06-3371 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: (06-00003371
Property Address: 78815 "VIA CARMEL
APN: 646 -430 -031 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 625
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisi of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professions Code d my License is in full force and effect.
License Class: 1311 icen 522890
�J
Date Contractor:
' r 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 mnre 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, 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. , BAP.C. for this reason
Date: Owner:
s 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/19/06
Owner:
SANDRA YOUNG
787815 VIA CARMEL
LA QUINTA, CA 92253
Contractor:
KIRK CONSTRUCTION INC, MIKE
72677 BEAVERTAIL STREET
PALM DESERT, CA 92260
(760)346-1820 �
Lic. No.: 521890
WORKER'S COZ EENSATION ON
1 hereby affirm under penalty of perjury one of the following
I have and will maintain a certificate of consent to self-inon, provided
for by Section 3700 of the Labor Code, for the performance o or hich thi permit is
issued.
_ I have and will maintain workers' compensation insurance, as required by Section f 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 CNCL'D 08/16/06 Policy Number 1090480-2006
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 th workers' compensation laws of California,
and agree that, if I�Idome subje t tothe rke 'compensation provisions of Section
3700 of the Laborll fort h com rhos revisions.
r
Date*S= Applicant: i
WARNING: FAILURE TO SECURE WORKERS' COM NSATION 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 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 ouinta, 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 crect. I a e to co ply with all
city and county ordinances and state laws relating to building con ructiWan�eby a oriz presentatives
of thisccouunnttyy to eennttte�r upon the above-mentioned property for ' sp 'o
iDate: "f: `T'�f signature (ApplicantorAgent(: -
.
t
Application Number . . . . . 06-00003371
' Permit . . . WALL/FENCE PERMIT
-
Additional d_esc
_
Permit -Fee 19.00- Plan Check
Fee
.00
Issue Date . . . . Valuation
625
Expiration Date 3/18/07
-
Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00 2.0000 HND BLDG 501-2,000
4.00-'
----------------------------------------------------------------------------
Special.'Notes and Comments
25 LF. 6' HIGH BLOCK WALL CITY STANDARD
Fee summary Charged Paid Credited
Due t
I!
Permit Fee Total 19.00 .00
.00
19.00
Plan Check Total .00 .00
.00
.00
1
Grand Total 19.00 .00
•
.00,
19.00_
1
'
^
7
LQPERMIT
•
_� .
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:' 7 S-- 6-(.7 t (fi C It LZ /ti F� L
Owner's Name: /rj•0 Y'(j((��
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: f/ F /Z (4 �G�� �`
Telephone:`
Address: 79— ft, j
Project Description:
fi—TeCity, ST, Zip: ilf-111(_l "" 09--
lephone:
Telephone:
a7.NJds"'7 "Y ' k AK .4y
� y
State Lic. # : r 1^ G'
City Lic. #:
v'
Arch., Engr., Designer:
Address:
City, ST, Zip: '
Telephone: -
State Lic..
' :';
'Construction Type: .,, Occupancy:
Project h'Pa circle one) New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:#
Stories:
#•Units:
Telephone # of Contact Person:
Estimated Value of Project:
' -APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
f
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction,: ,
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan
2°" 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 for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person ..
A.I.P.P.
Pub. Wks. Appr •
Date of permit issue
School Fees.
;
Total Permit Fees