05-4808 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00004808
Property Address: 156222 VILLAGE DR
APN: 764 -040 -017 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1500
Applicant: Architect or E
[P
T4ht °F4w
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
� D ncr 27 2005 L
OF lA QUINTA_
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: B License No.: 554910
ate: (' E� tsntractor: _ �•�V Dt (t
OWNER -BUILDER DECLARATION'
1 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.).
(_ 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/26/05
Owner:
JERRY WILLIAMS
56222 VILLAGE DRIVE
LA QUINTA, CA 92253
Contractor:
J W DESIGN & CONSTRUCTION, INC
P.O. BOX 1154
SAN LUIS OBISPO, CA 93406
(805)544=3130
Lic. No.: 554910
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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 the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 173035405
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
11 ,Jr A 'ant: 1). - DQS
/WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit. '
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of$uch permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above inf ation is correct. I agree to comply with all
city and county ordinances and state laws relating to building const ion, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspe t n purposes.
Q c �2 ` Sig re (Applicant or Agent):
Application Number . . . . . 05-00004808
Permit . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee . . .
. 35.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 1500
Expiration Date
4/24/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
10.00 2.0000 HIND BLDG 501-2;000
20.00
Special Notes and
Comments
....-
.................
60 L.F. 6' GARDEN
WALL, CITY STANDARD
Fee summary
-----------------
Charged Paid
--------------------
Credited
----------
Due
Permit Fee Total
35.00
.00
----------
00
35.00
Plan Check Total
.00
.00
.00
.00
Grand Total
35.0.0
.00
.00
35.00
LQPERMff
OCT. 26. 2005_ 4:07PMJ, W. DESIGN
J.W. Design & Construction, Inc.
P.O. Box 1154
San Luis Obispo, CA 93406
Project Title: LZ7,r 9%
Meeting Date: zo Gor ary
GlWi&r ''
44 i
44
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NO. 0634 P. 3
Page of
0
OCT. 26. 2005 4:07PM J, W. DESIGN
NO. 0634 P. 1
$1n # City of La Quinta
Bullding ex Safety Division
Permit # P.O. Box 1504, 78.495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: Gj(Q . UIQ Owner's 1118me_
A. P. Number: '7(� . �}(] •Ql" 1 .97 Address: CIO,
Legal Dcscription 2Se* City, ST, Zip. 66A LL.L,S
Contractor 0.#J- Te6A&if„( �d1�6'S-i; �IyG. Tcic hone: ,
P'� 701' • 7'L70
Address; gx240-ij s+..Empp or. j W11' x ProJect Descripdow
City, ST, Zip:..64A Wle� ANE 950W I
Telephone: (g,�j�-IP11j0
State Lie. 0: 1Q City Lic. !i: 6 V L F
Arch., Engr., Deslgner.
Address: (�1
Ci(y, ST, zip: la��
Telephone: " ' ' Consnvc[ion Type:
Tcicphone # of Contact Pmon: w
N Submittal
Plan Scor
Structural Calcs.
Truss Calcs.
Energy Cake.
Flood plain plan
Grading; plan
Sobcontactor List
Granr Deed
H.O.A. Approval
IN HOUSE. -
Planning Approval
Pub. Wks. Appr
Sehoo) Ines
I J 0110,/1 'Ohl
a Jtoncs:
Estimated Value of project:
APPLICANT: DO NOT WRITE BELpyy THIS LINE
Ri:c'd rn a r`T[rntr_
Occupancy:
Add'n A.Itcr Repair Dcmo
4 Units:
rr
PERMIT FEES
Plan Check submitted
Reviewed, ready for corrections
Called Contact Person
Plano Mcked up
Item
plan Check Deposit
Plan Chetsc Dalpnce
Construction
Amount
Plans resubmitted
Mechanical
204 Review, ready for corteet'ioutasuo
EI¢oer;cat
Called Contact Parson
Plumbing
Plans picked up
S.M.I,
Plans resubmillcd
Grading
Jn° Review, ready for correetionsrssue
Dcvctoperlropact FCC
Callod Conflict Person
Date of permit issge
Total Permit Fees
W.10 :7 C1)n7 X17 •, vn