07-2547 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-00002547
Property Address: 53502 .HUMBOLDT BLVD
APN: 767-200,998-R -330762-
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 21000
Applicant:
I hereby affirm under penalty of pi ju�ry that I am
Section 7000) of Division 3 of the iness and
License Class:: B C
ntractor:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
EAST OF MADISON LLC
PO BOX 1482 _
LA QUINTA, CA 922471
ID
0821
r 9 ommencing with
is in lull force and effect.
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 ($5001.:
(_ 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.).
(_ I 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. ,'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.1.' - -
Lender's Name: -
Lender's Address:
LQPER1A1T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/11/07
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Cnde, f . pr, orma )fthe.work for which this permit is
issued.have and will maintain worker ' ompensation insurance, as reby Section 3700 of the Labor
Code, for the performan of the work for which this permit ed. My workers' compensation
insurance carrier and olicy number�a�rm% �Carrier STATE FUND Po" ul7fber 044227
of
manner so as to jrQl,�Fryfj�u 'b to the
�f I should be
3700 of the
: is issued, I shall not employ any
compensation laws of California,
peasaLLgn_provisions of Section
those provisions.
f
te.plicant:
WARNING: FAILURE TO SECURE�ALES
MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CR 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 applicatio e, each person 'ose request and for
whose benefit work is performed and ursuant to any permit issued as esult of this application,
the owner, and the applicant, a grees to, and shall defend, indemnify and Id harmless the City
of La Quint; i icers, a is and employees for any act or fission related t the work being
performed der or fol Wing issuanc f thi p it.
2. Any perm}��ssued a result of thi pli io becom It and void if wor ' not commenced
within 1�0/days rpm date of i nc f ch per or cessation of we for 180 days will subject
M'
to OV
ation.
I celtify jK read this plication s th o information is «ect. I agree to comply with all
my ordinances an ate la r i b din onstruction, d hereby authorize representatives
t s county to enter upo he a oses.
ate: Signature (A n nt):
Contractor: ll
Architect or Engineer:
MCD CONSTRUCTION
49881 29 PALMS HIGHWAY
MORONGO VALLEY, CA 922:
l
1�
(760)363-7740
LiC. No.: 820821
0821
r 9 ommencing with
is in lull force and effect.
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 ($5001.:
(_ 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.).
(_ I 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. ,'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.1.' - -
Lender's Name: -
Lender's Address:
LQPER1A1T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/11/07
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Cnde, f . pr, orma )fthe.work for which this permit is
issued.have and will maintain worker ' ompensation insurance, as reby Section 3700 of the Labor
Code, for the performan of the work for which this permit ed. My workers' compensation
insurance carrier and olicy number�a�rm% �Carrier STATE FUND Po" ul7fber 044227
of
manner so as to jrQl,�Fryfj�u 'b to the
�f I should be
3700 of the
: is issued, I shall not employ any
compensation laws of California,
peasaLLgn_provisions of Section
those provisions.
f
te.plicant:
WARNING: FAILURE TO SECURE�ALES
MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CR 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 applicatio e, each person 'ose request and for
whose benefit work is performed and ursuant to any permit issued as esult of this application,
the owner, and the applicant, a grees to, and shall defend, indemnify and Id harmless the City
of La Quint; i icers, a is and employees for any act or fission related t the work being
performed der or fol Wing issuanc f thi p it.
2. Any perm}��ssued a result of thi pli io becom It and void if wor ' not commenced
within 1�0/days rpm date of i nc f ch per or cessation of we for 180 days will subject
M'
to OV
ation.
I celtify jK read this plication s th o information is «ect. I agree to comply with all
my ordinances an ate la r i b din onstruction, d hereby authorize representatives
t s county to enter upo he a oses.
ate: Signature (A n nt):
Application Number . . . . . 07-00002547
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee. 216.00 Plan Check
Fee
.00
Issue Date Valuation
21000
Expiration Date 3/16/08
Qty Unit Charge Per
Extension
BASE FEE
45.00
19.00 9.0000 THOU BLDG 2,001-25,000
171.00
----------------------------------------------------------------------------
Special Notes and Comments
•840 L.F. 6' BLOCK WALL, EAST OF MADISON,
ORCO SYSTEM
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 216.00 .00
.00
216.00
Plan Check Total .00 .00
.00
.00
Grand Total 216.00 .00
.00
216.00
Bin #
City of La Quinta.
