12-0245 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T,&t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 12-00 00024 5
Property Address:' 53776 AVENIDA MONTEZUMA
APN: 774-141-002-22 -000000-
Application description: WALL/FENCE
Property Zoning: COVE RESIDENTIAL
Application valuation: 6425
Applicant: _ .L Architect or Engineer:
Pik
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UCENSO CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I aC7giicensed un provisions -of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business a Pr ode, and icense is in full force and effect.
Lice a Class: C27 License No. - 45283
Date: "� � C rector:
OWN UILD R DE LARATI N
I hereby affirm under penalty of perjury that I am ex pt 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 1, 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.).
(_ 1 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:
LQPERMIT
Owner:
CULVERWELL,JOANNE M
600 W TOUHY AVE 208
PARK RIDGE, IL 60068
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/16/12
Contractor:
LOPEZ TREE SERVICE INC
17920 AVENIDA MANZANA
LA QUINTA, CA 92253 y r
(760) 329-4174
Lic. No.. 845283
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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
tom! issued.
V� 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
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 0005269-2011
I certify that, in the pVm
he work for which this permit is issued, I shall not employ any
person in any mancome s kers' compensation laws of California,
an ee that, if su jec o the work ' compensation provisions of Section
700 ofthe Laborth ' comply thos rovisionS.
App' ant:
WARNING: FAIP64 TO SECURE WORKERS' COMP SATION CO ERAG S UNLAWFUL, AND SHALL
SUBJECT AN MPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE.HUNDRED THOUSAND
DOLLARS (5100,000). IN 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 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 the abov nforma ' c . 5-92.0110 comply with all
city and county ordinances and state laws relating to building nstr io and hereby aut ze representatives
of this county to enter upon the ab ve-mentioned property f inspecti purposes.
,P4te:/Signa e (Applicant or Agent):
Application Number . . . . 12-00000245
Permit WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 90.00 Plan Check Fee
00
Issue Date . . . . Valuation . . .
. 6425
Expiration Date 9/12/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
5.00 9.0000 THOU BLDG 2,001-25,000
45.00
---------------------7------------------------------------------------------
Special Notes and Comments
130LF OF 6' GARDEN W/2' RETAINING AND
98LF OF 6' GARDEN W/1' RETAINING WALL AT
NORTH, EAST AND SOUTH PROPERTY LINES,
AND 17LF OF 5' GARDEN WALL WITH GATE AT
NORTH SIDE YARD (CITY AND ORCO
SPECIFICATIONS) PRECISION CONCRETE BLOCK
SHALL BE COVERED WITH STUCCO, PAINT, OR
TEXTURED COATING WHERE VISIBLE FROM
OUTSIDE THE PROPERTY. 2010 CALIFORNIA
BUILDING CODES.
March 16, 2012 2:17:11 PM AORTEGA
----------=-----------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 90.00 .00 .00
90.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 91.00 .00. .00
91.00
LQPERMIT
�
IF
OPEZ
TREE SERVICE, INC.
17920 Avenida Manana
Desert Hot Springs, CA 92241
(760)329-4174 Fax (760)329-3644
C27 Lie. # 845283
ftify Bonded, Worker's Comp &Liabiliily
Bid/Contract
Date
Number
1/18/2012
1016
Name /Address
Joanne Culverwell
53776 Montezuma
.La Quinta, CA 92252
Job Name
53776 Montezuma
Item
Description
Qty
Cost -
Total
Landscape & Irrigation
STUCCO TO BE INSTALLED ON NEW BLOCK WALL
4,675.00
4,675.00
INSIDE THE WALL ONLY.
Landscape & Irrigation
SAND BLAST AND RE -STUCCO EXISTING BLOCK WALL.
650.00
650.00
INCLUDING CUSTOMER SIDE ONLY.
Landscape & Irrigation
A DISCOUNT OF SEVEN HUNDRED AND NINETY
-790.00
-790.00
DOLLARS ($ 790.00) LOPEZ TREE SERVICE, INC_. AGREED
TO DEDUCT.
Once signed, Bid will automatically become a Contract, Anything beyond Bid will be at
Total $26,000.00
extra charge.
Santos Lopez Date Customer Signature Date
WORK CANNOT BEGIN UNTIL WE HAVE RECEIVED BY FAX OR MAIL, A SIGNED AND DATED CONTRACT.
