06-0248 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
,06`0000024'8'°'°"
53697'VIA DONA
APN:
772-420-999-35 -298944-
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
6250
Applicant:
c&ht 4 e(P Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
M/M INGSTER
7 VIA DONA
UINTA, CA 92253
aufur.
Y CONSTRUCTION, MARGARET
7 MASSON STREET
DESERT, CA 92260
)346-7227
No.: 463407
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/17/06
-------------------------------------------------------------------------------------------------
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 Bus' sand Prof sionals de, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B C29 lice a No.: 463407
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Date:,�-YYaaC��ontractor;- -
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
WNER-BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury tha exempt from the Contractor's State License Law for the
Carrier PREFERRED INS Policy Number WKN1157592
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 th f, if I sho bec me 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 abor C , I sha forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
�_-
an applicant for permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001.:
Y PP P 1 PP P Y^/Applicant:,.
Date:_ --
1 _ 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
WARNING: FAILURE TO SECURE WORKERS' COMPENS ON COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
li�SECTION
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 sold within
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.).
(_) 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 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
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 thniovnformation is correct. I agree to comply with all
city and county ordinances and state laws relating totruction, and hereby authorize representatives
of this countyyto enter upon the above-mentioned prection purposes.
Date: "�/�O,(iJ Signature•(A—licant
Application Number . . . . . 06-00000248
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 90.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 6250
Expiration -Date . . 7/16/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
5.00 9.0000 THOU BLDG 2,001-25,000
45.00
----------------------------------------------------------------------------
Special Notes and Comments
250 LF 6' BLOCK WATT PER nRrn RPT?r
Fee summary Charged Paid
-------------------------------------
Credited
----------
----------
Due
Permit Fee Total 90.00
.00
.00
90.00
Plan Check Total .00
.00
.00
.00
Grand Total 90.00
.00
.00
90.00
LQPERMIT
09/15/2005 11:19
7603605719
YOUNG ENGINEERING SE
PAGE 01
Telecopy Transmittal
To:
CITY OF LA QUINTA
Fax No.:
Attn:
TOM HARTUNG
Date:
From:
NALIN
Project/Re:
Tel. No.:
(760) 360-5770 EXT, 108
Job No.:
Description of Document:
Comments:
THANK YOU
(760) 777-7011
9/15/2005
INGSTER — LOT 350
Orig•Inal to be Mailed: ❑ Yes ® No
This Material Sent:
❑ Your Files Your Review
❑ At Your Request ❑ Please Call Upon Receipt
Other ❑
Copies:
Total Number of Pages (Including this Transmittal): 2
Note: Please call and ask for telecopier operator if you did not receive the total number of pages or
cannot read the pages transmitted. Thank you.
TELECOPIERS
Palm Desert
(760) 360-5770
YFS7/02
09/15/2005 11:19 7603605719 YOUNG ENGINEERING SE PAGE 02
Wildcat Df., Stc. C, Palm pcscrt, C 92211 (760) 361-5770 fax (760) 360 571
September 15, 2005
Tom Hartung
Building Official
City of La Quints
Re.,In sterResidence Lot35,D TheMideaw La Quinta CA
Dear Tom,
We have reviewed the truss calculations provided by JMW Truss dated 07/27/05 for the above-
mentioned project and find them to be in general conformance with our design intent.
If you have any questions please call.
Sincerely,
effrey B. Xouing, S.E.