09-0655 (BLCK)81307 Amundson Ave
09-0655
._i
1111111111111111111111111111 29
IE
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09-0000065.5 71
Property Address:
81307 AMUNDSEN AVE
APN:
767-690-020- -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
260
Applicant: I Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
-------------------------------------------------WONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am ensed under provisions of Chapter 9 (commencing with
Section'7000) of Division 3 of the Business an rofessionals Code, and my License is in full force and effect.
License lass: B License No.: 848057
ate: onuactor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjur that 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 than five hundred dollars ($500).:
(_ 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
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
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.). -
(_ 1 I, as owner of the property, am exclusively 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 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 the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPER 11T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/02/09
Owner:
MICHAEL H GRAY TRUS
PO BOX 9935 D
r A
NEWPORT BEACH, CA 9UL
Contractor: , r--- .._
BRADSHAW CONSTRUCT ON IN ,, {_4,, {
46248 ROUDEL LN
LA QUINTA, CA 92253
(760)347-4246
Lic. No.: 848057
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Y[ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
't Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are: '
Carrier DELOS INS P licy Number 01DKRM22005875
I certify that, in the performance of a work for which this permit is issued, I shall not employ any
person in any manner so as to come subject to the workers' compensation laws of California,
and agree that, if I should b me subject to the workers' compensation provisions of Section
3700 of the Labor Code, I all forthwith comply with those provisions.
ate: %6-09 Ap ant:
WARNING: FAILU EE TURF W RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIM AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001 IN ADDITI, N 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 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 permi or cessation of work for 180 days will subject
permit to cancellation.
1 certify that I have read this application and state that the abo ' formation is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin struction, and hereby authorize representatives
of this c my to enter upon the above-mentioned property inspection purposes.
of
SiSi i/ure/(Applicant or Agent):
Application Number . . . . . 09-00000655
Permit . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee
15.00
Plan Check Fee
.00
Issue Date . . .
.
Valuation . . .
. 260
Expiration Date .
. 12/29/09
Qty . Unit Charge
.Per
Extension
BASE FEE
15.00
--------------------------
Special Notes -and
-------------------------------------------------
Comments
SUPPORT WALLS FOR
SINGLE STONE SLAB
PEDESTRIAN BRIDGE,
(2) 6' WIDE X 5' HIGH
WALLS; PER APPROVED
ENGINEERING.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged Paid
--------------------
Credited
--------------------
Due
-----------------
Permit Fee Total
15.00
.00 .00
15.00
Plan Check Total
.00
.00 .00
.00
Other Fee Total
1.00
.00 .00
1.00
Grand Total
16.00
.00 .00
16.00
LQPERMIT
Bin # •.. ....
CitY of La Quinta
Building 8L Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # 55
p
0
Project Address: g _3p— '
Owner's Name: (S CS, D4-6af
A. P. Number: -7& 7- 90 _ o 1x -Address:
Legal Description:
City, ST, Zip:
Contractor' \
•; s' `aN8't R-uCa Gn
Telephone• ::•r.< ; . .»< <:'':#%s'>`>.
Address: Lv, _Z- a _ L
zgj
Project Description:
City, ST, Zip: (,.4,
Telephone: — '1 (Z {(o .
:; >••>.:•{>.„„:.::.:;:>}::.'fs.<.::;•.;.•,::>'`?
PPOQ.'1' Wkl_l..g .
State Lie. # :
City Lie. #;
;STONr, T3Ql,oec- Sit46cCL mor ll[. 1%
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone'
' `.:} :>•':' ? {: :•irs{:
State Lie. #: : €::>As >J:<.J:<.JJi:::J::%.::.>::}z
:}:.i
:>:%>'E#>: ^: %';.; t4;:
Construction type:
YP . Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIUNG PERMIT FEES
Plan Sets
a
Plan Check submitted—*trTem
Amount
Structural Calcs.
p
Reviewed, ready for co tions
Ian Check Deposit
Truss Calcs.
Called Contact Person
JUN 26- 009
lan Check Balance
Title 24 Calcs.
Plans picked up onstruction
Flood plain plan
Plans resubmitted JBY echanical
Grading plan
2nd 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
M HOUSE:-
''a Review, ready for correction issue VIM Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
. Appr
Date of permit issue
es
LSchool
TotalPermit Fees