07-1141 (BLCK)A
of Rakl
P O BOX 1504 y � VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA"' CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Dater 4/17/07
Application Number: . 0077-00001141 ~ j Owner:
Property Address -5" 3628 -VIA PALACIO t M/M PARKER
APN: 772'560-055- - - 53628 VIA PALACIO
Application description: WALL/'FENCE LA QUINTA, CA 9225
Property Zoning: LOW,DENSITY RESIDENTIAL
Application. valuation: 7500 q. p
' Contractor: Nf R 18
' �OOl _
Applicant: Architect or Engineer: CHEROKEE•DSGN' & V, INC.
73-180 HIGHWAY 1 1 CA
CITY OF
RT, 60 B A QUINTA
PALM DES ERT, R1MgNCE
(760) 341-0920
-- Lic. No.: 879734.
--- ---- --- - -- -------------------------------------------------------- — `
-- -- -- - - - - ---- -- ---- --
LICEN ED,CONT CTOR' DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affir under penalty of erjury that I am icensed u er pro Sion of Chapter 9 (commencing with - I hereby affirm under penalty of perjury one of the following declarations:
Section 700 1 of D' ision 3 of a Business and si6na Code, n 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 Cla B' icen_se o . 879734 for by Section 3700 of the Labor Code, for the performance' of the work for which this permit is
r •D _- _ - issued.
ate: Contracto . - - _ 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 -
' OW R -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that am exempt from the Contractor's State License Law for the Carrier EXEMPT' olicy Number EXEMP ^ '
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the pert mance of t e wo o whi h.this p i 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 person in in the r so as to bec m subjec to hers
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' a agree that, if I' hould become ject to to orpensation provisions of Section
License Law (Chapter 9 (commencing.with Section 7000) of Division 3 of the Business and Professions Code) ar 3 00 of the Labor ode, I shall fo with co pl witovisions. .
' that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by a� i ! y� �•�,
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)1 � Date: Applicant:
1 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 - WARNING: FAILURE TO SECURE WORKERS' OMPENSATION 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 CRIMINALPENALTIESAND CIVIL FINES UP.TO ONE HUNDRED THOUSAND -
and who does the work himself or herself through his orher 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 withinSECTION 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.). - APPLICANT ACKNOWLEDGEMENT
•
1—) I, as owner of the proper
y, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director'of Building and Safety for a permit subject to the -
7044, Business and Professions Code: The.Contractors' State License Law does not apply to an owner of . conditions and restrictions set forth on this apptication. -
property who builds or improves thereon, and who contracts for the.projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.l. .. whose benefit work. is performed under or pursuant to any permit issued as -a result of this application,
1 ) I am exempt under Sec. , B.&P.C. for this reason 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. `
Date: Owner: - 2. Any permit issued as a result of this application becomes null"and void if work is not commenced
CONSTRUCTION LENDING AGENCY - - - _ __ - _ _ _ - _ rm i t $O nrr lar nn. da issuan e o n ofwor will _ -
within to of ' c f suc or c k for 0 days 'll subject
-- - - - - pe _ i -
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that, I have read this application and state,hat a above inf matron i c rrect. I gre� to comply with all ~
work for which this permit is issued (Sec. 3097, Civ.,C.). , s city and co my ordinances and state laws relating to uilding cons coon, a ereby a hot ze representatives _
- - of this cou ty to ter upon the above-mentioned pr petty for in tion pur 0 S.
Lender's Name:
- /Date: _ ignature (Applicant or Agent): '
Lender's Address:
LQPERMIT
Application Number 07-00001141
;. .:Permit r WALL/FENCE PERMIT
Additional desc .
Permit. -Fee .99.00
Plan Check
Fee
.00"
Issue Date'
Valuation
7500
Expiration Date 10/14/07
Qty Unit Charge Per
Extension
BASE -FEE
:45.00
6.00: 9.0000 THOU BLDG,2,0:01-25,000
54.00
- - ------------------------7-----------7
. Special Notes and Comments
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--- -----------
300 LF 6" BLOCK WALL.PER CITY
STANDARD/APPROVED PLAN
Fee summary Charged
Paid
Credited
Due
- -- ----------
Permit Fee Total 99.00
----------
.00
---------
..00-
99.00
Plan Check Total .00
.00
.00
.00
Grand Total, •99.00
.00
.00
99.00
LQPERMIT--
Bin #
G�ty of La Quinta
Building 8i Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # /
1��/
Project Address:' U)A 4o&,_Aqc,-)(j)
Owner's Name:.
A. P. Number:
Address:
Legal Description: -
City, ST, Zip:
Contractor: Cis '0_—_S(G A) � ,,jct_2t,-
. Telephone::
Address: &o
Project Description:
City, ST, Zip:LdG�
C S
Telephone: In3760
City Lit. #:
�S
State Lic. # :
Arch., Engr., Designer:
Address: .
City., ST, Zip:
Telephone:
State Lid. #:
XJ
LN s
Construction Type: Occupancy:
Project type (circle one): New Add'n . Alter Repair Demo
Name of Contact Person: 1 f k o
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal .
Req'd
Recd
TRACMG .
PERMIT FEES
Plan Sets
Plan Check submitted
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
Floodplain plan,
Plans resubmitted
Mechanical
Grading. plan
2' 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