06-4051 (BLCK)\P
P.O. BOX 1504
`78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 06-0000405__.1 _
Property Address: 53264 VIA PISA '
APN: 772-500-055- -
Application description:' WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 8500
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
----—---------
_____________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that m licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Busi s an Professionals Code, and my License is in full force and effect.
License C`l/as�/ B Lice a 86919
Date/��L G*'a.'ontractor:
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 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.).
1 _ 1 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:
JEFF &CAM BARNES
53264 VIA PISA
LA QUINTA, CA 92253
Contractor:
GOLDEN CONSTRUCTION
73710 FRED WARING DR
PALM DESERT, CA 9226
(760)776-4215
Lic. No.: 786919
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/22/06
—---------------—----------—-------------------
,WORKER'S
___________________—_________________________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 STATE FUND Policy Number 0013325-2006
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as become subject to the workers' compensation laws of California,
and agree that, if I sho ec a subject to the workers' omp sation provisions of Section
))3700 of the Labor Gode, I II forthw' h comply with
s ovisions.
Date:/-G��icant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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, or cessation of work for 180 days will subject
permit to cancellation.
I certify that 1 have read this application and state that the ve formation is correct. I agree to comply with all
city and county ordinances and state laws relating to bu ding co tructio ,and hereby orize representatives
of this county enter upon the above-mentioned property for . pec ' rpop
s. _
.Date: 4ature (Applicant or Agent):
Application Number . . . . . 06.-00004051
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . 108.00
Plan Check
Fee
.00
Issue Date
Valuation
8500
Expiration Date 5/21/07
Qty Unit Charge Per
Extension
BASE
FEE
45.00
7.00 9.0000 THOU BLDG
2,001-25,000
63.00
---------------------------------------------
Special Notes and Comments
-------------------------------
340 LF 6' BLOCK WALLS PER ORCO
Fee summary Charged
---------------------------
Paid Credited
Due
----------
Permit Fee Total 108.00
----------
.00
----------
.00
108.00
Plan Check Total .00
.00
.00
.00
Grand Total 108.00
.00
.00
108.00
r..
v
LQPERMIT
Bin il`
'City of La Quinta
Building u Safety Division
Permit f!
P.O. Box 1504, 78-49S Calle Tampico
l 7iD
"l
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:
A. P. Number:
Owner's Name: �e��
Address:
Legal Description:
Contractor: ��(���
City, ST, Zip:
Telephone:
Address:
Project Description:
.City, ST, Zip:
Telephone:
State
Lic. It :
City Lic. #;
Cp G.r/.•1-LG — � 6
Arch., Engr., Designer:
Address:
City,. -ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Name of Contact Person:
Project type (eircle one): New Add'n Alter 'Repair Demo
Sq: FL:
#Stories:
#Units:
Telephone # of Contact Person;
dated Value of Project:
APPLICANT:
DO NOT WRITE BELOW THIS UNE
It
Submittal
Req'd.
Recd
TRACKIIYG.
Plan Sets
PERMIT FEES
•
Plan Check submitted
Item
Structural Calcs.
Review ed, ready for corrections
• Amount
Truss Cates.
nail Check Deposit
Called Contact Person'
Energy .Calcs.
Plans picked up
Plan Check Balance
Flood plain plan
Plans resubmitted
Construction
Gradiag.plaa'
2-' Review, ready for eorrectiow issue
Mechanical
Sabcontactor List
.
Called Contact Person
Electrical
'
Grant Deed
Plans picked up
Plumbing
Ii.O A. Approval
Plans resubmitted .
$ALL
IN IiOUSE:- ...
-
Review, ready for correetions/issue
Grading
Developer Impact Fee: ;
Planning Approval
Called Contact Person
Pub. Wks. Appr
Dale of permit issue.
A.I.P.P.
School Fees
,...; ,.: ..a...
.... ............. ..... .., Total.PermitFees ....
> 9