05-4892 (BLCK)tl,
0
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that.) am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.,
License Class: License No.: _
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
Licent
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions.Code) or
[hathr she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
zany- icant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
7 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 _ 1 I, as owner of the property, am exclusively co cting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: dors' State License Law does not apply to an owner of
property who builds or improves the n, a contracts fl the pro jectsJorith a contractor(s) licensed
pursuant to the Contractors' Stat icense I /
1 _ 1 1 am qi eSnpt under Sec. &P.C. for is eason
Date: rr V J 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
It 131%1> -
Owner:
PAUL VAN VLYMEN
53935 AVENIDA VILLA
LA QUINTA, CA 92253
(760)564=5126
Contractor: �ID
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/03/05
-p u
NOV 0 32005
C9TY QF LAQUI14TA
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
de, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy num r are:
Carrier ---------------- - - - --- icy Number
*I certify that, in the paebec
k for which th' permit is issued, I shall not employ. any
y
person in any mariubject to the rkers' compensation laws of California,
and agree that, if It to the work s' mpensation provisions of Section
37000ofthe Laborcornet{wit h e provisions.
Date:? A Applicant:.IV/
WARN( G: 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 isperformedunder 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 Quints, its officers, agents andemployees f y act or omission related to the work being
performed under or following issuance of this per it.
2. Any permit issued as a result of this application null and void if ark is not commenced
within 180 days from date of issuance uch p mit, or c ation of w
Ark
for 80 days will subject
permit to cancellation.
I certify that I have read this application and stat that the abov inf at i is corre agree to comply with all
city and co my rdinances and state laws relating building c ctiori 1, e y thorize representative
of this cou ty t enter pa the above-mentioned pro rty fo n p ction p r oses.
)1
Date: -r ( Q A`Signature {Applicant -or -Agent):.
Application Number:
\05-000048.92
Property Address:
53935—AVENIDA—VILLA
APN:
774-173-022-10 -000000-
Application description:
WALL/FENCE
Property Zoning:
'COVE RESIDENTIAL
Application valuation:
1675 ,
Applicant:
Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that.) am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.,
License Class: License No.: _
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
Licent
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions.Code) or
[hathr she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
zany- icant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
7 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 _ 1 I, as owner of the property, am exclusively co cting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: dors' State License Law does not apply to an owner of
property who builds or improves the n, a contracts fl the pro jectsJorith a contractor(s) licensed
pursuant to the Contractors' Stat icense I /
1 _ 1 1 am qi eSnpt under Sec. &P.C. for is eason
Date: rr V J 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
It 131%1> -
Owner:
PAUL VAN VLYMEN
53935 AVENIDA VILLA
LA QUINTA, CA 92253
(760)564=5126
Contractor: �ID
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/03/05
-p u
NOV 0 32005
C9TY QF LAQUI14TA
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
de, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy num r are:
Carrier ---------------- - - - --- icy Number
*I certify that, in the paebec
k for which th' permit is issued, I shall not employ. any
y
person in any mariubject to the rkers' compensation laws of California,
and agree that, if It to the work s' mpensation provisions of Section
37000ofthe Laborcornet{wit h e provisions.
Date:? A Applicant:.IV/
WARN( G: 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 isperformedunder 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 Quints, its officers, agents andemployees f y act or omission related to the work being
performed under or following issuance of this per it.
2. Any permit issued as a result of this application null and void if ark is not commenced
within 180 days from date of issuance uch p mit, or c ation of w
Ark
for 80 days will subject
permit to cancellation.
I certify that I have read this application and stat that the abov inf at i is corre agree to comply with all
city and co my rdinances and state laws relating building c ctiori 1, e y thorize representative
of this cou ty t enter pa the above-mentioned pro rty fo n p ction p r oses.
)1
Date: -r ( Q A`Signature {Applicant -or -Agent):.
Application Number . . . 05-00004892
Permit. WALL/FENCE PERMIT'
Additional desc .
Permit Fee . . 39.00 Plan Check Fee
.00
Issue Date Valuation . . .
... 1675
Expiration Date 5/02/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
12.00 .2.000,0 HND BLDG 501-2,000
24.00
------------------------------------------------------------
Special Notes and Comments
67 LF 32" RETAINING WITH 6' GARDEN WALL
PER CITY.STANDARD ALONG SIDE PROPERTY
LINE FROM BACK P/L'FORWARD.
Fee summary Charged. Paid Credited
Due
---------------------
Permit-Fee Total 39.00 00 .00
39.00
Plan Check Total .00 .00 .00
.00
Grand Total 39.00 .00 .00
39.00'
Bin #
City of La Quinta
Building a 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:A vc-,,j 16.4 v,
A. P. Number:
Legal Description:
now
Owner's Name: ✓A,,J Ij
Address: S3 ! 3S— - ✓,fav l V(11A
71
City, ST, Zip: •G4 A SZZS3 _
Telephone: S(Q �/ Z (p •'+ • �;
Project Description:
1
p �
7�N
Contractor:�
Address:
City, ST, Zip:
Telephone:
State Lie. # : City Lie. #:
Arch., Engr., Designer:
pp
C. n)ak N (r—/4"I NIN GAAbE"i WO
I
�f
S
Address:
City, ST, Zip:
Telephone: '
State Lie. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft:: # Stories: -# Units:
Estimated Value of Project: 400
Telephone # of Contact Person:
APPLICANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°d 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:-
M 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