)969-1400 17 200
Lic. No.: 750957 CIYyoF�
Fff11AROCE QUINTA
EPT.
--------------- --------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
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 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 No.: 750.957 for by Section 3700 of the Labor Code_, for the performance of the work for which this permit is
issue
�1 d,. $ God.
Date: '@`n�t a torr
_ I have and will. maintain workers' compensationinsurance,as required by Section 3700 of the Labor
'
- - .Code,.for the performance*of the work for whicfi this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION -� '— - in surancecarrier and policy number are:
I hereby. affirm under penalty of perjury that Iam exempt from the Contractors State License Law for the Carrier STATE FUND Policy Number 719000.223
following reason (Sec. 70.31.5, 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 ofthe Contractoi's Slate _ and agree that, if I should become subject to the workers' compensation provisions of Section,
License Law (Chapter .9'(commericing with Section 7000). of Division 3 of the Business and Professions Codel or • .. 3700 of the Labor Code, I shall forthwith. comply with those provisions. -
that he or she is exempt;there'from and'the basis for the alleged exemption. Any violation of Section 7031.5 by'
any applicant for a permit subjectsthe applicant to a civil penalty of not more than five hundred dollars.155001:: � D` �i v fT Applicant:_.
(_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and -
ihe structure.. is not intended or offered for sale (Sec. 7044, Business and ProfessionsCode:',The WARNING: FAILURE TO SEC RKERS' COMPENSATION COVERAGE IS UNLAWFUL; AND SHALL
Contractors"State License Law does not apply to an owner of property wi ko builds or improves thereon, SUBJECT AN EMPLOYER.TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANDd
and who�does.the work himself or, herself through liis 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 soldwithin SECTION 3706 OFTHE LABOfi CODE, INTEREST, AND AT,TORNEY'S FEES.
one year.of completion, the owner -builder, -will have the burden of proving that he or she diC not build or.
improve -for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Cade: 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.).
(_ 1 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.1.
Lender's Name: _
Lender's Address:
LQPERMIT
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 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 correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Application Number . . . . . 08-00001577
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 72.00
Plan Check
Fee
.00
Issue Date
Valuation
4700.
Expiration Date 3/16/09
Qty Unit Charge Per
Extension
BASE
FEE
45.00
3.00 9.0.000 THOU BLDG
2,001-25,000
27.00
-------------------------------------------------------------.---------------
Special Notes and Comments
188 IN FT X 6 FT HT GARDEN WALL
PER CITY
STANDARDS AND APPROVED PLANS
Fee summary Charged
Paid Credited
Due
Permit Fee Total 72.00
.00
.00
72,00
Plan Check Total .00
.00
.00
.-00
Grand Total 72.00
.00
.00
72.0.0
LQPEF.A1IT
C*4
vi
/48035
CITY OF LA COLI IN TA
BUILDING & SAFETY DEPT.
APPROVED
FOR CfNSTRUCTION
n,&0- 17//00"7 It-)ZI
Pr
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Bin #
City of .La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760)777-7012
Building Permit Application and' Tracking Sheet
Permit #
Project Address:Azle) �� d . 0
Owner's Name: R At1 Cv
A. P. Number:
r Ito
Address: O .49
Legal Description:
City, ST, Zip:
Contractor: 14- '
Address: 3057s- .v ' Q .
Telephone: % J/�-
Project Description:
City, ST, Zip: P/
Telephone:
State Lic: # :7S 5-7
City. Lic. #:
Arch., Engr., Designer:
. j^
/
Address:
City, ST, Zip:
Telephone:
State Lic.
.tConstruction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: /� �j£ '
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: Z % f —337 Estimated Value of Project
APPLICANT: DO. NOT WRITE BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Rec'd
TRACKING
Plan Check submitted
PERMIT FEES
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Pelson
Plan Check Balance
Energy Calcs.
Plans picked up µ
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2a' Review, ready for correctionsfiissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review, ready for correctionsfiissue
Developer Impact Fee
Planning Approval
Called Contact'Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees