06-1274 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address: -
�r APN:
Application description:
ri Property Zoning:
�) Application valuation:
Yf
C
4
Applicant:
06-00001274_
51390—CA-LLE JACUMBA
770-166-026- -
WALL/FENCE
MEDIUM DENSITY RES
3750
T41tt 4 4 Qm&&
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
GREEN MARK
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 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 Deco ubject to�thecers+eompensation provisions of Section
3700 of the Labor Code, 1 a I f fh ith h tho;� provisions.
'Da3 G�rAPPlica /
WARNING: FAILURE TO SECURE 44ElS' 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 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 i rmation is corre to comply with all
city and county ordinances and state laws relating to buil ' g co uction, eby authorize representatives
of this coynty tQ enter upon the above-mentioned prop y for ' trio S.
LQPERMIT .
Application Number . . . 06-00001274
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 63.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. .
3750
Expiration Date 9/25/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
2'.00 9.0000 THOU BLDG 2,001-25,000
18.00
---------------------------------------------------------------
Special Notes and Comments
150 LF 6' BLOCK WALL PER APPROVED PLAN
& CITY STANDARD.
Fee summary Charged Paid Credited
Due
----------------- ---------- ---------- ----- -----
Permit Fee Total 63.00 .00
----------
.00
63.00
Plan Check Total .00 00
.00
.00
Grand Total 63.00 .00
.00
63.00
LQPERMIT .
r
Bin '#
-,
City of La Quinta.
Building U SAV Division
Box 1504, 78-495 Calle Tampico
La Ql!iInta, CA 92253 - (760) 777-7012.
Building Perinit Application and Tracking Sheet
Permit #P.O.
Project Address:'51 S 61kiel -Nazo MIJ741
70
Owner's Name: 67 (7-fAtW
�A. P. Number: ? 7 0 Agn 40 (2
Address:
Legal Description:
Contractor:
City, ST, Zip:
Telephone:
Address: T5"4 -ems
Project Description: �q x
City, ST, Zip:
i2CC7
Telephone:
State Lic. # City Lic.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic.
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: F# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec.'d
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted.
Item
Amount
Structural CaIcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Caics.
Called Contact Person
fPlan
Check Balance
Energy Calcs.
Plans Picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan
2°d Review, ready for corrcctionsrissue
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