06-3061 (BLCK)• �r _7
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
06-00003061
81365 GOLF VIEW DR
762-410-036- -
WALL/FENCE
LOW DENSITY RESIDENTIAL
173
Tiiy/ 4 4v Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/23/06
LAI if
Owner:
RON & JANE GRIJALVA
AUG 3 0 2006 81365 GOLF VIEW DRIVE
01LA QUINTA, CA 92253
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I m licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the B ine rofessi Code, and my License is in full force and effect.
License Class: C53 -B Lic se No.: 816057
te: ontractor:
�a
O ER- UILDER 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 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 _ 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.).
I ) 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
Contractor:
METROPOLITAN POOL BUILDERS INC
23230 LYONS AVENUE
SANTA CLARITA, CA 91321
(800)480-0059
Lic. No.: 816057
------------- ---------------------------------
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 ZENITH INSURANC Policy Number 'CO68551201
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 c the workers' compensation laws of California,
and agree that, ' houlr1sh!
a sub' ct to the workers' compensation provisions of Section
3700 of the or od forth ith comply ith those provisions.
ate: Ob pplicam.
WARNING: FAILURE TO SECURE WORKERS' CIOMPENS TION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN IVIL 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.
Xilyt I have read this applicati and state the a abov 'nf mation ' corr I agree to comply with all
nty ordinances and st laws relatingtouiingn ion, d hereby thorize representatives
mentioned pro ert for'nspe pu oses.
S' ature (Applicant or Agent): '
Application Number . . . . . 06-00003061
Permit
WALL/FENCE
PERMIT
Additional desc .
Permit*Fee . . .
. 15.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 173
Expiration Date
2/19/07
Qty Unit Charge Per
Extension
BASE
FEE
15.00
---------------------------------------------7--------------------=---------
Special Notes and
Comments
(2) WALLS 4 L.F.,
5' HIGH, CITY
STANDARD
Fee summary
Charged
Paid Credited
Due
Permit Fee. Total.
----------
15.00
--------
.00
----------
.00
15.00
Plan Check Total
.00
00
.00
.00
Grand Total
15.00
.00
.00
15.00
LQPERMIT
0A
t)A L(
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
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Permit #
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Project Address:
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Owner's Name: lT
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A. P. Number:
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Address: '3 6 S U V (� �J/�l—
Legal Description:
City, ST, Zip:
Contractor L /� (� L f�(
Telephone:
Address: o G U!` S 114
Project Description:
City, ST,Zip: -
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Telephone:,ft G, G ()el
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State Lie. # : F16 66
City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lie. #:
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
Req'd
Rec'd
TRACKINGpy/
PERMIT FEES
Plan Sets
Plan Check submitted
n
�l 7t n
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"" Review, ready for correctionstiissue
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