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
'La Quinta, CA 92253 - (760) 777-7012
..Building Termit Application and Tracking Sheet
Permit.#
Project Address:'AggErE -, % C
Owner's Name:
A. P. Number:
Legal Description:
City, ST, Zip: eye
Contractor:
Telephone: -7V— b.
Project Description:
Address:
City, ST, Zip:
Telephone:.
State Lie. # : City Lie. #:
Arch.,•Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Construction T 4' '
YPe: ;. Occupancy -
Project type (circle one): New Add'n .Alter Repair Demo .
S9# 3>on # Units: .
Estimated Value of Project:
Telephone # of Contact Person:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACH. G _
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amoant
Structural Calcs.
Reviewed, ready -for corrections
Plan Check Deposit
Truss Cales.
Called Contact.Person
Plan Check Balance
Energy Calcs..
Plans picked up'.
Construction
Flood plain plan.
Plans resubmitted
Mechanical
Grading plan
tad•Review, ready for eorrcetions/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:
''d Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET
PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT
Form updated & effective 11/17/2006
Green_ Sheet a rovals are forwarded to the Building& Safety Department directly by Public Works, -
Please DO NOT submit the Green Sheet (Public Works Clearance). Packet to the Public Works Department
until ALL requirements listed below are :complete. Incomplete applications or applications which cannot
be processed will be returned to applicant.
Date: ? O Developer: ( GCS`$
Tract No .� 6rL Tract Name:
Address(s) W�pr-c,t_ .�-d>Ell1 S - 'Tb f g tr-LJ .
The following are the requirements for Public Works Clearance to authorize issuance of a building permit
from the Building & Safety Department:
❖ CUSTOM HOMES: PROVIDE'ITEMS#2 #3 #4 AND #5 BELOW
❖ 'TRACT HOMES: PROVIDE ITEMS #1 #2 #3, #4 (AS APPLICABLE) AND #6 BELOW
COMMERCIAL BUILDINGS/OTHER: PROVIDE ITEMS #1 #2, #3 AND #5 BELOW
WALLS: PROVIDE ITEMS #7 BELOW
SIGNS: PROVIDE ITEMS #8 BELOW
J.r Attach Pad Elevation Certificates in compliance with the approved design elevation for building
pad (maximum allowable deviation of +%- 0.1 foot). Pad Elevation Certificates must be current
(within 6 months of -current date). If a precise grading plan creates the pad for approval, please
j withhold green sheet submittal until a Pad Elevation Certificate can be provided.
2. Attach geotechnical, certification of grading plan compliance.
Attach recorded final map showing proposed building locations are legal lots.
4. Attach a completed, < 1 acre.:per lot or, infill project Fugitive Dust Control project information form,
PM10 plan & agreementor provide alternative & valid City approved PM10 plan set reference
number or. hard copy plan.- PM 10 plans for commercial & residential developments (beyond 1 lot)
are 'submited separately with grading plans & are subject to additional requirements.
5. Attach an approved precise grading plan for the building location(s). AO flood zone developments
will 'require an approved flood plain development plan..
6. Attach. an. approved rough grading plan for the building location(s).
tach wall plan &related approved grading plan.�-�,'
ttach sign iayout/plan & related precise grading/larid5 ape plan.
'��`� .
,�
I have reviewed and confirmed. the requirements listed above as presented and find the improvemen
be sufficiently complete for construction of t proposed buildings/structures./walls/signs on the subject
lots)-. Pursuant n e a ove p o` ct may be released for building permit issuance.
Recommended b Dated:
Public Works Distribution:.. (�C reen Sheet to Building & Safety counter
(_) Green Sheet to Community Development
Declined for approval for reason(s) as follow(s), please correct and resubmit: