05-5261 (BLCK)r�
I
P.O. BOX 1504 4
^�
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 05-00005261 Owner:
Property Address: 78621 DEACON DR E APC
APN: 770-230-002- - - PO BOX 3420
Application description: WALL/FENCE PALM DESERT, CA 92260
Property Zoning: LOW DENSITY RESIDENTIAL D LJ
Application valuation: 3500 u
rr-n Co�� actor:
Applicant: Architect or Engineer: L =�' 011005 PR1E i ION MASONRY
P.O. BOX 3938
GIN (2FLAQUINTAPALM DESERT, CA 92261
FIIdANE ®PY (760) 779-5100
Lic. No.: 472843
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: C29 eg License o.: 472843
Date' Contractor:
OWNER-BUILDERAECLA TION
I hereby affirm under penalty of perjury that I am exempt from the Cont actor'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 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 1 am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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: J -P
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
WORKER'S COMPENSATION DECLARATION
Date: 12/01/05
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.
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 1615077
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 to become subject to the workers' compensation laws of California,
and agree that, if I should become subje t to the worker ' cmpensation provisions of Section
3700 of the Labor Code, I sh «h the it 6seoprovisions.
Oate42'/_Of r Applicant:
WARNING: FAILURE TO SECURE WORKERS OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). 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 above information is correct. 1 agree to comply with all
city and county ordinances and state laws relating to building constructio and hereby au prize representatives
of this county to enter upon the above-mentioned property fo 'a pec ' pur
Date/0_ Signature (Applicant or Agentl:
v
LQPERMIT
Application Number . . . . . 05-00005261
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 63.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 3500
Expiration Date 5/30/06
Qty Unit Charge. Per
Extension
BASE
FEE
45.00
2.00 9.0000 THOU BLDG
2,001-25,000
18.00
----------------------------------------------
Special Notes and Comments
------------------------------
_140 LF 6' BLOCK WALL PER PROTO SPEC
Fee summary Charged
-------------------------------------
Paid
Credited
----------
----------
Due
Permit Fee Total 63.00
.00
.00
63.00
Plan Check Total .00
.00
.00
.00
Grand Total 63.00
.00
.00
63.00
1
11/16:2005 WED 9:1.8 FAX
Bin #
City ®f La Quinta
Building 8Z 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: 78-621 Deacon Drive E. Owner's Name: Andrew Pierce Corp.
A. P. Number: Address:. P.O. Box 3420
Legal Description: Lot#12 Tr28470-1 Tradi' City, ST,Zip:Palm Desert, CA 92261
Conira0cTelephone: hone:
Precision P 760 346-3228
Address: P, O. Box 3938 Project Description: Lot 12 Tract 28470-1
City,ST,Zip: palm Desert CA 92261 Traditions
Telephone: 760 779-5100
State Lic. #: 4 7 2 8 4 3 City Lic. #:
Arch., Engr, Designer:
Address:
City, ST, Zip:
Telephone: CmsrMction Type: Occupancy:
Slate Lic. 4: Project type (circla one • New Add'n Alter Repair Demo
Name of eontact Person: Darren Mont omer Sq. Ft. f # Stories: # Units:
Telephone *of Contact Person: Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
9
Submittal
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Coles.
Reviewed, ready for corrections
Plaa Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Energy Cales.
Plans picked up
Construetlou
Flond plain plan
Plans resubmitted
Mechanical
Grading.plan'
2.d Review, ready for correctionsAssue
Electrical
Subeuntaetor List
Called Contact Person.
Plumbing
GrautDced
Plans picked up
S.M I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review, ready for correctioas/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
L t`