07-2933 (BLCK)ci
4
P.O. BOX 1504. ^' VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
' LA QUINTA; CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/13/07
Application Number: 07-00002933 Owner:
Property Address: 80475 VIA TALAVERA TOLL CA V
APN: 772-250-999-148 -30357 -,_ C/O KEVIN D DUERMIT
Application description: WALL/FENCE 8901 E MOUNTAIN VIEW 200
Property Zoning: LOW DENSITY RESIDENTIAL SCOTTSDALE, AZ 85258
• - Application valuation: 8125 •1�3®3��0�1� .
\� Contractor: d1N�(1�d'�
Applicant: Architect or Engineer: TOLL BROS, INC. I FRED %R�
PALMDESERT, CND SAS OL uu Q� "" Li n
(760)564-9930 U
Lic. No.: 777699 Q '
-------------------
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 Id Professionals Code,land 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: 13 - ense o.: 777699 a for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. -
r Date:l Contractor: - _ 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
OWN-BUILDE DECLARATION - insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from t e Contractor's State License Law. for the Carrier ZURICH AMERICAN Policy Number WC3878213 - 02
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
C 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' compensationlaws 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 come subject to a wor rs' 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 shorthwi[h ply wi those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by ffy
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate:_ J �_J p� P licant:
1 _) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and fZ
the structure is not intended or offered for sale (Seo. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION VERAGE 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 CIVILNES 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 COMPE SATION, 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—) 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 I am exempt under Sec. , BAP.C. for this reason theowner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
fL O' ff' I f
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
o a umta, its o kers, agents and emp ogees or 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. -
certify that I have read this application and state that the above information is correct. Iagree to comply with all
city and county ordinances and state laws relating to building co struction, and her y out rize representatives
of this cou ttty ttoo/enter upon the above-mentioned propert for 1 isppec�&n�purpc es -
Date1& i (Signature (Applicant or Agent):
,.
Application Number 07-00002933
Permit . . . WALL/FENCE PERMIT
l
Additional desc .
Permit Fee 108.00
Plan Check
Fee
00
Issue Date
Valuation
8125
Expiration Date 5/11/08
Qty Unit Charge Per
Extension
BASE.
FEE
45.00
'
7.00 9.0000 THOU BLDG
2,001-25,000
63..00
- ------------------------------------------------------------
Special Notes and Comments
BLOCK WALL ORCO WALL SYSTEMS 325
IN FT
X 6FT HT
- Fee summary.' Charged
Paid Credited
Due.
-
Permit Fee Total 108.00
------ ----------
.00
----------
.00
108.00
Plan Check Total .00
.00
.00
.00
Grand Total 108.00
.00
.00
108.00
LQPERMIT
..
Bi" #
City of La Qu i nta
Building a Safety Division
P.O., Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building.Permit Application and Tracking Sheet
Permit #
Project Address:'
Owner's Name: �� C.
n C-
A. P. Number: e �t �4%
Address: 14icstu n4k T
Legal Description: ADUIVOM\J
City, ST, Zip: D4 Ie— A 7 Zy,0
Telephone:
Contractor: "t -o ` e
Address:
Project Description:
City, ST, Zip:e z
celik k
4 �!
Telephone: Sb 1� g
4� _
d4 9
State Lic. # : City Lic. #:
Arch., Engr., Designer: AA
LIZ, `CL 0. 0._
I `
Address: 42ve
City, ST, Zip: Lo, qui4e, C. 9aasl
Type: Occupancy:
Telephone: 1 ®1{Construction
1 �
State Lic. #: o p '., $ ;
Name of Contact Person: Geor e
Project type (circle one): ew Add'n Alter Repair Demo
Sq. Ft.:32 # Stories: # Units:
Telephone # of Contact Person: (—. 8
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE(,�jri 760-ZiS-g7$
#
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 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd 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:-
'"" 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