BLCK (13-0194)58588 Madison St
13-0194
P.O. BOX 1504 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: 2/25/13
Application Number: 13-00000194 Owner:
Property Address: 58588 MADISON ST- CORAL OPTION I
APN: 764-200-999-5 -316812= 81570 CARBONERAS D
Application description: WALL/FENCE LA QUINTA, CA 92253 W U
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 36625 2013
Hca 2 r
Contractor:
Applicant: Architect or Engineer: TD DESERT DEVELOPMENT LP Ii CITY OF LA QUINTA
P.O. BOx 1716 I FINANCE DEPT.
LA QUINTA, CA 92247
(760)771-1941
Lic. No.: 762987
V
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) f Division 3 of the Business and Profes ' e, and my License is in full force and effect.
Liven Class Lic se No.: 762987
VA
Contracto 0 Z'
R -BUILDER DECLARATIO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Jate 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 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
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.).
(_ 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
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.
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 CA REST MUTUAL Policy Number CR01124517
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
Ind agree that, if I sho come subject kers' compensation provisions of Section
700 of the Labor, l aI II forthw' omply w those provisions.
WARNING: FAILURE TO SECURE WORKERSlikOIfPENSATION CODLRAGE NLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, D AGES 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 ation is correct. I agree to comply with all
city and count rdinances and state laws relating to buil ' nstru and hereby au rize representatives
of thfcount# enter upon the above-mentioned prop for inspection poses.
D Signature (Applicant or Agent):
Application Number . . . . . 13-00000194
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 330.00 Plan Check Fee
00
Issue Date . . . . Valuation
36625
Expiration Date . . 8/24/13-
/24/13Qty
QtyUnit Charge Per
Extension
BASE FEE
252.00
12.00 6.5000 THOU BLDG 25,001-50,000
78.00
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Special Notes and Comments
1,465 LIN.FT. OF 6FT HGT. PERIMETER WALL
PER PRECISE WALL PLAN AT THE CORNER OF
MADISON ST & AVENUE 60. ORCO OR
ENGINEERED DESIGN. (CMU BLOCK WITH FOAM
CAP / STUCCO) ENGINEER: JULIAN DE LA
TORRE C43880.
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Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
2.00
Fee summary Charged Paid Credited
Due
---------------------------------------------------------
Permit Fee Total 330.00 .00 .00
330.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 2.00 .00 .00
2.00
Grand Total 332.00 .00 .00
332.00
LQPERMIT
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l. ti}/ Of Quintd
WUng 8T Safety Dlvisfon
7C/ 5 P.O. Box f SD4, 78-495 Calle Tampfco
1a Qulnta, CA 92233 -:(760) 777-7012
Building Permit Application and Tracking Sheet :
Permit #
ProjedAddress:/fo . £4-p
ownu'sNama.
A. P. Number !o ?_/0 0 0
Addressp t
Legal Description: %2 3j 4 s / . '
City. ST, Zip:G L'¢ Z z
Conttactor.. 90 L
Telephone: (o o '7 -7 7
Address
ProjectI mription:
City. ST, TaP Z Z 37 3..
TelaphoneL?(e o_7'7 7 f 7 ?/
State Lir— N: 2;4j p 7 City Lic
Arch., Engr., Designer.
Address 2 9 o 4-e
City.. ST, Zip: XAVf i ZZ 7'0
Telephone: be ZA g 61.1 CorustructlonType: , occupancy:
State Lia: project type (circle one) Add'a Alta. Repair Demo
Name of Contact Person: 'e'r e s ' Sq. FL # Stories: S Urdu:
Telephone of Contact Petsan: Bstinuitod Value of Project
APPLICANT: DO NOT WRITE BELOW TM UNE
N
Submittal
RWd
geed
TRACKING QERbUTFEE4-
Plan Sets
Pian Check submitted Item Amount
Structural Cala.
Reviewed, ready for corrections Plan Check Deposit. .
Truss Calci.
Called Comaet Person PtaaChWcBalsoce_
Title 24 Cates.
Plans picked up Construction
Flood plain plan
Plans resubtmltted • . Mechanical
Giading plea
2`! Review, ready for correctlo a f ' ecd ictal
Subcontactor List
Caped Contact Person ♦it Plumbing
Grant Deed
Plans picked up
H.O.&_Approval.....
_...._........._....Plain
resubmitted Grading
IN HOUSE:-
'" RcAcw, ready for corrccdona/'tssuc Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
-Pub. Wks. APPr
Date of permit issue
School Fees
Total Permit Fees