07-0453 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07-00000453
Property Address:
53663 VIA DONA
APN:
772-420-999-36 -298944-
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1250
Applicant:
(00 0, C)Ok
c&ht 4 4 Q"
Architect or Engineer:
0
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 C29 License No.: 463407
Date: -13 Contractor: _
OWNER -BUILDER DECLARATION
1 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 _ 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.).
f _) 1, ac ,r,r,, of rhn prgpgrty, am gnoluoi -sly aantraminy tv .....buu idle yivJeu (3eu.
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. , 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
Owner:
NRI CCP I
C/O NRI CCPI
81100 AVENUE 53
LA QUINTA, CA 92253
Contractor:
DRURY CONSTRUCTI0
73807 MASSON STREET4
PALM DESERT, CA 922
(760)346-7227
Lic. No.: 463407
VOICE (760) 777-7012
FAX (760) 777-7012
INSPECTIONS (760) 777-7153
Date: 2/13/07
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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 PREFERRED INS Policy Number WKN1157594
I certify that, in the performa a of the work for which this permit is issued, I shall not employ any
person in any manner s as o becomes t to the workers' compensation laws of California,
and agree that, if I sho Id ecome ject to the orkers' compensation provisions of Section
3700 of the Labor C I shall orthwith comply ith those provisions.
DaYe"� Applicant:
WARNING: FAILURE TO SECURE WORKERS ATION 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
ifviF6F%TAIv 1 Npyin;auwi Is ileleuy nlaue to Ude ulrecior of uulming ano Satety to? a 066 id sublect 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 thea ation is correct. I agree to comply with all
city and county ordinances and state laws relating to buil g nstructi and hereby authorize representatives
of this county to enter upon the above-mentioned propelr inspection rposes.
Application Number . . . . . 07-00000453
Permit . . . WALL/FENCE
PERMIT
Additional desc ...
Permit Fee . . . . 31.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 1250
Expiration Date . . 8/12/07
Qty Unit Charge Per
Extension
BASE
FEE
15.00
8.00 2.0000 HND BLDG
501-2,000
16.00
----------------------------------------------------------------------------
Special Notes and Comments
50 L.F 6' GARDEN WALL PER ORCO
Fee summary Charged
-------------------------------------
Paid Credited
Due
Permit Fee Total 31.00
----------
.00
----------
.00
31.00
Plan Check Total .00
.00
.00
.00
Grand Total 31.00
.00
.00
31.00
LQPERMIT
Bin #
City of La Quinta'
Building U Safety Division
Permit #
P.O. BOX 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:
O NtiL'� Owner's Name: /S/-1✓,�/�
A. P. Number:
5/�2
Legal Description:
Address: 5 3 la/v3 VI -A Do�vva
City, ST, Zip: 44 Q�i�.✓ -
Contractor: /.�.E' 'T ,D2CJl1 L - Telephone: S'
hen
Addos
ress: - 8 O 7
'J %. Project Description: 2
City, ST, Zip:
C� 922100
Telephone: &- -77.-2-7
G ��2G�.0 w,4GL
State Lic. # : p 7
DMZ o 5�lzGS , •
City Lir. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Consttuctioa Type: Occupancy:
State Lic. #:
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: SUCJ G�
APPLICANT: DO NOT WRITE BELOW THIS
UNE
# Submittal Req'd
Recd TRACWNG
Plan Sets
PERMIT FEES
Plan Check submitted
Structural Calcs.
Item Amount .
Reviewed, ready for corrections
Truss Calp.
Plea Check Deposit
Called Contact person
Energy Cales.
Plan Chick Balance
Plans Picked up
Flood plain plan
Construction
Plans resubmitted
Grading. plan'
Mechani:al
2" Review, ready for correedens4ssue
Subeontactor List .
Electrical
Called Contact Person
Grant Deed
Plumbing
Plans picked up
ILO.A. Approval
S.M.L
Plans resubmitted
IN HOUSE:-
Grading
''' Review, ready for.corrections/iasue
Planning Approval
Developer Impact Fee
Called Contact Person
Pub. Wks. Appr
A.LP.P.
.Date of permit Issue
School Fees
Total Permit Fees