10-1307 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: �1100�00�001TO
Property Address:, 52-2� 570-WH-ISP-ER'ING WY
APN:- 767-740-046- -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
AuuliUbIdUr1 vaivatiorl' 2115'^ "
Applicant: Architect or Engineer:
4 VOICE (760) 777-7012"
FAX (760) 777-7011
BUILDING &SAFETY DEPARTMENT. INSPECTIONS (760) 777=7153
BUILDING PERMIT ,
Date: 12/01/10
Owner:
DESERT CHEYENNE, INC.
78401 HIGHWAY 111, SUITE G
LA QUINTA, CA 92253-
(760)777-9920
- - - - - - - - - - - - - - - - - - - - - - - — — — - — — — — — — — — — — —37
— — — - — — — — —
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C29 LicenseNo.: 370756
Date: Contractor: -
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 ($500).:
(_ I I, asowner 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.).
(
<, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Cade: 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.). -
1 I am exempt under Sec.or th reaVn
JCON�RUCTION LENDINGAGENCY
thereby affirm under penalty of perjury that there i 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:
LQPERA9IT
Contractor: D A
PULLIAM MASONRY, JOHN
1535 NANDINA AVENUE 1
PERRIS, CA 92571 ' (1Cncr 1 2010
(951)940-4441
Lic. No.: 370756 CITY OF LA QUINTA
FINAK Jr nEPT,
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 OAK *RIVER INS Policy Number 220'0056668101
I certify that, in the performance of the work fo which this permit is issued, I shall not employ any
person in any manner so as eco sub' ct to the workers' compensation laws of California,
and agree that, if I o com bjec o the workers' compensation provisions of Section '
700 of the Lab e, I sh rthwi comply with those provisions.
-_..Date Applicant:
'WARNING: FAILURE TO SECU E WOR RS' MPENSATION 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, ssation of work for 180 days will subject
permit to cancellation.
certify that I have read this application and state that th inform n is rrect. I agree to comply with,all
city and county ordinances and state laws relating uildi con n, an ereby authorize representatives
of this county/o enter upon the above -mention prope ec ' n pur ses. "
Date: _..,•. ignature (Applicant or ent):
Application Number
. . . .'. 10-00001307
Permit. . . . . .
., WALL/.FENCE PERMIT
Additional desc
Permit Fee
54.00
Plan.Check
Fee
.00
Issue Date . . .
.
Valuation
.
. 2125
Expiration Date
5/30/11
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000
THOU BLDG,2,001-25,.000
9.00
Special Notes and
---------------------------------------------
Comments
85 -LN FT X 6 FT HT
INTERLOCKING BLOCK
WALL ORCO STANDARD
PER APPROVED.PLANS.
Other Fees . . .
BLDG STDS ADMIN (SB1473)�
1-00
Fee summary
Charged Paid
Credited
Due
Permit Fee Total
54.00
.00-
.00
54.00
Plan Check Total
•.00
.00
.00
.00
Other Fee Total
1.00
.00.
.00
1.00
_ Grand.Total
55.00,
.00,
-00
55.00
LQPERNIIT
..
.
L
7 Y
7Y
o
48480
27.61'
TW 491.20
483 .80
FG 4-85.20
TI
A
1+ f
PP:.A 0 --3
Bin #
City of La Quinta
-Building 8t• Safety Division
P.O. Box 1504, 78-495 Calle Tampico
P Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address�5�
Owner's Name: e
A. P. Number:
Address: v i %
Legal Description:
City, ST, Zip-
Contractor:
Addres f
Telephone.
Project Description:
City, ST, Zip , _ -
l/
C
Telephon :10
State Lie. #:&Z City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
<<.<:.:+:::,><:r
:iv:l:t'v jt� v:;:::•i�Q'Nµ�
Construction Type: Occt anc
P Y
State Lie. #:
Project type (circle one): New Add'nAlter Repair Demo
Name of Contact Perso$aii� de Z
Sq. Ft.:
# Stories:
# 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 Cafes.
Reviewed, ready for corrections
Plan Check Do-.posit
Truss Cafes.
Called Contact Person
Plan Check R.Jance
Title 24 Calcs.
Plans picked up
Construction
Floodplain plan
Plans resubmitted
Mechanical
Grading plan
2nd 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
�4'