11544 (BLCK)Building
Address '7p-7rr,
Owner
john Ca
mailing
Address P.O. Bax 977
City Zip
La Quintan 9
Contractor
44
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 11544
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Tel.
2253 ( Legal Description
Project Description Alock wall 2601 of 61 hiah
Address _--
_n_ Anx 47
BY:
Minimum Setback Distances:
Front Setback from Center Line
City
T.,a O. rota
Zip
922553
Tel.: "
(F1.9)7r2 -432
Side Street Setback from Center Line
State Lic. -
& Classif.
City
Lic. # 269.
Sq. Ft.
Size
No. No. Dw.
Stories Units
-Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address.
Tel.
r
'
City
Zip
State
Lic. #
v i —LICENSED CONTRACTOR'S DECLARATION
I hereby affirm/tthat I atn licensed under provisions of Chapter 9 (commencing with Section
f Diiviission3 of the Business and'Professions Code, and my license is in full force and
e000)ffec` lt
_
SIGNATURE DATE
' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec.. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, Improve• demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section. 7000). of
Division 3 of the Business and Professions Code, or that. he Is exempt therefrom, and the basis
for thealleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
' subjects the applicant to a civil penalty of hot more than five hundred dollars ($500).
' ❑ 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,.Buisness and
Professions .Code: The Contractor's License Law does not apply to an owner o/ property who
builds or Improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year o/ completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner o/ property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to -the Contractor's License Law.)
. ❑ I am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
�s
V Q • d�
PERMIT
,
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
-
Const.
9p 00
Mech.
Electrical
Plumbing
.70—
S,M.L
„
Grading
Driveway Enc.
Date owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) '
Policy NO-- Company
11�1opy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 11 the permit is for one hundred dollars ($100) valuation
or less.) -
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date . Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions o/ the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) -
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I 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 -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
s
Infrastructure
{ V51 P'f'NM,O%' i A `{.(t4-9 pf; tri +t 4.
TOTAL 90.70
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation..
r
■
COACHELLA VALLEY FRINGE -TOED LIZARD
SECTION 10A MITIGATION FORM
FROM:
APPLICATION
DATE:
APPLICATION .FOR
GRADING OR BUILDING
PERMIT NUMBER
ASSESSOR'S PARCEL NO(S).
ADDRESS
CITY OF LA QUINTA
Z-- 90
,VIA ��IvCS /-%V4
r (Nam; of Developer) has applied for a
building/grading permit affecting 4/6,S' acres.
This proposal will require the payment of $ 219, /0 _e2
($600. 00 X g,5 acres) . 085 'FA% VMAi ii I$ 00.00i0
By: G✓_ l�! /✓-�ii
Title
* * * * * * * * * * * * * * * * * * * * * * * *
We have received mitigation in the amount of
($600.00 X _'M-5- acres) in the form of cash on
from 44,110 -4& vJ-
Name of Developer
$ Z 9�
Z-/Y - 90
Title
BJ/FORM.006