07-3104 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-00003104
Property Address: 78611 TALKING ROCK TURN'
APN: 770-300-030- - -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1875
Applicant: Architect or Engineer:
I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 "am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Profession f ode, a d my License is in full force and effect.
License Cl s: C2ff9 cense�/o�.� 381984
te: `7 C actor: /{ 4/
1
OWNER -BUILDER DECLARATION
'I hereby 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 requires the applicant for the
permit to file a signed statement that he or she 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 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).:
(_ 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 intended or offered for -sale (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 not intended 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( ) 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.).
Lender's Name:
Lender's Address"
LQPERMIT
Owner:
VAN DEN BERG
78611 TALKING ROCK TURN
LA QUINTA, CA 92253
r '
Contractor:
WHEELOCK MASONRY, S.K.
P.O. BOX 12459
PALM DESERT, CA 92255
(760)275-9672
Lic- No.: 381984
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/10/07
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 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 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 for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1744382-2007
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to workers' compensation provisions of Section
3700.of the Labor Code, I s fort with ply wit those pr visions.
��01
e: A cant:
WARNING: FAIL RE 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 [o 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 informatio is correct. I agree to comply with all
city. and county ordinances and state laws relating to buildin constructs nd he eby authorize representatives
of this county to ent?ignZre(Applicant
er.upon the above-mentioned pro or ins ec ' purpo
Datr7. Z�/� or Agentl:
: Application Number 07-00003104
' Permit . . WALL/FENCE
PERMIT
Additional-desc-.
-
Permit Fee 43.00
Plan -Check
Fee
00
Issue. -Date
Valuation
1875
Expiration Date 6/07/08
Qty Unit Charge Per
Extension
BASE
FEE
15..00:
14:.00 2.0000; HND BLDG
501-2,000
.28:00
Special Notes and Comments
75 L.F. 6' GARDEN WALL & 85 L.F.
OF <31
PLANTER WALL;'BOTH ORCO SYSTEM
Fee summary -Charged.
Paid Credited
Due
----------------- ------
Permit Fee Total 43.00
.00
.'00
43.00
Plan Check Total .00'
.00
.00
.00
Grand Total 43.00
.00
.00
43.00
• t ,
LQPER1k11T - -
-
Bin #
-
`
t City of la Quints
Building 8t Safety Division
` P.O. Box 1504;. 78495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
-Building Permit Application and Tracking Sheet F
Permit.#,
. 1
Project Address: .. / ,`�Lu
79 . l '
Owner's Name:
Ile,
A. P. Number: (r e-� : t
Address: LD7 SL 7i Kip /�ocK
Legal Description:. '— i
City,ST Zi
Contractor:'
,• fid! ��`i'C" L� G� �
Telephone:. -
Address: Q ' L f Z ��
Project Description:
City, ST, Zip: ��Lm CS%�. C/�-'�ZZS�S
'%S�L�� G.• i� C�,f%�D>s�!/�6�G.
Telephone:7&_ 10 2?!5 % '%(>
�� L � C LdaU•, ��c � �' i i� W� l
State Lic. #":
CityLic. #: C—
0/-zC,0
Arch. Engr, Designer:
Address: € .
City, ST, Zip:
Telephone:.
lr
Construction Type:, Occupancy: •
State Lic. #:
Project type.(circle.one): New. Add'n Alter ,• Repair- Demo
Narrie of Contact Person:
Sq. Ft.:
# Stories:
# Units:`
Telephone # of Contact Person:
tW
Estimated'Value of Project: 15i -06, --
^ APPLICANT:-DO NOT WRITE BELOW THIS LINE
#
Submittal
�Req'd
Rec.'d.-
• TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted .'
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
l
Truss Calcs.
}+
Called Contact Person
Plan Check Balance
314
Energy Calcs.
PlanSpicked.up ,M ..
Construction
Flood plain plan.
Plans resubmitted
Mechanical
"
Grading. plan''„
�2"' Review, ready for corrections/issue
Electrical
Subcontactoi, List
Called Contact Person
Plumbing
t '
Grant Deed `.
Plans picked up
S.M.I.
H.O.A. Approval
,-
Plans resubmitted
w
Grading
IN HOUSE:-
3d 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
•
:r
-Total Permit Fees