06-1117 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
06-00001117
80598 VIA PESSARO
772-500-014- -
WALL/FENCE
LOW DENSITY RESIDENTIAL
4375
Tityl 4 4 w
Architect or Engineer:
M alb
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjur ! that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of t/BuYness a PaIs ode, and my License is in full force and effect.
Lic a e 755775
Dontracto
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 70001 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 1$500).:
(_ 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 exclusively contracting with licensed contractors to construct the project (Sec.
7411, ®uoin000 ono ArofQeai„nr. rnrIry Thn (^nntrartnro' Stam I it ancc I aw rfnos not apply to Rn nwnar 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. , BAP.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: %I FA
LQPERMIT
VOICE (760) 777,-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/20/06
Owner:
GROVER KENT
80598 VIA PESSARO
LA QUINTA, CA 92253.
Contractor: D
PINNACLE COMMUNITIES, INC MAR 2 0 2006
15 ENTERPRISE, SUITE #250
ALISO VIEJO, CA 92656
(949)609-0740 CITY
Lic. No.: 755775 FIN
------------------
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.
A,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 1594304
_ I certify that, in the perfor nce of a work for which this permit is issued, I shall not employ any
person in any manner as to tome subj t to the workers' compensation laws of California,
agree that, if I sh Id bec e I ers' compensation provisions of Section
0 of the Labor C Is I w' c y with t rovisions.
ate:
264� plicant:
WARNING: FAILURE TO SECL14 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
nnnditinns rind restrirtiona Set forth Gn this @ppliG@tign.
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 tha I have read this application and state that Mri
rmation is correct. I agree to comply with all
city and co my or finances and state laws relating-to-bi an ereby authorize representatives
of t pop the above-mentioned propes.
Applicant or Agent):
Application Number . . . . . 06-00001117
Permit . .
. WALL/FENCE
PERMIT
Additional desc .
.
Permit Fee ... .
. 72.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 4375
Expiration Date
9/16/06
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
3.00 9.0000
THOU BLDG
2,001-25,000
27.00
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Special Notes and
Comments
175 L.F. 6' BLOCK
WALL, 125 L.F.
301-
0"BLOCK
BLOCKWALL, ORCO
SYSTEM
Fee summary
Charged
Paid Credited
Due
Permit Fee Total
72.00
.00
.00
72.00
Plan Check Total
.00
.00
.00
.00
Grand Total
72.00
.00
.00
72.00
LQPERMIT
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 #
Project Address:' —
Owner's Name:
A. P. Number:
Address:
Legal Description:
Contractor.
City, ST, Zip:
Telephone:
Address:
Project Description:
City, ST, Zip:
Telephone:
City Lic. #:
State Lie. # :
S �9 '
Arch., Engr., Designer:
Address:
City, ST, Zip.
Telephone:
Cpl'
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter' Repair Demo
Name of Contact Person:Sq.
Ft.:
# Stories:
# Units:
Telephone # of Contact Person`
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req14
Recd
TRACKING.
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
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2"d Review, ready for corrections/iissue
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