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11-0431 (BLCK)4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: REDEVELOPMENT AGENCY 78495 CALLE TAMPICO LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 CITY OF L Contractor: Applicant: Architect or Engineer:HENRY'S MASONRY, INC., n P.O. BOX 5185 LA QUINTA, CA'92248 (760)'2'50-8253. Lic. No.:. 7.04270 11 Date: 4/29/11 • LICENSED CONTRACTOR'S DECLARATION P.O. BOX 1504 1 hereby affirm under penalty of perjury that I am'li ensed under provisions of Chapter 9 (commencing with 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: t11.OA_0n0 --5 Property Address: €53Y75�AVENIDA OBREGON APN: 774-044-021-9 -000000- Appli6ation description: WALL/FENCE' Prope rty, Zoning: COVE RESIDENTIAL Application valuation: 1625' 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: REDEVELOPMENT AGENCY 78495 CALLE TAMPICO LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 CITY OF L Contractor: Applicant: Architect or Engineer:HENRY'S MASONRY, INC., n P.O. BOX 5185 LA QUINTA, CA'92248 (760)'2'50-8253. Lic. No.:. 7.04270 11 Date: 4/29/11 • LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury that I am'li ensed 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•; � o ofessionals 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 Licen e'ClaSs:' C29 License No - 704270 for by Section 3700 of the Labor Code, fouthe'perforrrance of the work'for which this permit is - ... _ U issued. _ . .'. I have compensation insurance, as required by Section 3700 of the Labor at ntrac'or: - and will maintain workers' :Code, for the performance of the work for which this permit is issued. My workers' compensation NER-BUILDER.DECLARATION.' insurance carrier and policy number are: I hereby affirm under penalty of, perjury that I am exempt from theContractor's StateLicense Law for the Carrier HARTFORD INS Policy Number 41WEGPZ5043 following reason (Sec. 7031.5, Business and Professions Coder Any city or county that requires a,permit to _ I cerWy,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 beco subject to the workers' compensation laws of ,California, permit,to file a -signed statement that he or sheds licensed pursuant to the provisions.of the Contractor's State and agree�that, if 1'should be me bject to the workers' compensation provisions of Section License Law -(Chapter9-(commencing with.Sect ion 7000) of Division 3 of the Business and Professions Code) or _3700 of the Labor Code, !Aa rthwith comply with those provisions. 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: (') 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, BusinessandProfessions Code: The, WARNING: FAI RE'TO SECURE WORKERS' COMP• TION COVERAGEIS UNLAWFUL, AND SHALL ' Contractors'.State License Law does :not apply to arrowner;of property who builds or improves thereon, - SUBJECT. AN EMPLOYER TO CRIMINAL PENALTIE ND 6tll_ FINES'UF.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 ADDITIONTOTHE 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, ANDATTORNEY'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 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 riot 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(sl'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.&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 issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: 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 of work for 180 days will subject permit to cancellation. - I certify that I have read this application and state that t ove information is correct. I agree to comply with all city and county ordinances and state laws relating to i onstruction, and hereby authorize representatives of this county.to enter upon the above-mentioned o or inspection purposes. fSatpS )/ �U�/Signa e (Applicant or g Application Number . . . . . 11-00000431 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 39.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 1625 Expiration Date 10/26/11 Qty Unit Charge Per Extension BASE FEE 15.00 12.00 2.0000 HND BLDG 501-2,000 24_.00 ---------------------------------------------------------------------------- Special Notes and Comments 65,L.F. 6- GARDEN WALL, CITY STANDARD. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN-•(SB1473) 1.00 Fee summary Charged Paid ------- Credited Due ----------------- Permit Fee:Total 39.00 .00 .00 39.00 Plan Check Total .00 .00 .00 .00 Other.Fee Total 1.00 .00 .00 1.00 Grand Total 40.00 .00 .00 40.00 LQPERMIT QWNf1C-'05 N1Wffit-H �• a ©� W N/ / G'r 1 ErI 0N O % 4. • / 531Z� ROW y-NA„�fi No! t i obi,j t�aw� 6s o� 6�tk t_A i,_j G�_)dee m 6�+ede� riewe 1A) Bin # . . Crty,.of La Quinta . Building 6r�Safety. Division P.O. Box 1504, 78 495 Calle Tampico La Quinta,'CA 92253 .(760),777.-7012 Building: Permit:Applka:and Tracking Sheet Permit # `J 1 Project Address:3� %S 06A o �u Owner's Name • dk A. P. Number. Address: Legal. Description:ity; Contractor: 9 Y S %✓% - Address:L0 UCS V S,14,h)1)C ST, Zip: .Telephone:. �•>>����:>:�>:«<:<>.<::<.Yv:»>#>�> Project Description: City, ST, Zip: 1,) S O 14SOXJ Tele hone: —Q < p 2 So CJ �> � .:.::I.:Yc: 'u` ?:.'•.:;z'::;s%;> : ':::s ::<:;<'s#'s^>:r:#f:.. (/� r State Lic. # : '� . City Lic. #.: Arch., Engr, Designer: Address: City, ST, Zip: Telephone: w�•iiiil�i:i:.::::.hy+���Y:::: r: r: vri'L r.i:iiviii:•iiv: State Lic. #: :,i ,; <.i;;i;:•Y:.•. s<<: -: Name of Contact Person: Construction. Type: Occupancy - .. .'� Project ct type (circle one): 'New Add'n Alter Repair Demo Sq. Ft,: -# Stories: T# Units: Telephone # of Contact Person: Estimated Yalue of Project: . APPLICANT: DO NO,T<WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item. Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Tide 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 20° Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3rd 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