06-3689 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tity/
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
-
-----=------------------------- - -----------------
a 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: B LicenseNo.: 751389
Dater n e� Contractor: ®�
. _, /
OWNER -BUILDER DECLARATION
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 f
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_) 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.).
(_) 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 am exempt under Sec. , BAP.C. for this reason
tr
f 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
VOICE (760) 777-7012
FAX (760),777-7011
INSPECTIONS (760) 777-7153
Date: 10/17/06
Owner:
Application Number:
. 06=00003689 ,
Property Address:
51325 CALLE GUATAMALA
APN:
770-161-005-5 -000000-
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2200
Tity/
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
-
-----=------------------------- - -----------------
a 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: B LicenseNo.: 751389
Dater n e� Contractor: ®�
. _, /
OWNER -BUILDER DECLARATION
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 f
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_) 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.).
(_) 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 am exempt under Sec. , BAP.C. for this reason
tr
f 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
VOICE (760) 777-7012
FAX (760),777-7011
INSPECTIONS (760) 777-7153
Date: 10/17/06
Owner:
TOM KREBS
51325 CALLE GUATEMALA
D
a
LA QUINTA, CA 92253
OCT 17 2006
Contractor:
Cir' OF
JC CONSTRUCTION
FIAI�N Au1NYA
®
67325 MISSION COURT
�
CATHEDRAL CITY, CA 92234
(760)275-6769
Lic. No.: 751389
-----------------------------------------------
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 229-0024928
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 subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shallforthwith complywiththose/provisions.
-Date: /6 0 Applicant: O��/s'✓l.�i i�^`^��^'fr
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 I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection
/purposes.
Date:/ //ww''__, Signature (Applicant or Agent):
T
Application Number . . . . . 06-00003689
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 54.00_ Plan Check
Fee
.00
Issue Date . . . . Valuation
2200
Expiration Date 4/15/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0'000 THOU BLDG 2,001-25,000
9.00
----------------------------------------------------------------------------
Special Notes and Comments
88 LF 6r BLOCK WALL PER CITY STANDARD
ALONG SIDE P/L.
Fee summary Charged Paid Credited
Due
-----------------------------------------------
Permit Fee Total 54.00 .00
----------
.00
54.00 _
Plan Check Total .00 .00
.00
00
Grand Total 54.00 .00
.00
54.00
rN
LQPERMIT
Bin # .
City of La Quinta
Building 8t: Safety Division
Permit #
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
b
Building Permit Application and Tracking Sheet
Project Address: 5�. 3� S �Ies�4'�lAL
Gs#'l�,Pi
Owner's Name:
A. P. Number
AddressS. 3 a 5 t� G uA �e�w�► /A
----------------
Legal Description:
City, ST, Zip: �4 9�a S 3
Contractor: J li
L
Gp�S'U C, 71 o -J
Tj'
Telephone:
Address: Pd00
Ave, LA ' t11S-(q 11,4
Project Description:
City, ST, zip: G -
G GA Jaa3
60 ,4 W4 66
Telephone: %6 D
Stttio
State Lie. # : ��
5,
7 3g9
City Lic. #:
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
P cy=
State Lic. #:
Project type (circle one): New Add'n Alter 'Repair Demo
Name of Contact Pelson:
Sq. Ft.:
#Stories:
#Units:
Telephone # of contact Person:
Estiinaled Value of Project:' f 5Oo - P c�
APPUCANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd.
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit .
Truss Cales,
Called Contact Person
Plan Cheek Balance
Energy .Cates,
Plans picked up
Construction
Flood plain plan
Plans resubmitted,
Mechanical
Grading.plan
2" Review, ready for eorrections(ssue
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 correctionsrssue
Developer Impact Fe' .. ;
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
_
,
._. :.. .. .......: ...Total
Permit. Fees ".:..:
t
' y