BLCK (07-0584)51425 Madison St
07-0584
P.O. BOX 1504 ^' VOICE (760) 777-7012
CALLE TAMPICO ._ _ r -_— , — : _ - - _ - FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING 8c SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 y
BUILDING PERMIT
Date: 2/22/07
Application Number: 07-0000.0584.: i Owner:
Property Address: 51425 MADISON ST BOB SMITH
APN: 777-030-004- - _ 51425 MADISON ST
Application.description: WALL/FENCE LA .QUINTA, CA 92253
Property Zoning: VERY LOW DENSITY RES
Application valuation: 1600
Contractor: 1
Applicant: Architect or Engineer: WHEELOCK MASON S.K.
6
P.O. BOX 12459 FEB 22 2001
PALM DESERT, C 255
(760) 275-9672 ®F AQUIWA
Lic. No.: 38198 NCd:DE
-----------------------------------
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury that I am licen rovisionsChapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Profesnse is in full force and effect. _ I have -and will maintain a certificate of consent to self-insure for workers' compensation, as provided
LicenseClass: C29 984 for by Section 3700 of the Labor Code, for the performance of the'work for which this permit is
Da7 % d 7 issued.
te! cam. Co Mractor: `•' _ 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 perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND 'Policy Number 1744382-'2006
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify 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 become 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 shouldbecome subject t 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, all forthwit ply wi hose isions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section-7031.5 bye, _LZ_p -.,. ., ,
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: .Date A cant:
(_ I 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, Business and Professions Code: The - WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL 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
1, 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.). 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
- 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.
Date: Owner: - 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
CONSTRUCTION LENDING AGENCY permit to cancellation. -
hereby affirm under penalty of perjury that there is a construction lending agency for the performance :of the I certify that I have read this application and state that the above information is ect. I agree to comply with all
* work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building construction, h eby authorize representatives -4
of this county to enter upon the above-mentioned propert inspect' n rp es.
Lender's Name:
OS,lature (Appli_cant or Agent): L
Lender's Address: ..1
LQPERMIT
—Application Number . 07-00000584
_-- -' Permit WALL/FENCE
PERMIT
Additional desc ..
Permit Fee 37.00
Plan Check
Fee
.00
Issue Date
Valuation
1600,-
Expiration Date 8/21/07
Qty Unit Charge Per
Extension
BASE
FEE-
15.00
11.00. 2.0000 HND BLDG
501-2,000
22.00
---------------------------------------------------------------------
Special Notes and Comments
100 LF OF 3 1/2' RETAINING WALL
PER
ORCO STANDARD.
Fee summary Charged
Paid`. Credited
Due
--------------- --------- ----------
Permit Fee Total 37.00
---.-------
.00
----------
.00
37.00,
Plan Check Total .00
.00
.00
.00
Grand Total 37.00
.00
00
37.00
LQPERMIT
Bin #
Permit of
Project Address:'
A. P. Number:
Contractor: , U4
Address:
City, ST, Zip:
Telephone:
State Lic. # g / f 0 4
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
City of La Quinn
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
0—fs o N
C)A)k
Lic. #: zf -
t/ Owner's Name:
Address: j'
CitY, ST, Zip: 47 e
Telephone:
Project Description:
V.
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Estimated value of Project:
T WRITE BELOW THIS UNE
TRACKING . PERMIT FEES
A Item
Amount .
corrections Plan Check Deposit
°n Plan Cheek Balance
Construction
Mechanical
r correctionstissue Electrical
m Plumbing
S.M.I.
Grading
.correctionstissue Developer Impact Fee
rn A.I.P.P.
Total Permit Fees
APPLICANT:
DO NO
#
Submittal
Req'd
Reed
Plan Sets
Plan Check submitt
Structural Calcs.
Reviewed, ready foi
Truss Calcs.
Called Contact Per,
Energy Calp.
Plans picked up
Flood plain plan
Plans resubmitted
Grading. plan•
2-' Review, ready A
Subcontactor List
Called Contact Pers
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
IN HOUSE:-
'' Review, ready foi
Planning Approval
Called Contact Pers
Pub. Wks. Appr
Date of permit issue
School Fees
t/ Owner's Name:
Address: j'
CitY, ST, Zip: 47 e
Telephone:
Project Description:
V.
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Estimated value of Project:
T WRITE BELOW THIS UNE
TRACKING . PERMIT FEES
A Item
Amount .
corrections Plan Check Deposit
°n Plan Cheek Balance
Construction
Mechanical
r correctionstissue Electrical
m Plumbing
S.M.I.
Grading
.correctionstissue Developer Impact Fee
rn A.I.P.P.
Total Permit Fees