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11-0310 (BLCK)81307 Amundson Ave 11-0310 LI IIIII ILII III VIII IIII 79 P.O. BOX 1504 IE4 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: 4/05%11 Application Number: 11-00000310 Owner: Property Address: 81307- AMUNDSEN AVE MICHAEL H GRAY TRUST APN: 767-690-020- - - PO BOX 9935 Application description: WALL/FENCE NEWPORT BEACH, CA 92658 Property Zoning: LOW DENSITY RESIDENTIAL.k.%fYOFLAQUINTA t7 Application valuation: 4400 Contractor: APR 8 2011 Applicant: Architect or Engineer: BRADSHAW CONSTRUCTION 46248 ROUDEL LN LA QUINTA, CA 92253 (760)347-4246AUrpnePT. Lic. No.: 848057 ------------------------------------------------------------------------------------------------- LICENSE ONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I ?a1ben:d 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 arole onals Code, and my License is in full force and effect. 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: B License No.: 848057 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. /ate: ontractor: 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 insurance carrier and policy number are: I hereby affirm under penalty of perjur that I am exempt from the Contractor's State License Law for the Carrier DELOS INS Policy Number 03DKRM22005875 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that,in the performance o he 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 t ecome 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 and agree that, if I should b orrie subject to the workers' 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 Labor Code, hall forthwith 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: Applicant: . (_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 01 X the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AWEMPLOYER TO CRIMI AL PENALTIES 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 ADDITION TO 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 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 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. 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.I. 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 issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: /_ '> 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 d void if work is not commenced within 180 days from date of issuance of such permit, Or. r ssation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above i rmation is correct. I agree to comply with all city and county ordinances and state laws relating to building co ruction, and hereby authorize representatives of th/isWlytor upon the above-mentioned property for ' spection purposes.) dFa: Si ure (Applicant or Agent): Application Number 11.-000.00310 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee. 72.00 Plan Check Fee 00 Issue Date Valuation . . . . 4400 Expiration Date 10/02/11 .Qty .Unit Charge Per Extension BASE FEE 45.00 3..00 9.0000 THOU. BLDG 2,001-25,000 27.00 --.-------------------------------------------------------------------------- Special Notes and Comments A TOTAL OF 194 L.F. DIFFERING HEIGHT COMBO WALLS THROUGHOUT PROPERTY, PER APPROVED ENGINEERED PLANS. 2010 CODES.' --------------------------------------=---------------------------- Other Fees BLDG STDS ADMIN (SB1473) --------- 1.00 HOURLY PLAN CHECK 245.00 Fee summary Charged Paid Credited Due ----------------------------------------- Permit Fee Total 72.00 •.00 .00 72.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 246.00 .00 .00 246.00 Grand Total 318.00. .00 .00 318.00 LQPERMIT