BLCK (14-0834)51820 Avenida Madero
14-0834
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
r
Application Number:
14-00000834
Property Address:
51820 AVENIDA MADERO
APN:
773-154-004-21 -000000-
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1750
Applicant:
1C
1 '4Q
Tit!t 4
Architect o eer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/11/14
Owner:
GAMINO RESIDENCE
51820 AVENIDA MADERO
PALM DESERT, CA 92260 (
f
ii
Contractor:'ip j4
AA MASONRY I.
77530 DELAWARE PL Ci ^!t:F9_ ---
PALM DESERT, CA 92211 1 r r 4tJi1 lA
(760) 360-7388
Lic. No.: 804168
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LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C29 License No.: 804168
_ 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.
Date: Contractor:
_ 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 DECLA 10
insurance carrier and policy number are:
I hereby affirm under penalty of perjury th I am exempt from the C actor's State nse Law for the
Carrier MIDCENTURY INS Policy Number A09472186
following reason (Sec. 7031.5, Business and Professions Code: y cit y 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, pri s 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 should become 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
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
3700 of the Labor Code, I shall forthwith comply with those provisions.
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: Applicant: A%;,- '
-7 -
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
T
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WOR RS' COMPENSATION LAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
&GE
SUBJECT AN EMPLOYER TO CRIMINA PENALTIES AND FINHUNDRED 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 OMPENSGES 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 A
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.).
(_) 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:
LQPERMIT
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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize rep ,resentatives
of this co ty to enter upon the above-mentioned property for inspection pur oses.
Date: Signature (Applicant or Agent):
Application Number . . . 14-00000834
Permit .. . . . WALL/FENCE PERMIT 2013
Additional desc . .
Permit Fee . . . . 47.19 Plan Check Fee
..00
Issue Date . . . . Valuation . . .
. 1750
Expiration Date . . 12/08/14
Qty Unit Charge Per
Extension
1.00 - 47.1900 LS MISC WALL, FIRST 100 LF
47.19
--------------------------------------------------------------
Special Notes and Comments
--------------
BLOCK WALL -70 LF X 6 FT HT (PER
ATTACHED APPROVED PLAN AND ORCO
SPECIFICATIONS] PRECISION CONCRETE -BLOCK
SHALL BE COVERED WITH STUCCO, PAINT, OR
TEXTURED COATING WHERE VISIBLE FROM
OUTSIDE THE PROPERTY. 2013 CALIFORNIA
BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, WALLS
60.06
Fee summary Charged Paid Credited.,
-----------------
Due
----------------------------------------
Permit Fee Total 47.19 .00 .00
47.19
Plan Check Total .00 .00 .00
.00
Other Fee Total 61.06 .00 .00
61.06
Grand Total 108.25 .00 .00
108.25
LQPERMIT
5 _ g Axe vl i Ac,% Mo&mo
.. Qo (r4z , CA .
70 LF // "an rem; s - n bl® , k
t.Ja to ru ir"d1 m
/YyUL
P
k
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
JDATF_ BY
Bin #
Qty of La Quinta
Building u Safety Division
P.O. Box 1504, 78 495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: ,Jr' `_ a®
Owner's Name:r=XX v1_1 c V S_
A. P. Number:
Address:rj i _ VZ
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
Address: SIO
Project Description: 7012E e r
City, ST, Zip: Com/
t .
State Lic. # : U ((e %
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
' ......<
......................
Construction Type: Occupancy:
Project a 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
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'! Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
3" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees