06-3876 (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:
06,=,00003876
46-6-6`0—WASHINGTON ST
6437020-999-3 -30903
WALL/FENCE
REGIONAL COMMERCIAL
2650
�I��I11,ICt/
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WASHINGTON 111 LTD
- JACK TARR
80618 DECLARATION AVE
INDIO, CA 92201
Contractor:
Architect or Engineer: WL BUTLER CONSTRUCTION
7 GOODYEAR
IRVINE, CA 92618
(949)587-2206
Lic. No.: 355353
VOICE (760) 777-7012
FAX (760) 777-7011
.INSPECTIONS (760) 777-7153
Date: 11/01/06.
i�` 0 2 2006
CITY OF LA QUINTA
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B License No.: 355353 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is.
issued. -
Date: Contractor: _ _ 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 workerscompensation
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ABD INS Policy Number 71WC12012701
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to ) I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the r person inany manner so as to become subject to the workers' compensation laws of California,
permit to file a signed' statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith comply with those provisions. '
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by /J,� -
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: � � 114-D6 ' Applicant:\ �f1/9_ Ira,4&4,!,, 2b- 11 Lj/,
(—) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and "� J '
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL - _
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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, 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 '
A
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
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 information is correct. I agree to comply v1h all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives'
of this county to enter upon the above-mentioned property for ins% ction purposes.
natal ll-/ -ot Si—mrp IAnnlinnnt nr Anpntb [1erpA /. c L!._ 7t _ /iL! rh `
Application Number . . . . . 06-00003876
Permit . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 54.00
Plan Check
Fee
00
- Issue Date . . . .
Valuation
. .
2650
.
Expiration Date 4/30/07
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
- -- - - - - - -
- - - - - -
- - - - - - - - - ------
106 LF 6' BLOCK WALL PER CITY STANDARD
TO FORM TRASH ENCLOSURE PER CDD
APPROVED PLAN & APPROVED PRECISE
GRADING PLAN.
Fee summary Charged Paid
Credited
Due
-------------------------------------
Permit Fee Total 54.00
----------
.00
----------
.00
54.00
- Plan .Check Total .00
.00
.00•
.00
Grand Total 54.00
.00
.00
54.00
3
LQPERMIT
a
1"
- ml� 7k,K_rl, r 7r�
-M2—
Btn #
---.46UU* �ss
:ia-
City of La Quinta
Building U Safety Division
i, P.O. BOX 1504, 78-495 Calle Tampico
"-Quilita, CA 92253 - (760) 777401.2
Building Permit Application and Tracking Sheet ',
Permit ff
Project Address:
Owner's Name:
A. P. Number.
Legal Description:
Address:. �U v/l�
City, ST,09-
Zip:
Contractor:
� � C
----------------
Telephone: ',�` .2-� ?V
-
Address:
Project Description: .
.City, ST, Zip:
Telephone:
State Lic. # :
Arch., Engr., Designer:
City Lic. #•
Address:
V
Construction Type:.. Occupancy:
City,. -ST, Zip:
Telephone:
State Lic. #:
Project type (circle one): New Add'n Alter 'Repair Demo
Name of Contact Person:
/
Z
Sq; Ft:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: '�,? S Lo a^
APPLICANT:
DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd .
Rec'd
TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed,, ready for corrections
Plat•Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy .Ciles.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading,plau
V Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact PersonPlumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted .
Grading
IN HOUSE:-
'•" Review, ready for correctionstissu_s
Developer Impact Feb.. ;
Planning Approval
Called Contact Person
A.I.P.P.
.Pub. Wks. Appr
Date of permit issue.
School Fees
otal Permit Fees . ..
2,4i-4'
yb filo io6
�Co
X66
2-16
Ll