05-2926 (BLCK)P.O. BOX 1504
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address'
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
05-00002926
78370 COYOTE CANYON CT
770-240-009- - -
WALL/"FENCE"
LOW DENSITY RESIDENTIAL
6250
COA17-eAC-TO f\'
Architect or Engineer:
0 to-
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
----------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the B;�I�nessa'Professionals Code, andmy License Is in full force and effect.
License CI17 License No.:.
�te: / / Q Contractor.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty, of perjury that I am exemptfrom the Convector's State Ucense,Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, -alteri'improve, demolish; or repair ,a_ny-Vueturer.prior to its issuance, also requites theapplicant-for the
permitto file a signed statement that he or she is "licensed pursuant to the provisions-of"the Contractor's State
License Law (Chapter 9 icommenang 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 Sectiod7031.5 by
any applicant for a permit.subjects the applicant to a civil penalty of not more than five hundred dollars ($500)..-
1,
5500).:1, 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 (See. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an ownevof 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.).
(_) 1; as,ownerof the property,. am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Lew does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects wit -Ka contractor(s) licensed
pursuant -to the Contractors' State License Law.).
(_ 1 I am exempt,under Sec. , B.✓yP.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I herebyaffirm under penalty of perjury thatthere 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-701.1
INSPECTIONS (760) 777-7153
Date: 7/14/05
Owner:
B L MIRAGLIA TRUST
Contractor:
GOLDEN CONSTRUCTION INC, PAUL
WCC: STATE FUND
WC: 0013325-2005 01/01/06
CSLB: -786919 11/30/06
------------------
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the followirigdeclarations:
_ 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.workifor'which this permit, is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
�a Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number -,are: _
Carrier B Policy Number --'--------------
_ 1 certify that, In the performance of the,work for which this permit is, issued, I shall not employ any
person in any mannerso; come subject to the workers' compensation laws of California,
and agree that, if I sh9Amei- bject to the workers' compensation provisions of Section
370 of the Lab. -oda, I all w' comply with those provisions.
e: Applice
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
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'behelf this applicationis-made; each persomat;whose request and for
whose benefit work is performed under or pursuant to anypermit 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 Ouinta, its officers, agents and employees for any act or omission related to the work being
performed under orfollowing 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 ) 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
ofthiiii/county to enter upon the above-mentioned proparty- ins purpo
Date / ignature (Applicant or Agent):
Application Number . . . . . 05-00002926
Permit .
. WALL/FENCE PERMIT
Additional desc .
.
Permit Fee . . .
. 90.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 6250
Expiration.Date
1/10/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
5.0.0 9.0000 THOU BLDG 2,001-25,000
45.00
----
Special Notes and
-- -- --------------
Comments
--
-- ------------------
250 L.F. 6' BLOCK
WALL, ORCO SYSTEM.
Fee summary
-----------------
Charged Paid
--------------------
Credited
--------------------
Due
Permit Fee Total
90.00
.00
.00
.90.00
Plan Check Total
.00
.0.0
.00
.00
Grand Total
90.00
.00
.00
90.00
LQr Rmff
Bin !f
Crty Of La. Quinta..
Building U Safety Division '
Petmic # P.O. Box 15.04, 78-4.95 Calle Tampico
La Quinta, CA 92253 - (760) 777.7012
5 �z� Building Permit Application and Tracking Sheet
Project Address: ?� 7a C� f/t C Owner"s Name: J
A. P. Number: ' Address: .
Legai Description: % City, ST, Zip:
Contractor: O }. d,. , Telephone:
Address: Project Description:
City,ST, Zip:r
�`� Lig✓ /�7 0
Telephone:2,12 .t? .ice -::x:��,,,:`f-•'. ��;� / / v.
State Lic. # : City Lic. #:
Arch., Engr., Designee • � ��'�
Addtess:
City, $T, Zip:
4,-14- G
Telephone: " . Construction T Occupancy:
Type: Occu an
State Lic. #: type t ) p
Project circle one New Add'n Alter Repair Demo
Name of Contact Person: Sq, Ft.: # Stades: # Units,
Telephone # of Contact. Person: Estimated. Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
Submittal
Pian Sets
Rcq'd Recd TRACIZING PERMIT F'EFS
Plan Chttk.sub mitted Item Amount.
Structural Calcs.
Reviewed, reads for corrections Plan Check- Deposit
Truss Calcs.
Called Contact Person Plan Check Balance,
Title 21 talcs.
Plans picked up- Construction
Hood plain -plan
Plass°resubmitted Mechanical
Grading plan
2" Review, readyfor carr tctions/issut Electrical
Subcontsetor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.111.1.
H.O.A. Approval
Plans. resubmitted Grading -
IN HOUSE:-
3': Review eady for correctionsfissuep Developer Impact Fee
Planning approval
Called Contact Person A:I.P.P.
Pub. Wks. Appr
Date of perink issue
School Fees
L-7—
Total Permit Fees