11-0486 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:11� 00000486--�'
Property Address: 53347 VIA MALLORCA
APN: 772-420-999-43 -298943-
Application description: SPECIAL INSPECTION
Property Zoning:' LOW DENSITY RESIDENTIAL
Application valuation: 0
T4ht °F 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WILLIAM SHIELDS
5004 YAKIMA, WA
YAKIMA, WA 989108
( \
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: . 5/11/11
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 ISec. 3097, Civ. C.)•
Lender's Name:..
Lender's Address: -
LQPERMIT
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 of4reli
ch permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application ane thatth a formation is correct. I agree to comply with all
city and county ordinances and state laws to ddin cons uction, and hereby authorize representatives
of thi"countyt upon the above-mentioned op or-insp ction purposes.
/!sate.ignature (Applicant or Age t): (p
Contractor: 'Z_rJ�, "
Applicant: Architect or Engineer:
MONARCH HOMES DESERT.IVSN C
49950 JEFFERSON ST, ff 134Y�
INDIO,'CA 92201 /
(760)413-8863
Lic: No.:. 457228
---
' CONTRACTOR'S DECLARATION `
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty per' that I a i ensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 Business a P fessionals Code, and my License is in full force and effect.
Ihave and will maintain acertificate of consent to self -insure for workers' compensation, as provided -
_ Licen Cla s: B License No.: 457228 - _
C_ +
_
_ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued...
Dale/ n actor: Js % (AA/�
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 is umber 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 719000322 - -
- following. reason (Sec. 7031:5, Business and Professions Code: Any city or county that requires a. permit to• _
_ I certify that, i e erfor nce o he 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 i ny nner o as to be ome 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 agr a that if Iould becom subject to the workers' compensation provisions of Section •. - -
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the BusinessandProfessions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
3 00 o the b Cod all fith comply with those provisions.
1 NYS
"//-/ �
any applicant for a'permit subjects !he applicant to a civil penalty of not more than five hundred dollars IS5001•: � �
ate!S � Applica
'j— •
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 SEC E WO S' 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 CRI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND -
' and who does the work himself or herself through his or her own employees, 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
SECTION 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, 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, 6
(_) I am exempt under Sec. , B.&P.C. for this reason
_
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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 ISec. 3097, Civ. C.)•
Lender's Name:..
Lender's Address: -
LQPERMIT
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 of4reli
ch permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application ane thatth a formation is correct. I agree to comply with all
city and county ordinances and state laws to ddin cons uction, and hereby authorize representatives
of thi"countyt upon the above-mentioned op or-insp ction purposes.
/!sate.ignature (Applicant or Age t): (p
.r.
Application Number 11-00000486
Permit SPECIAL INSPECTION
Additional desc
_
- Permit Fee 100.00
Plan Check
Fee :
.00 ,
Issue Date
Valuation
. . .
. 0
Expiration Date 11/07/11
Qty Unit Charge Per
Extension
._'BASE
FEE
100.00
Special Notes and Comments
SPECIAL INSPECTION TO RE -INSTATE
PERMIT
#06-3497 TO FINISH SFD
Fee summary Charged
Paid Credited..
Due +
Permit Fee Total 100.00..
.00
.00
100.00
- Plan Check Total .00
.00
.00
.00
Grand Total 100.00.
.00
00
100':00 '.
r
LQPERMIT
Bin #
City of La Qulnta
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#
- -g
Project Address:' �3 3 1// A14aolz C-14
Owner's Name: ili i tLI ��✓` f
A. P. Number:
Address: .SOU Atw FS I % E �,2 ✓�u� .
Legal Description:
Contractor: ON �L y►t��-, �,
City, ST, Zip: (� q lot
Telephone:
Address: 0_ IS-D JAT J S' 1 � 3 0 /1�3l3'�
Project Description:
City, ST, Zip: d,&g CA 2L O l
Telephone:
ILe - �J r"j�{'1 t Ems•- � 1 �
State Lic. # :
City Lic.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person: 04V,'o 5.4<-.i .5 .etj
Construction Type: Occupancy:
Project type (circle one): , New Add'n Alter Repair -Demo
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: -70-4k 3-7 W(9 '
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
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 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading.plan
2°" Review, ready foreorrections/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:-
7n° Review, ready for correctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
Q (b ? GCM t'j'
School Fees
m Alp
7i,.��P
-- -
_ _..........
�PdGa�7
to
Total Permit Fees
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