07-3225 (BLCK)P.O. BOX 1504 - VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011 x
LA QUINTA,'CALIFORNIA 92253 , ' BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 12/28/07
Application Number: 0�Owner:
Property Address: 52958 VIA DONA MITCHELL RESIDENCE
APN: 772-410-999-11 -298944-' 1544 EUREKA RD #140' .
Application description: WALL/FENCE ROSEVILLE, CA 95661
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5020 0
Contractor: D
Applicant: Architect or Engineer:. GRAYSTONE 'CONS T ON
A 79405 HIGHWAY 1 AMNY
SU ?4200a
LA QUINTA, CA 9 25
(760) 564-6934 A1C UES
Lic. No.: 86374 Q�
• a
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LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: -
Section 7000) of Division 3 of the Business and Professionals Cade, and my License is in full farce and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as Provided
License Class: B kens No.: 863749 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date:��Contractor: 1 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy -Number 1828934
following reason (Sec. 7031.5. Business and Professions Code: Any city or county that requires a permit to _ I certify that; in the performance of the work for which this permit is issued, I shall not employ any '
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant'for the person in any manner so as to become subject to the workers' compensation laws of California, _
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 3700 of the Labor Code, I shall forthwit ply 'th th a provisions. _
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
an a licant for a per subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: "Date: (�T Z b ��A licant:
K PP P I PP P Y �.`i� PP
(_ 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
.Contractors' State License Law does not apply to an owner of property who builds or improves thereon; SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is soldwithinSECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors" State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason • the owner, and theapplicant, 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.
Date: Owner: - 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). 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 p ses.
Lender's Name:` ate: (
l 2 g � �`Signaturer_e plicant or -Agent): -
Lender's Address:
LQPERA11T - -
J
r`Application,Number
. . 07-00003225
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit. Fee 81.00
1 Plan Check
Fee
.00
Issue Date.
Valuation
. . .
5020
. Expiration Date 6/25/08
Qty Unit Charge Per
Extension
BASE.
-FEE
45..00
4.00 9:0000 THOU `BLDG
2,001-25,000
36.00
Fee summary Charged
Paid Credited_
Due
' Permit Fee. Total 81.00
.00
.00
81.00
Plan Check Total .00
.00
.00
00
Grand Total 81.00
.00
.00
81.00
LQPERMIT
Bin #
'� .. • -
City, of La Quanta. -
Building'& Safety Division
;— P.O. Boz 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777=7012
-Building Permit Application and Tracking Sheet M.
Permit # <'
Project Address:" V .D d N k
Owner's Name: �' 1 LrLL '
A: P. Number: 7 7-'/O
Address* 7,., IST-.hb�
Legal Description: L s
City, ST, Zip:
Contractor: �j-3:q`r aCV-7 ri ;� e""-
Telephone:
Address:_ ``/I
% 4 � S n—I I (� �- �/�/
Project Description::'
City, ST, Zip: LP, (j i N f.1- Z Z
_. S l 7� ' IIS Z C
,Telephone: , ° 7-5 V - . O G(
Al Z
State Lic. # : ` 2F 6 3 7 e•/ City Lic. #: j O(7 $ 3 y
Arch., Engr., Designer: M. �L A Nr�rt/ A-fL (
7
l 5-6. r
Address:. I i S -(l Y 1—v rL.c^ic-tt- fu
r
_
City, ST,•Zip:
Telephone: `
State Lic. #: C 7-1 6 ? ..
!Name of Contact Person: Je SAN -, pct
Construction Type: ' Occupancy: ` {
Project type (circle one): New Add'n -AlterRepair Demo
Sq. Ft.:
# Stories:.
# Units:,,.
Telephone # of Contact Person: Z 3 $ - ®�/ l / .
Estimated Value of Project: f -57-
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted • `
r
Item •
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs..
Called Contact Person . ,
Plan Check Balance
Energy Cates.
Plans bicked up
Construction
Flood plain plan
Plans resubmitted -
Mechanical
Grading.plan
•
2"' Review, ready for corrections/issue
Electrical
;
Subcontactor List
w
Called Contact Person
Plumbing
t
+
Grant Deed
Plans picked up
S.M.I.
;
H.O.A. Approval
Plans resubmitted
Grading
. .
IN HOUSE:-
Jrd Review, ready for corrections/issue
Developer Impact Fee
,Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue L
School Fees y
+
Total Permit Fees F
'
a'
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CITY OF LA QUINTA
BUILDING. AND SAFETY DEPARTMENT
GARDEN WALL STANDARD _
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14 O 32' Horiz
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GARDEN WALL .
Scale: 3/8" 1'—p'