06-1137 (BLCK)P.O. BOX 1504 -
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
06-00001137
53665 AVENIDA CORTEZ
714-101-013-7 -000000-
WALL/FENCE
COVE RESIDENTIAL
1750
Ta�14�44"
Architect or Engine)
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am li and rovislons of Chapter (commencing with
Section 7000) of, Division 3 of the Business and fessiona ode, and my, License is in full force and effect.
so Class: cane No.: 836472
Date: rt G Contractor:
OWNEWBUILOER DECLARATION
Thereby affirm under penalty of perjury that 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 requiresthe applicant for the
`..-gpnit to file a signed statement that hworshe 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.forthe alleged exemption. Any'viofation of -Section 7031.5 by
any applicant for apermit subjects,the applicant to a civil penalty of not ,more than five hundred dollars (6500)::
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is notintended or offered`forsale (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 notintended 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.).
(_) I, as owner of the property, am exclusively contracting with.lioensed contractors to construct the project, (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply town 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 thWreason.
Data. Owner:
CONSTRUCTION LENDING AGENCY
I. hereby affirm under penalty of perjury that there is a construction lendingagency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQiPElt m1T
Owner:
BEN SHOSHAN
53665.AVENIDA CORTEZ
LA QUINTA, CA 92253
Contractor:
CHAMPION CONSTRUCTION
83292 GREENBRIER DRIVE
INDIO, CA 922.01
(760)835-3234
Lic. No.: 836472
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Dater 3/20/06
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintafma certificate of consent to self -insure for workers' compensation,, as provided
for by Section 3700 of the Labor Cade, 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-forwhich this permit is issued. My workers' compensation
insurance carrier.and policy number are:
Carrier STATE FUND Policy Number 229040028780
_ I certify that, In the performance of the work for which.this permit is issued, Tshall notemploy any
person in any manner so as to become - jecLto the workers' compensation laws of California,
and agree that, Ifis'"I shall f with :became: of to the workers' compensation provisions of Section
!yry3/J000 of the Labor C comply with those provisions.
Date: Applica- -
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO. CRIMINAL PENALTIES AND CIVIL FINES UP TO'ONE HUNDRED THOUSAND
DOU:ARS(6100,000).. 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 shell defend, indemnify and hold harmless the City
of La 0uinta, 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 beeomesmulland'void if work is not commenced
within 180 days from date of issuance ofsuch 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 informatio correct. I agree to.comply with all
city and county'o d'nances and state laws relating to building c ructio nd hereby authorize representatives.
of thisQ ty t Mer upon the above-mentioned property fo specti rposes.
Date Y Signature (Applicant or Agent):
Application Number . . . . . 06-00001137
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 41.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 1750
Expiration Date 9/16/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
13.00 2.0000 HND BLDG 501-2,000
26.00
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Special Notes and Comments
70 LF 6' BLOCK WALL FROM REAR P/L @
SIDE P/L PER ORCO STANDARD.GENERAL
CONTRACTOR ALSO'DOING MULTIPLE TRADES.
Fee summary Charged Paid
Credited
Due
-
Permit Fee Total 41.00
------------
.00
---
.00
----
41.00
Plan Check 'Dotal .00
.00
.00
.00
Grand Total 41.00
.00
.00
41.00
.'r
LQPERMIT
Bin #
City of La Quints
Building ex Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
2
Project Address: �� 3 (o �o r- 4t7
Owner's Name: S OS '), Q
A P. Number:
Address:
Legal Description: G C.J2,I I X 2 0City,
Contractor:Telephone.
Address: of ^, ti e f r
ST, Zip:LA QQ
Project. Description: �L
City, ST, Zip:�jp CI nap 3
LOC'1hkr , 0 n
Telephone -6.0— S 3 3
CA, 0�- Sd OL
State Lic..# : 3 City Lic. #:
Arch., Engr., Designer.
Address:
City, ST„Zip:
Telephoner
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New dd'n . AlterRepair. Demo
Name of ContactPerson:Sq.
FL:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated' Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACING .
PERMIT FEES
Plan Sets
Plan Check sdbmitted
Item
Amount
Strnetural.Calcs
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Ener” Coles. -
Plans pieked up
Construction
Flood plain plan
Plana resubmitted
Mechanical
Grading. plan'
2e° Review, ready for correctionslissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked.up
S.1H.L
FLOA.•Approval
Plans resubmitted
Grading
IN HOUSE:
''" Review, ready for cor.metionsiissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Prop oSEA t-l_Uc'k-WAm_
-H ou SE
50
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LA_Glo%w-vA , CA: NT s
92253. W. -
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I -A QwtATAJA 322-53
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APPLICATIO14 FOR TREE PLANTING
I (we), the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if trees are required under River-
side County Ordinance No. 457, the applicant agrees to install said, trees prior to final,*, It is understood that no final inspection
will be given until said requirements have been met or exception has been granted by the County. Now, therefore, it is agreed that the prop-
erty owner shall cause the property lines to be surveyed in the event no survey stakes con be found. Further, it is agreed that the County of
Riverside shall assume no responsibility should trees have to be removed due to lot line errors.
Owner's Name C-Ol7fZ S-OV\STr C-0. A -1\C .
Mailing Address 6,4 City L
Job Address _5Z-6L5'S tCor �z
Legal Description %_ at 7 �t-k 1Q.Sc¢JrC i a
Assessors Map, Book & Page 774 f) 1 3
Type of Soil Is water available �CeS --Road Dept. Plot Plan No.
Type of existing trees in road right—of—w{ '. f�� e
(� c171 1 YG. 00A -
Trees preferred by applicant (1) (2)
Date . -7-31-29 Owner's Signature
Planning Commission Case No.
ROAD DEPARTMENT APPROVAL
(3) C)\l Je—
Approved species:Ceratonia siliqua (Carob) Number of trees 1
CL Spacing of trees Distance from lot lines: Front 2' in R/W Side
i c Additional requirements Pet plot plan on reverse. No street trees will be planted
within 10' of driveways. I __ r%
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Date Building and Safety notified 10/79 Signature
REQUEST FOR EXCEPTION
Reason
(attach additional page if necessary)
Request ,for hearing: YES ❑
Owner's Signature
(Forward application to Planning Dept. if exception requested).
Planning Dept.
Concur ❑
Date
Road Dept.
NO REQUEST FOR HEARING
Non-coneur ❑ Explanation
Signature
Concur ❑ Non -Concur ❑
Date Signature
REQUEST FOR HEARING AND COMMITTEE DECISION
Date hearing established Date hearing notice mailed to owner
Approved ❑ Disapproved ❑ Date Owner notified of decision
Date Building & Safety notified Signature
Final Date Inspector —
Job Address
Requirements .for tree planting complied with
Remarks
APPROVAL BY BUILDING INSPECTOR
Building Permit No
-ommun i ty
(Detach and forward above information to Road Department Riverside)
284-230, REV. 1/74
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