06-4199 (BLCK)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 04199jLr,
48554 VISTA PALOMINO
649-540-030- -
WALL/FENCE
LOW DENSITY RESIDENTIAL_
130
I hereby affirm under penalty of pe
Section 7000) of Div n 3 of the
Date:
Class:
Date: V4ntractor:
c??itit 4
�.
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
PIR
LICENSED ONTRY
R'S DE LARATION
that I am li sed undovisio of Chap9 commencing with
less and o essionalse, and y Lice e i in full force and effect.
No.: 7 3
OWNER -BUILDER 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 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:
LQPERAI IT
Owner:
LAVERTY GUY
48554 VISTA PALOMINO
LA QUINTA, CA 92253
Contractor:
CHEROKEE DSGN & DEV,
73-180 HIGHWAY 111
PALM DESERT, CA 92260
(760)341-0920
Lic. No.: 879734
VOICE (760) 777-7012
FAX (760) 777-7011.
INSPECTIONS (760) 777.-7153
Date: 12/05/06
DEC 06 2006 a
---
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 th rk for which this permit is issued. My workers' compensation
insurance carrier and policy, umber a
Carrier EXEMPT Policy er EX6PT
certify that, in the perfor ance of thew i for whi hath' per is i ued, 1, shall not employ any
pr7�son in any manner o as to beco subject to he ork ' co pensation laws of California,
dy�d agree that, if I sh uld become act to the or rs' ompe sation provisions of Section
I X3700. of the Labor Collie. I shall fo ith comp ,wit ose Drikisions.
WARNING: FAILURE TO SECURE WORKERS' OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENH TIES 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 b omes nu I a void ' work is not corn nced
within 180 days from date of issuance of suc ermit, or sation o work for 180 d will subject
permit to cancellation.
I certify that I �haa readthis application and state that t aboveinf anon is «ect. I agre comply with all
cityantl cou ttlinances and state �ws relating to b dding con ion, a hereby auth representativesof this cou nttuPonthe-mentioned prop y for insp 'dn p ores.
Dat Sign re (Applicant or Agent):
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # �r,
"l
1A
Project Address: "Zoo VCJ 1,q /O%c Q-�-o Imf 0
Owner's Name: 6a4
A. P. Number:
Address:
Legal Description:City,
Contractor: s.
ST, Zip: C� �t ,.J Z ✓� Z Z S�
Telephone:
Address: -3— eQ �o p
Project Description:
City, ST, Zip:
Telephone:
City Lic. #:
State Lic. # :
Arch., Engr., Designer: Clk4d
Address:'3 _ g�
City, ST, Zip:
Telephone: ?j y(
State Lic. #: '�
Name of Contact Person: (!!✓J ��
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: q6T - A6 (o
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
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"
tad Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d 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
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