08-1967 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 08-00001967,—'
Property Address: 49399 VISTA LUNA
APN: 602-180-999-1 294574 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 144
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
T D DESERT DEV D
P O BOX 1716
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
DEC 2g 1808
Date: 12/18/08
Contractor: C17Y J, U
Applicant: Architect or Engineer: TD DESERT DEVELOPMENT FICA Epl�Pq
'P O BOX 1716
!� LA,QUINTA,`CA 92247 ' J
(760)77141941 +. }
`r Lio. No. 762987
.. f
LICENSED CONTRACTOR'S DECLARATION - y 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 and Professionals Code, 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 provided. -
. . License Class: B License No.: 762987 , — t` for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date:- 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
OWNER -BUILDER DECLARATION • i, .insurance carrier and policy number are:
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the - Car rierC MPWEST INS CO Policy Number CA005001482004
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.become subject 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 - a d agree that, if I should a subject.to th ' compensation provisions of Section
_ - License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code)ior, 700 of the Labor Code shall, orthwith c ply with t se provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5
a
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).::• licant:.-
(_) 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 WARN NG: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE I?ONENDRED
UL, 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 THOUSANDand who does the work himself or herself throughhis or her own employees, provided that the - DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DS 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 theproperty, 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 am exempt under Sec. , B. is 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
A /17A99 performed under or following issuance of this permit.
ate: caner: - -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 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 information is cor I agree to omply with all
- -,work for which this permit is issued (Sec. 3097, Civ. C.). _ city and county dinances and state laws relating to buildin struction, and reby authorize r presentatives -
' of this co fy t enter upon the above-mentioned propert ori pection pu oses. -
Lender's Name:
'gnature (Applicant or Agent)'
Lender's Address:
LQPERMIT
Application Number 08-00001967
Permit . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee
15.00
Plan Check
Fee
.00 ,
Issue Date . . .
.
Valuation
144
Expiration Date
6/16/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
Special Notes and
Comments
------------------------------
9 L.F..4' MASONRY
WALL_ FOR MONUMENT SIGN
"VISTA LUNA", PER
SA # 2008-1332, CITY
STANDARD
Fee summary
Charged Paid
Credited
Due
Permit Fee Total
15.00
00
.00•
15.00
Plan Check Total
.00
.00
.00
.00
Grand Total
15.00
.00.
.00
15.00 -
LQPERMIT
Bin #
Cityof La Qu►no
Building 81 Safety Division
Permit # I\
P.O. Box 1504, 78-495 Calle Tampico
\kl_
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: fc
L,.o,t44 Owner's Name:!'Q 0-eye
A. P_ Number:
Address: D
City, ST, Zip: l
Legal Description: %1 Z 9cFj % _ �� � �
Contractor: Q iJ �l �PJ �Al Telephone: ❑ 7 ?7 /;7T1,
Address:
Project Description:
City, ST, Zip ,- 6t
Telephone:? —7 7 / 7 7
State Lic. # .
City Lic.
Arch_, Engr., Designer:
Address:
City, ST, Zip:
See 54,.e�l.� r�rC /�e-S
Telephone:
Construction Type: Occupancy:
State Lic_ #:
Project type (circle one)Ne Add'n Alter Repair Demo
!--r7
Name of Contact Person: ID � Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:fD
77 Estimated Value of Project: Zo p
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd
Req'd TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Calls.
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 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
CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET
PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT
Form updated & effective 6/26/2008
Green Sheet approvals are forwarded to the Buildin & Safet De artment direct) Public Works. Please DO
NOT submit the Green Sheet (Public Works Clearance) Packet to the Public Works Department until ALL
requirements listed below are complete. Incomplete applications or applications which cannot be processed will be
returned to applicant.
Date: 0 q'� Developer: 6i J I �jq
TractZ Tract Name: Lot No.(s):
Address(s): Phone Number:
IkLscdf--, Works following are the requirements for Public Wor s Clearance to authorize issuance of a building permit from the
Building & Safety Department:
❖ CUSTOM HOMES: PROVIDE ITEMS #2, #3, #4 AND #5 BELOW
❖ TRACT HOMES: PROVIDE ITEMS #1, #2, #3, #4 (AS APPLICABLE) AND #6 BELOW
❖ COMMERCIAL BUILDINGS/OTHER: PROVIDE ITEMS #1, #2, #3 AND #5 BELOW
❖ WALLS: PR ITEMS #7 BELOW
SIGNS: PROVIDE bS -Z`'f �/ !A���
❖ OTHER: PROVIDE ITEM #9 BELOW F
t►
1. Attach Pad Elevation Certificates in compliance with the approved design eleva�rf fof�ual�ring;+luas
(maximum allowable deviation of +/- 0.1 foot). Pad Elevation Certificates must be current (within 6
months of current date). If a precise grading plan creates the pad for approval, please withhold green sheet
submittal until a Pad Elevation Certificate can be provided.
2. Attach geotechnical certification of grading plan compliance including compaction reports from a licensed
Soils Engineer. Recently rough graded 'residential developments which have a previously approved
geotechnical certification are exempt from this requirement.
3. Attach recorded final map or title information/grant deed showing proposed building locations are legal lots.
Final maps may be viewed at the following website:
http://www.la-guinta.org/PlanCheck/m search.aspx
4. Attach a completed <1 acre per lot or infill project Fugitive Dust Control project information form, PM10
plan & agreement or provide alternative & valid City approved PM10 plan set reference number or hard copy
plan. PM10 plans for commercial & residential developments (beyond 1 lot) are submitted separately with
grading plans & are subject to additional requirements. A current PM10 certification number is required.
5. Attach a copy of the precise grading plan to the Public Works Department showing building location(s). AO
flood zone developments will require an approved flood plain development plan.
6. Attach an approved rough or precise grading plan for the building location(s) for pad elevation verification or
City plan set number if available. Plans may be viewed at the following website:
http://www.la-guinta.orQlPlanCheck/m search.as x
ach wall pl rrSc refated-app n.
ttach si n !a out) Ian r I ed recise radin Ilan _p are_ 9. Attach supporting documentation for grease trap or special facility installations. l
I have reviewed and confirmed the requirements listed above as presented and find the improvements to be
sufficiently complete for con4struction of the pr posed buildings/structures/walls/signs on the subject lot(s).
Pursuant to my i , the a e a
.ay j released for building permit issuance.
Recommended by- Dated: Z9= 8
Public Works Distribution: Green Sheet to Building & Safety
() Green Sheet to Planning Department
Declined for approval for reason(s) as follow(s), please correct and resubmit:
Page 1 of 4
City of La Quinta, California
PM 10 Fugitive Dust Control Project Information (< 1 acre/lot or Inf ill Project)
(Form Updated & Effective 6-26-08)
Project Information
Project Contractor:
Project Phase
(check one)
Project Name:
❑ Construction
❑ Demolition
Project Tract Number:
Anticipated Start Date:
Lot Numbers:
Project Street Address:
Anticipated Completion
Date:
Total Acres in Active
Construction (< 1 acre
per Lot):
Project Contact
Please note: Dust control is required 24 hours a day, 7 days a week, regardless of
Information
construction status. Person listed below is responsible for dust control during
business and non -business hours.
Name:
Title:
Company Name:
Mailing Address:
City:
State:
Zip Code:
Primary Phone #:
Fax #:
24 Hour
Access/Emergency
Phone#:
Cell Phone #:
Email address:
PM 10 Certificate #:
❖ Expanded PM 10 plans for commercial and residential developments > 1 acre are required by the City of La
Quinta.
Page 2 of 4