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7-2480 (BLCK)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 Permit Application and Tracking Sheet Permit # 1tf %1 Project Address: 77A Owner's Name: r , A. P. Number: 777 - 6 o jo 2 ?; Address: Legal Description: Contractor:-j5.4 City, ST, Zip-5� Telephone:--(,j�p� Address: Av +v Project Description: G(��►-LG S City, ST, Zip: T,44;k•Ql 6,4 Telephone: /V G (� State Lie. # CityLic. #: /� ,/ e Arch., Engr., Designer: Mr- S! DE Address: lG��l`l /I.JL� �/ • �� �(% 1 City, ST, Zip:' Telephone: qz,,:- —� 3 Construction Type: Occupancy: P cY: Project type (circle one): New Add'n Alter Repair Demo State Lic. #: Name of Contact Person: Sq. Ft : #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project• �p APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACKING . PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance Energy Cales. Plans picked up Construction Flood plain 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. II.O.A. Approval Plans resubmitted Grading IN HOUSE: Review, ready for correctionsrssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Application Number . . . . 07-00002480 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 81.00 Plan Check Fee .00 Issue Date Valuation . . . 5140 Expiration Date 3/05/08 Qty Unit Charge Per. Extension BASE FEE 45.00 4.00' 9.0000 THOU BLDG 2,001-25,000 =--------- 36.00 ----------------------------------------------------------- Special Notes and Comments =------ SIDE PROPERTY WALLS PER APPROVED PRECISE GRADING PLAN. CITY STANDARD BLOCK WALL 180 L.F. X 6' HIGH/40 L.F. X 30" HIGH. Fee summary Charged. Paid Credited Due ------------------------------------- Permit Fee Total 81.00 ---------- .00 ---------- .00 81.00 Plan Check Total .00 .00 .00 .00 Grand Total 81.00 .00 .00 81.00 LQPERMIT !► P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 07-00002480 Property Address: 53444 VIA PISA APN: 772 -530 -063 - Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 5140 c&t!t 4 4 a" Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- 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: B license No.: 466537 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).: 1 _ 1 1, 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 excl 11v y contracting with licensed contractors to construct the project (Sec. 7044, Business and Profession Cod The Contractors' State License Law does not apply to an owner of property who builds or improv s ther on, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' ate Li nse Law.). (_ 1 I am exempt under Sec. , B. .C. for this reason^ \ Date, ^� ( \ Ow c I hereby affirm under penalty per work for which this permit i ss d Lender's Name: Lender's Address: LQPERMIT CONSTRUCTION LENDING AGENCY ry that there is a construction lending agency for the performance of the (Sec. 3097,.Civ. C.). Owner: SOBA RESIDENCE 1 CROW CANYON CT. ST SAN RAMON, CA 94583 Contractor: SOBA CONSTRUCTION CO, 7026 KOLL CNTR PRKWY, PLEASANTON, CA 94566 (925)426-3000 Lic. No.: 466537 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/07/07 100 ----------------------------------------------- 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 an licy number are: Carrier STATE FUND Policy Number 0012912-2007 I certify that, in th perfor nce of the work for which this permit is issued, I shall not employ any person in any anner s as to become subject to the workers' compensation laws of California, and agree that, if 1 sho d become subject to the worker ' compe ation provisions of Section 3700 of the La or Co e, I shall forthwith c ply with ose pr isions. Date: `Applicant: i WARNING: FAILURE TOS E WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). ODITION 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 comes null and void if work is not commenced within 180 days from date of issuance of su rmit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and statA ve information is correct. I agree to comply with all city and county ordinances and state laws relatinconstruction,anof this county to enter upon the above-mentionein ection purpDate:�ignature (Applicant or Age 14 0 1� N 010C O A' A r- �n 131 R LA %0 0 8 r R 30'-8" R 26'-5" R 13'-0" R 3'-1o" 32e-10" R 18'-6" E 61'-1o"