12-0452 (BLCK)P.O.. BOX 1504 '
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA' 92253
Application Number:
12-00000452
Property Address -528"8'0
AVENIDA OBREGON
APN:
773 -315 -007 -7 -000000 -
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application'valuation:
1750
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION "
I hereby affirm under penalty of. perjury that I am licensed under provisions of Chapter 9 -(commencing with
•Section:T000I;of Division 3 of the Businessend Professionals Code, a d;my. License is in'full force and effect.
License Class.`'BlJcenseN 926128' .
Date:�i-I��C�r:- I
OI NER-BUILDER DEC" RATION_
I hereby affirm under penalty of perjury tha"t 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 thanfive 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•offered46r.sale (Sec, 7044, Business and: Professions Code: 'The
Contractors' Stafe,License,Law doesmotlapply to an owner of property who builds oaimproves thereon,
and who does the work himself or herself throughhis or her own employees, provided that the
improvements are not intended oi'offered for sale: If, however, the building or'.impiovement is sold within
one yea -r 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.):.
(_) I, as owner of the property, -am exclusi'vely 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.).
I—) 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 theperformance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
IQPERMIT
Owner:
GARZA RESIDENCE
52880 AVENIDA OBREGON
LA QUINTA, CA 92253
Contractor: -
15ANTOR MARTINEZ CONSTkI�ON
81057 AVENIDA ROMERO
INDIO,,CA 92201 .
(760)..702-6209
Lic". No.: 9261281 CI
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760)' 777-7153
Date: 4/25/12
APR 2 j 2012 �U!
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: r
-1 have and will.maintain"a certificate` of coinsentto self -insure for workers' compensation; as provided
for by Section 3700 of the Labor Code, for.ttie performance of the'work for which this permit is
issued. .,. - .. ��
I have and will maintain workers' compensatiodinsurance',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 NTL INS Policy Number" 19609972011
1 certify'tnat, in'the performance of the work for which this permit is issued, I shall not employ any
person idany manner so alto become subject to the workers' compensation' laws of California,
and agree that, if 1 s Id become5bjo the wort ers', compensation provisions of Section
3700 of the Labor ode I shallfoomply wit those Prov s ns.
Dater Applicant:
WARNING: FAILURE TO SECURE W RKERS' COM PEN S TION.COVERAGE ISNLAWFUL,.AND SHALL .
SUBJECT AN EMPLOYER TO CRIMINALPENALTIES'AN" CIVIL FINES UP TO -1,E HUNDREDTHOUSAND
DOLLARS ($100,000). ft 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 Ouinta, its officers, agents and employees for anyact or omission, related to the work being
�performedvnderor following: issuance of this permit. - -
2. Any permit issued as aresult 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
permit to cancellation.
certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to b ing construction, nd hereby authorize representatives .
of this county to enter upon the above-mentioned prop rt for inspection p poses.
r I �_
Application Number . . . 12-00000452
Permit; WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 41.00. Plan Check Fee
.00
Issue Date Valuation
1750
Expiration Date 10/22/12
Qty Unit Charge Per a.
Extension
BASE FEE
15.0:0
1.3..100-z. 2..00,00• HND BLDG'501-2, 000
26.00
• ----- -- ------ - - - - --
Special Notes .and:. Comments.
.. 6WALL.7W-"L.F:'%PER- ;CTTVJSTANDP;RD
SIDEYARD: WALL.'. PER B -.H-. APPROVAL
--------------.-----_----------------- 77 7- ------------
Other :Fees' BLDG STDS-ADMI&t'-(SB1473) :
1.00
e summaryCharged Paid - Credi=ted
Due
Permit Fee. Total `. 41,=. 0`0 -00 00 -.00
41.00
•
=Plan-":Check..To't '1 0'0.' A A0
019
<Other: Fee.,Total 0.0 00.
1'.00
Grand .Total 42::'00 00 00
4'2.:00
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Cr }r of U .4Wh to
Buttdtng Safety Division'
P.O Box'f 504, 78-495; Catfe Tampico '
U-Qidnta,CA 92253 (760) 777400 .
Building Peiink yApplrcation and�Tracking Sheet
Permit #
f
j' ✓
Project Address:.Z 8 G Q r- a
er'sNaiiid::1.me . .L ec R r al Q ✓ 7 a
A. P. Number.
<
Address: •.: 2 PB.o_-_ .G ' �_ p, a.�
Legal Description:
City, ST, Zip:
Contractor.
'Telephone:
Address: G S 7 y o�G �<
Project Description:
City, sT, Zip: b
;-76
4 L2
Telephone:760 Z G 2 2.6
State Lic. "# : 2 6 . /
City Lie. #;
_
Arch., Engr., Designer
;S /` �• r R r
Address:
City., ST, Zip: s
Telephone: r �7
State Lie. #: '`'u`� Y r'a
:construdionType:. `• Occupancy:
};Protect type (c,rele`one). , New " 'Add'n~ Alter Repair Demo
Name of Contact Person:
Y.+
Sq Ft : #. Stories:.
#Unita
Telephone # of Contact Person:
4.E Value'U Prole
APPLICANT:. DO NOT,WRITE BELO*THIS UNE •:
# Submittal Req 'd Rec'd TRACMG r•; PERMIT FEES
Plan Sets
Plan Check submitted
Y
Item
Amount
Structural Calcs
Reviewed, ready for. corrections .;, :
Plan Check Deposit.Truss .
C21cs
Called'Contact Person "
Plait Check Salem
Title 24 Cates.
Pians picked up
Construction
Flood plain plan
`Plans resubmitted'..
Mechanical
Ginding plan
tad Review, ready for correctionsitssue
Electrical
Subcontector List
Called Contact Person
Plumbing
Grout Deed
Plans picked, up
S M L
H.O.A. Approval
Plans resubmitted
Grading
IN HOWE:-
7n6 Review; ready for correctionslissue
' Developer. ImpaeC Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
'
School Fees
Total Permit Fees