06-4372 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number
11
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
'Applicant:
80980 VISTA DEL MAR
772-260-019- - -
WALL/FENCE
VERY LOW DENSITY RES
14960
Architect or Engineer:
�u�dtl
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/22/06
Owner:
FADEL AHMED S.
82762 BOSTON CT
INDIO, CA 92201 `
I e
Contractor: D,
ESR DESIGN BUILD CC11 CTOR
74123 WINDFLOWER COUF T
C 6 206
PALM DESERT, CA 9221 UCI.
` (562)40.: 300
879
. • l - Y Lic. No. ; 879022 CITY OF 4A®edIEBTA
FINMCE DEPT
- _ - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ --------------------------------
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION '
I hereby affiim under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of-perjuryone of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. -
License Cl s: B 2 _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as'provitled
for by Section 3700 of the Labor Code, for the performance of the work -for which this permit is
issued.
tea. ` .ntr..or: - _ 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
OWNER -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 EX MPT - 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 requiresthe applicant for the _ person in any manner so as to become subject to the workers' compensation laws of California,
permit to files signed statement that he or she is licensed pursuant to the provisions of the Contractor's State .and agree that, if I should become subject dike w rs' ompensation 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; I shall f hw' y with th e�pr visions. '
that he li she o exempt therefrom and the basis for the alleged exemption. Any violation of ed doll s ($50 )by .-
'any applicant for a permit subjects the applicant to.a civil penalty of not more than five hundred dollars IS5001.:
(_ I I, as owner of the property, or my employees with wages as their sole compensation, will do the work, andthe structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The - WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL s
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
111 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—) 1 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. -
I 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 informatgp�
a ee 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 constructiobythoriz epresentatives .•
_ of thi ounty to enter upon the ab ve-mentioned property for inspection '
_ Lender's Name: -
- _ Date>/C7�• Si re (Applicant or Agentl: - • .� `
Lender's Address:
I.QPER;IIT
- Application Number . . . .. . 06-00004372
Permit WALL/FENCE
PERMIT
Additional `desc .
Permit.Fee 162.00
Plan Check
Feer.
.00
Issue Date . . .
Valuation
14960
Expiration Date 6/20/07
Qty Unit Charge Per
Extension ,
BASE
FEE
45.00
13.00 9.0000 THOU BLDG
2,001-25,000
117.00
----------------------------
Special Notes and Comments
------------------
------
---------------
560 L.F. 6' BLOCK WALL, 60 L.F.
4!
BLOCK WALL, BOTH CITY .STANDARD
Fee summary Charged
Paid Credited
Due
--------- ----
Permit Fee Total 162.00
------------- - - -
.00
----
.00
---- - -
162.00
Plan Check -Total `' .00
.00
.00
.00
Grand Total 162.00
.00
.00
162.00
'LQPERMIT
Bin #
City of La Quinta
.
Building U Safety Division
Permit ff ,
P.O. Box 1504, 78-495 Calle Tampico '
I
La Quinta, CA 92253 - (760) 777-7012
Building
Permit Application and Tracking Sheet
Project Address: V1
Owner's Name:
'
A. P. Number:
Address:
Legal Description:. LD ►�, 'r9hGT" �4 to t�67�j
,
City, ST, Zip: j 249
Contractor: -pyq�Q GpNS Ip
Telephone: R
Address: G / L ` �_1 _ � ' LO �-•s'IZ•L7
,Project Description:•
�O 0 �"r Q �?c .
City, ST, Zip: c
G 22� 4'
O aid 2, IN
Telephone: a_ 2
5lvU LF ® ' 4
State Lic. # : -176 1
City Lia #•
� � � .
Arch., Engr., Designer: 4� .•• -� �
,
L
Address:
City,:ST,Zip:1"
�J
Telephone: '7&0121 o (:
' C Type: CSG Occupancy: -
AInstrucGon
State Lic. #:
P.ro J type (circle one): New Add'n Alter 'Repair Demo
Name of Contact Person: pDW(a� I TIS Sq: Ft.: # Stories: # Units:
Telephone #.of Contact Person: 560,2 - sFpa• �0��7 Estimated Value of project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
+ # Submittal Req'd - Rec'd TRACKING ." PERMIT FEES
• Plan Sets
Plan Check submitted Item Amount
Structural Cities.
Reviewed,.ready for corrections Plan -Check Deposit
Truss Cities.
Called Contact Person Plan Check Balance
Energy .Csilcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
' Grading.plan
2" Review, ready for correctiousrissue Electrical
Sabcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted . Grading
INHOUSE:-
Review, ready for correctionsrssue Developer Impact Fee.. ;
Planning Approval
Called Contact Person A.I.P.P.
.Pub. Wks. Appr
Date of permit issue
School Fees
... , TotaLPermit Fees ...
t