07-0267 (BLCK):+ P.O- BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant -
T4'1v1-4-4Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
07 -00000267
79798 DANIELLE CT
602-390-031- -
WALL/FENCE
LOW DENSITY RESIDENTIAL
240
I hereby affirm under penalty of perjuXthat I
Section 70 0) of Division 3. of the Visiness a
LicenseC ss: C8 C27 C29
Date: V —/ Contractor
Architect or Engineer:
NIS -
CONTRACTOR'S DECLARATION
nsed under provisions of Chapter 9 (commencing with
as sio als Code, and my License is in full force and effect.
I License No.: 656128
I 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 iny structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or st a is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with S ction 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the ba is 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).:
(_) 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 I, 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.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
COLLIVER RESIDENCE
79-798 DANIELLE CT.
LA QUINTA, CA 92253
Contractor:
TESERRA
P - O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
I
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/24/07
JAN 25 2007
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 worker compensation insurance, as required by Section 3700 of the Labor
Code, for the performance 0 the work for which this permit is issued. My workers' compensation
insurance carrier and policy n mber are:
Carrier SEABRIGHT ii Policy Number BB1070510
person in any mann so E
and agree that, if I s ould
3700 of the Lab:I
Date: t/ - Applicant:
WARNING: FAILURE TO SECURE WORK
SUBJECT AN EMPLOYER TO CRIMINAL I
DOLLARS ($100,000). IN ADDITION TO
SECTION 3706 OF THE LABOR CODE, II`
>f the work for which this permit is issued, I shall not employ any
me subject to the workers' compensation laws of California,
e su ct to the workers' compensation provisions of Section
forth h comply with those provisions.
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
:ST, AND ATTORNEY'S FEES.
1:1PPUCANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made
to a 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 pu ant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, n shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and,of r any act or omission related to the work being
performed under or following issuane of this p r it.
2. Any permit issued as a result of this application a omes null and void if work is not commenced
within 180 days from date of issuance of such �io
essation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that t ' abo infotio ' correct. I agree to comply with all
city and county ord' ances and state laws relating to c trun, an hereby authorize representatives
of this%co ty to a iter upon the above-mentioned pro y for ec urposes.
Date :u' '°�C/ V ature (Applicant or Agent):
Application Number
. . . . . 07-00000267
Permit . .
. WALL/FENCE PERMIT.
•.Additional desc .
Permit Fee
15.00
Plan Check
Fee
.00
Issue Date
Valuation.
240
Expiration Date
7/23/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
Fee summary
-----------------
Charged Paid
--------------------
Credited
----------
----------
Due,
Permit Fee Total
15.00
.00
.00
15.00
Plan Check Total
.00
.00
.00
.00
Grand Total
15.00
.00
.00
15.00
LQPERMIT
I—
Bin #
i
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:? °/ -
A. P. Number:
Owner's Name:
Address:
Legal Description:
City, ST, Zip:_
Contractor: 5� �-y�
Address:P Y_ 12
Telephone:
Project Description:
City, ST, Zip:60PC EUV-tJ ClS CIZ23 r'_
%L.
Telephone:.39 g �J ZZ Z'
State Lie. #
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #: j
Name of Contact Person: C_
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft: # Stories: # Units:
Telephone # of Contact Person: C -2-57',,C)_ .2 J Estimated Value of Project:
APPLICANT: DO NOT WRITE,BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Recd
TRACKING A
Plan.Check submitted
PERMIT FEES
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 pian
Plans resubmitted
Mechanical
Grading.plan"
2" Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
Mo:A. Approval
Plans resubmitted
Grading
IN HOUSE:-
i
3W Review, ready for correctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees