11-1292 (BLCK)C• -, IV ":eity000, 4 Qld4z'
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: 12,/06/11
Application Number: 4L11709,QQ12,92°� Owner:
Property Address: 80810 VISTA LAZO SUNBIRD INVESTMENTS LTD
APN: 762-250-021- - - �23 NW HAWKHILL MEWS
Application description: WALL/FENCE CALGARY, AB T3G •2-V1
Property Zoning: LOW. DENSITY "RESIDENTIAL
Application valuation: 12000 (�
Contractor: 1I
Applicant: Architect or Engineer: DE CHRISTOPHER, INC tCt
t��C i`r 2011
42575 MELANIE PL, STEL! l ��
' PALM -DESERT, CA 92211
(760)346-3838' riiYc%1• �.A:�UINIA
iE^ SFT,
n ; LiC. No. 428701 er�,ea
- - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -. - - - - - - - - -
'15•.
LICENSED CONTRACT RATION WORKER'S COMPENSATION DECLARATION • " `
hereby affirm under penalty otr der provisions o hapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: -
Section 7000) of Division 3 ofon ode, y 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 - 428701 -for by Section 3700 of the.Labor Code, for the performance of the work for which this permit is
_ a issued.
ate:.: b �' • C ac - 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
BUILDERDECLARATION insurance carrier andpolicy number are:I hereby affirm under penalty ot from the Contractor's State License Law for the Carrier STATE FARM • Policy Number 90BLX4078
following reason (Sec. 7031.5,usiness and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work f permit is issued, 1 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 su ct tot orkers' 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
1 uId become s act to ' 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 L r Code, 1.sh • I f with c ply with those r 'sions.,
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).: ate: plicant:: -
(_ 1 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 SECURE RS' MPENSATION 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 TOC INA ALTIES 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 AD ITIO O 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 C DE, 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. t , .! •
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 theContractors' 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
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 issuedISec. 3097, Civ. C.).
Lender's Name:
Lender's. Address: P I P
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 of issuance of.such permit, or cessation o r r 180 days will subject '
..permit to'cancellation.
I certify that I have read this application and state that the above ' n is cor ee to comply with all '
city and county ordinances and state laws relating to Bull ' on;tructi , and reby authorize resentatives
of.this coumvito alter udon the above-mentioned p rty for in aGt n p oses.
- . - • r--- �- r.. 7
(_ V 0 L Signature (Applicant or Agent):
r
r
o
AIA�
?plication Number . . . 11-00001292
Brmit WALL/FENCE PERMIT
iditional-desc .
�rmit Fee 135.00 Plan Check.Fee .00
asue Date Valuation 12000
cpiration Date 6/03/12
Qty Unit Charge Per Extension
COLUMNS ORCO SYSTEM.
2010 CODES.
-------------------,- -------------------------------------------
Other Fees
. .
BLDG STDS ADMIN.(SB1473)
-
1.00
' Fee summary
Charged
Paid
Credited
Due
--------------.---
Permit Fee Total
----------
135.00
.00
.00
135.00
' Plan Check Total
00
.00
.00
.00
Other•Fee Total
1.00
.00
00
1.00
Grand Total
136.00
.00
.00
136.00
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Bin #
City of• b Qu,,nto
. Buildingwr Safety. Division ..
P.O. Box t504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
;
Permit #; _I
r'� , /
Project Address: gO v V s\ x} L.{t t -z
Owner's Name: .Q i Nil
A. P. Number:
Address: 4(,ZS ZS -7V- s u, `VE- C
Legal Description:
Contractor:p
E Cl'ii(i5� 1 NC,
City, ST, Zip: t M t u,— C A Q aaL �.
wax;>•:{,<' e�k::v�,r„VL.�:i>icr
Telephone: 760 70,Z^4�=`p hQQf:ra.•< s::"
Address: �I 2 57 5 :• Mt ,w. (t-
Project Description:
City, ST, Zip: t ���„� (
'fele hone %
State Lic. # :
City Lic. #;
Arch., Engr., Designer: 7 ,,
Address: `
City, ST, Zip:
Telephone: 4 • `Su}
a 'any
�';; .o.•�r:N: � ':'�~�•.�•.--•--�- • �.''r;
State Lic- #:a> >Ysr<':>:
Name of Contact Person:
Construction Type: e: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
#Stories: #Units:
Telephone # of Contact Person:
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 Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title U Calci.
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.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