06-0802 (BLCK)P.O. BOX 1504.
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
KEITH BUTHENSON
56605 VILLAGE DR
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760),777-7011
INSPECTIONS (760) 777-7153
Contractor:D B
Applicant: Architect or Engineer: BOVENZI HOMES
P.O. BOX 1714
TRUCKEE, CA 96160 FEg 27 2006
(530)613-1173
Lic. No.: 710230
CITY OF LA QUINTA
Date: 2/24/06
s,
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION A7
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 and PrAsioCosde, 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 providedLicense Class: B e No.: 710230 - for by Section 3700 of the Labor Code, for the performance of, the work for which this permit is
issued.
(� Date V Contractor: _ 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
WNER-BUILDER DECLARATION insurance carrier and policy number are: _
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EXEMPT Policy Number EXEMPT
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 be e s ' ct 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 that, if I should beco sub' o 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 Labor Cod , I sh ort 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 - --
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Data: 2-21-0`40Applicant,
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 S CU WORKER 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 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 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 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,
(_ 1 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 -
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.__._____ ,
Date: Owner: - 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above infor, tion is ct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating . to building constr ion, a reby authorize representatives '
of this county to enter upon the above-mentioned property f 'nsp ion p p se
Lender's Name: _ -
Date: 27 �a Signature (Applicant or Agent):
�'
Lender's Address:
LQPERMIT -
Application Number,
06-00000802_
Property Address:
56605 VILLAGE DR
APN:
764-050-015= - -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2775 .,
Owner:
KEITH BUTHENSON
56605 VILLAGE DR
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760),777-7011
INSPECTIONS (760) 777-7153
Contractor:D B
Applicant: Architect or Engineer: BOVENZI HOMES
P.O. BOX 1714
TRUCKEE, CA 96160 FEg 27 2006
(530)613-1173
Lic. No.: 710230
CITY OF LA QUINTA
Date: 2/24/06
s,
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION A7
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 and PrAsioCosde, 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 providedLicense Class: B e No.: 710230 - for by Section 3700 of the Labor Code, for the performance of, the work for which this permit is
issued.
(� Date V Contractor: _ 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
WNER-BUILDER DECLARATION insurance carrier and policy number are: _
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EXEMPT Policy Number EXEMPT
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 be e s ' ct 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 that, if I should beco sub' o 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 Labor Cod , I sh ort 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 - --
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Data: 2-21-0`40Applicant,
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 S CU WORKER 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 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 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 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,
(_ 1 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 -
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.__._____ ,
Date: Owner: - 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above infor, tion is ct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating . to building constr ion, a reby authorize representatives '
of this county to enter upon the above-mentioned property f 'nsp ion p p se
Lender's Name: _ -
Date: 27 �a Signature (Applicant or Agent):
�'
Lender's Address:
LQPERMIT -
Application'Number 06-00000802
'Permit. . WALL/FENCE PERMIT
Additional.desc .
Permit Fee 54.00
Plan Check
Fee
.00
Issue Date
Valuation
2775
Expiration Date, _ 8/23/06
Qty, Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU .BLDG 2,001-25,000
9.00 u
------------:---------------------------------------------------------------
Special Notes and Comments
111 LF 6' BLOCK WALL PER CITY STANDARD
& SFD PLAN
Fee summary Charged Paid
Credited
Due
-------------
Permit Fee Total 54.00
----------
.00
----------
.00
54.00
Plan Check Total ..00
.00
00 -
.00
Grand Total 54.00
.00
.00
54.00
LQPERMIT .. - - . •
_
.. .
Bin #
- >.
City of. La Quinta -
Building u 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: �—
A. P. Number:
Legal Description:L
Owner's Name:
Address: 1 i
S 5 �� Q e t^ ;w.e
Ci Zi ii
Pity, ST , P: ,LcL CL,,/Ac, CA aS�
Telephone:'
Project Description:
,
G'
Contractor:VD00c, in Z.1 5
Address:
City, ST, Zip��yC'
Telephone: �4�'
State Lic. # : 7 / 2 3
q
City Lic. #: /
Arch. ngr., Designer: i, `•
Address:
City, ST, Zip: rt Cq.. J
!
Telephone: 7 60
State Lic. #: n
/1� L /n�
Name of Contact Person: /A
-
Construction Type:W A Occupancy:
Project type (circle on� Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: ZSR 73
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 Cala.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
2°" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S:M.L .
H.O.A. Approval
Plans resubmitted °
Grading
IN HOUSE:-
'"d Review, ready for corrections/. issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
"Total Permit Fees