Page 2
t t; w
-OPEZ
TREE SERVICE, INC,
17920 Avenida Manzana
Desert Hot Springs, CA 92241
(760)329-4174 Fax (760)329-3644
C27 Lic. # 845283
F11I19 Bonded, Worker's Comp dt Liability
Bid/Contract
Date Numbers
1/18/2012 1016
Name / Address
Joanne Culverwell
53776 Montezuma
La Quinta, CA 92252
Job Name
53776 Montezuma
Item
Description
Qty
Cost
Total
THE FOLLOWING IS A ROUGH ESTIMATE OF WORK TO
BE PERFORMED AT 53776 MONTEZUMA LA QUINTA, CA
92252
Landscape & Irrigation
THREE (3) FENCES LOCATED ON NORTH,EAST AND
2,050.00
2,050.00
SOUTH SIDE OF THE PROPERTY TO BE REMOVED.
INCLUDING HAULING TO THE DUMP. ALSO,
BOUGAINVILLEA TO BE REMOVED BY THE NORTH SIDE
OF FENCE.
Landscape & Irrigation
ONE (1) QUEEN PALM TO BE REMOVED.
1
185.00
185.00
Landscape & Irrigation
ONE (1) LARGE OCOTILLO TO BE RELOCATED.
1
250.00
250.00
Landscape & Irrigation
BLOCK WALL TO BE BUILD WITH REGULAR GRAY
17,900.00
17,900.00
BLOCK. TOTAL OF TWO HUNDRED AND THIRTY-FIVE
(235) LINEAR FEET 6' FEET HEIGHT INCLUDING 76' FEET
OF RETAINING BLOCK WALL BY 24" INCH HEIGHT.
STUCCO NOT INCLUDED.
Landscape & Irrigation
DISCOUNT TWENTY-ONE (2 1) LINEAR FEET OF GRAY
-630.00
-630.00
BLOCK WALL.
Landscape & Irrigation
SPRINKLERS HEADS TO BE RELOCATED BY THE GRASS
350.00
350.00
AREA.
Landscape & Irrigation
GRAIDING & RESEEDING.
1,360.00
1,360.00
Once signed, Bid will automatically become a Contract, Anything beyond Bid will be at
extra charge.
Total
Santos Lopez Date Customer Signature Date
WORK CANNOT BEGIN UNTIL WE HAVE RECEIVED BY FAX OR MAIL, A SIGNED AND DATED CONTRACT.
Page.1
131n.#
C%/ Of %d Qi1fl2td
Buiidlrig 8E Safety Dhwon
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner'sName:.JOaY1ne CvI
A. P. Number.
Address: cj
Legal Description:
City, ST, Zip: LC( V t /I -+Q 64 g Z 2 S 2
Contractor. L o -p— Z Tree, E er v i• ce- I r1 C. -
Telephone(1 13) Z I S- 2-115 MMUMA
Address: 0
ProjectDescription- Land SCa pe, �, dock l/Va(.I
City, ST, Zip: DeS HD-� S Yfn CA-Q22y1
-�
L e 'b -Ulf tti T
2'
Telephone: 16013 �� I7r4-
City Lie.. 9, 0 F. e) (2
l
c
StatcLia#: gyS2�?j
Arch, Bngr., Designer h I g lICC I • n o A—% o ei a: l cs
Address: i 734 COV c) n' e - ieR-2 'Z- L► i vel
City, ST, Zip: Pa In, C)esp4 CA 92-,.?-(/
Telephone: ( 7 jq0) -77 2-1 I (o
State Lic. #: 1-150L
Name of Contact Person: Son
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
L O peZ Sq. Ft.: # Stories: # Unitp:
Telephone # of Contact Person: 0 .
2L4 1-7 Estimated value of Project: 4 2 (O 1. 0.0 O
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACKING
PERbirr FEES
Plan Sets
Plan Check submitted
[ f
Item Amount
Structural Calm
Reviewed, ready for corrections
Plan Check Deposit.
Truss Cafes.
Called Contact Person
Plan Check Balance
Tide TA Calci.
Plans picked up
Construction
Hood plsia plan
Plans resubmitted.' .
Mecharilcal
Grading plan
X' Review, ready for correctionslissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review; ready for corrections/issue
Developer Impaet Fee
Planning Approval.
Called Contact Person
A.LP.P.
Pub. VVka. Appr
Date of permit issue
School Fees
Total Permit Fees