05-4862 (BLCK)A
{
P.O. BOX 1504 i
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: � 00:004-862`
Property Address: 78442"TALKING`ROCK TURN .
APN: 770-300-012-. - -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 7620
Applicant:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT .
\I
rlo
Architect or Engineer: O ��
I . - �1_ Id
------------------
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 Business and Professionals Code, and my License is in full force and effect.
License Class: License No.:
D��//—�' °rte Contrac
' 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 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, 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'L'aw.).
(_ 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.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
SLIFER CAROL S
P O BOX 16465
DENVER, CO 80216
1_0 LraCLOr:
CA IFORNIA POOLS & SPAS
SEABRIGHT INS
WC: BB1050510
CSLB: 656128
VOICE (760) 777-7012;,,
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
01/01/06
10/31/06
-
Date: 11/01/05
------------------------- - --------------------
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.
�l 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 C8 C27 C29 C53 Policy Number - - - - - - - - - - - - - - -
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 the workers' compensation provisions of Section
37000 the Labor Code, I shall forthwith comply with those provisions.
n
WK: 41L �-C'�Applicartt:
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 (5100,000). 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 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 count rd"ances and state laws relating to buildin fonstruction, and hereby authorize representatives
of this co to enter upon the above-mentioned grope for inspection purposes.
Date: '•i�,ep Signature_(Applicant or Agent
Application Number . . . . 05-000.04862
..
�. PermitWALL/FENCE PERMIT
Additional.desc .
Permit Fee 99.00 Plan Check"
Fee "• .
00
Issue -Date Valuation.
-7620
Expiration Date 4/30/06•
Qty Unit Charge Per ."
Extension
BASE FEE.
45.0"0
" 6.00 9.0000 THOU BLDG 2",001-25,0.00
54.00
------- ----------------- - --- --- -----------
-Special Notes and Comment's
-------------
160 L.F. 6' RETAINING:BLOCK WALL, ORCO
SYSTEM;,52 L.F. 6' BLOCK WALL, CITY
-_ STANDARD; AND 145 L.F. 3' -RETAINING .
' BLOCK WALL; CITY STANDARD..
Fee. summary Charged Paid Credited
Due
----------- ---------- ---------- --------
Permit Fee Total 99.0"0 .00
----------
.00
-
99.00
Plan Check .Total .00 .00
..00
.00
Grand Total- 99.00. .00
.00
99.00
LQPERMIT
Bin #
CIity ®f La QuInta
Building 8U Safety. . Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
/
Project Address: 7S 6/yz 1K� t✓ Tvz v�
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor
Telephone:
4
Address:`,
Project Description:
�. City, ST, Zip: Coo, C J o
X G A. ' c O
Telephone:7�,Z
State Lic. # : OCY 0
City Lic. #:
'L -F X (D �2�Irl
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person: (�1
Sq. Ft.:
# Stories:
#Units:
r/
Telephone # of Contact Person: Z d • elil ,5' 021 r
Estimated Value -of Project: $ (p) O O
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal
Req'd
Recd
TRACHING .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21d 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 fdr corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees .
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