BLCK (12-0431)53575 Avenida Madero
12-0431
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000431
Property Address:53575 AVENIDA MADERO
APN:. 714 -102 -015 -3 -000000 -
Application description: WALL/FENCE
Property Zoning: COVE RESIDENTIAL
Application valuation: 2467
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DIANE WENAYNO
53575 AVENIDA MADERO
LA QUINTA, CA 92253
I
IID
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/19/12
Contractor: u
Applicant: Architect or Engineer: WINDMILL EXCAVATING f C NSTA 010
13181 DESERT VIEW AVP- !'!{ 201
1 WHITE WATER, CA 9228
- (760)485-9395 .t I®F
Jr l Lic. No.: 939586 PIMAAI E10)
LICENSED CONTRACT R'S DECLARATION \ WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury 'ha
am licensed and provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 70 0) of Division 3 of the Busine and Profession ode, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License CI s p 13 i nse No.: 939586 for by' Section 3700 of the Labor Code, for the performance of the work for which this permit is
, C. _ issued. .
ate: nuac _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
.. Code, for the performanceof the work for which this permit is issued. My workers' compensation
r
OWNER DECLARATION insurance carrier and policy number are:
..I hereby affirm under penalty of perjury that I am examtafurolthe Contractor's State License law for the Carrier .EXEMPT Policy Number EXEMPT
- following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to rthat, 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 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 me subject to 11 to ISrkem' compensation provisions of Section .
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3 O0 of the Labor Code, I all forthwith co ply ith those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by AG:F
01
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (55001.: e: scant:
(_ 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 WARLURETO SECURE WORKERS' COMPELTION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT ANEMPLOYERTO 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
(_) I,, 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 contractors) licensed i . . 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 aA
f this apptic tion becomes null and void if work is not commenced
within 180 days frissuance f uch permit, or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY - permit to cancellatiI 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 apd state the above inf mat. n is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and cou y ordinances and relatin o building const trio , and hereby aut orize representatives
of this un toe er upon theti property for ins trio purposes.
Lender's Name:I J ye: {•' • Sign re (nt):
Lender's Address:
LQPERMIT
ApplicationNumber• 12-00000431
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . 54.00 Plan Check Fee
.00
Issue Date Valuation
2467
Expiration Date ." 10/16/12
Qty Unit Charge Per
Extension
BASE FEE
45.00 :
1.00 9.0000 THOU BLDG -2,001-25,000
9.00
Special Notes and Comments
10 L.F. 5' GARDEN WALL & 90 L.F. 6'
" GARDEN WALL BOTH ORCO SYSTEM. PERMIT TO
INCLUDE DEMO OF 16".X 10' CONCRETE DEMO,
PER BH APPROVAL. 2010 CODES.
----------------- ---------------------------------------------------------
. Other Fees .. . . . . BLDG STDS ADMI14:(SB1473)
1.00
Fee summary Charged Paid- Credited
Due
Permit Fee Total 54.00 .00 .00
54.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00. .00
1.00
Grand Total 55.00 .00 .00.
55-00
LQPERMIT _ -
Bin #
Pemilt # :
,3I
a.
Project Address: . '" '7 5
uth
Bonding 9 Safety Division
P.O. Box .1504,78-495 Calle Tampico
La.Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and, Tracking Sheet
Owner's Name:. L ! -,+ J PJ C w (7),j d
A- P. Number
Address:3 , -7- A ee !
Legal Description:
Contractor. l ry D m j j
v KC Al U 71 fes-
City. ST, Zip: Civ c ,L/ 7,4
Telephone: 77(p, D' " `C8S 'f 3 S
Address: ( esll P ►'
.. l ioi U
Project Description:
)),
City, ST, Zip: W 'l. ( i .BW w4 r.
! - 2 L—'L_ 5 7
Telephone: D LtU-13 S
State Lia # : 3 `) S—' $
Arch, Engr.. Designer.
L O L C JG L L
City Lie. #: W`176
Address:
City, ST. Zip:
! ,P i' 2C3
Telephone:
State Lia #:
.
Name of Contact Penson:
_M.,
Construction Type:. Occupancy:
Project type (circle otic): Add'n Altet Repair Demo
Sq. Ft:; #Stories #unit;:
Telephone # of Contact Person: Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal Beq'd Recd TRACENG PERNIIT FEES
Pian Seta
Pian Cheek submitted Item Amount
Structural Cales.Reviewed,
ready for conwaons Plan Check Deposit. .
Titles Cala.
Called Contact Person Plan Cheek Man"
Mile 24 Cates.
Plans picked up Construction
Flood plaits plea
Plans resubmI ted.' . Mechanical
Ginding plan
Z'! Review, ready for corrwdonsriasue Electrical
Subeontaetor List
Called Contact Person Plumbing
Grant Deed.
Plans picked ap S.MJL
H.O.A. Approval
Plans resubmitted Grading
IN iI0L1SEi-
Review; ready for cormcdons/lssue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. ARpr
Date of permit issue.
School Fees
Total Permit Fees