BLCK (11-0202)54775 Avenida Madero
11-0202
P.O. BX 1504
78-495 CALLE TAMPICO
LA QUINTA,-,CALIFORNIA 92253
Application. Number: 11-00000202
Property. Address: 54775 AVENIDA MADERO
APN: 774-264-022-11 -000000-
Application description: WALL/FENCE
Property Zoning:COVE RESIDENTIAL
Application valuation: 9000
Applicant: Architect or Engineer:
SDN
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
hereby. affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the B iness ano*rofessio s Code, and my License is in full force and effect. -
License Class: B LiceAse No.: 431792
Date:Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt 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 _ 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
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 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/28/11
Owner:
EMPEY CHAD K/MILLER RAE L
54775 AVENIDA MADERO
LA QUINTA, CA 92253 -- -
Contractor: FEB 8 2011
TR CONSTRUCTION
77224 CALLE POTRERO CITY OF LA QUINTA
LA QUINTA; CA 92253 FINANCE DEPT.
(760)831-1863
Lic. No.: 431792
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WORKER'S COMPENSATION DECLARATION -
1 hereby affirm under penalty of perjury one of the following declarations:
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 EXEMPT Policy Number EXEMPT
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,
and agree that, if I should ome subject to a workers' compensation provisions of Section
3700 of the Labor Code shall forthwit c ply with those provisions.
Date Lv w A, Applicant:
WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL .
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating t buildin onstruction, and hereby authorize representatives
of this coou ntty to enter upon the above-mentioned pro r inspection
Date 2%0 ( ,Signature (Applicant or Agent): - .
Application Number . . . . . 11-00000202
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . 108.00 Plan Check Fee
.00
Issue Date . . Valuation . . .
. 9000
Expiration Date_. 8/27/11
Qty Unit Charge Per
Extension"
BASE FEE
45.00
7.00 9.0000 THOU BLDG 2,001-25,000
63.00
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Special Notes and Comments
SITE PROPERTY LINE WALLS: 10OLF OF 6'
HIGH (HALF BLOCK/ROD IRON) AT REAR PL,
140LF OF 8' HIGH (COMBINATION 31/51)'AT
SOUTH PL; 50LF OF 5' HIGH GARDEN AT
NORTH PL, AND 70LF OF 5' HIGH GARDEN AT
FRONT PL [CITY/ORCO STANDARDS] MINIMUM
WALL HEIGHT TO BE (5) FEET PER LQMC
9.50.090(16) AND ALL PRECISION BLOCK TO
:
BE COVERED WITH STUCCO, PAINT OR A
TEXTURE -COATING APPROVED BY THE
DIRECTOR, ON ALL SURFACES VISIBLE FROM
OUTSIDE THE PROPERTY PER LQMC
9.60.030(E)(3). 2010 CALIFORNIA BUILDING
CODES.
February 28, 2011 10:26:11 AM AORTEGA
------------------------------------------------------,-----------------------
Other Fees . ... . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 108.00 .00 .00
108.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 109.00 .00 .00
109.00
LQPERMIT
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BUILDING & SAFETY DEPT.
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CITY OF LA QUINTA SUB-CONTRACTOR.LIST
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JOB ADDRESS ffy "775_AlVewt 4
1 PERMIT NUMBER OWNER : _ _ „BUILDER
This form shall be Dosted on the job with the Building
Inspection Card at all times in a conspicuous place. Only per ns appearing on this list or their employees are authorized to work
,
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance.'
of building permit. Fo(each applicable trade, all information requested below must be completed
by applicant. "On File" isnot an acceptable response.
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Bin #
City of La Quinta
Building K Safety Division
P.O. Box 1504, 78.495 Calle Tampico
La Quinta, CA 92253 -.(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
OZo
Project Address: - (J ` I lQ rtw
«Owner's Name: — 4
A. P. Number:
(Address: 519 — 77 ketl _ //R/14Ale
Legal Description:
CCity,"ST, Zip:
.Contractor: --' TIE,L4eX s
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st >:<:'>> <`::'.'.:fz<::?:>:`•:>::i:•
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,,,,Telephone:
Address: ZZ C/ i- /C 'T/ /2d
ProjectDescription:
f
City, ST, Zip:
Telephon 74-6 g
>
:
State Lic. # : /V3/7 9Z City Lic. #: /0 `7760y:
Arch., Engr., Designer:
I
Address:
f x :!5-
City, ST, Zip:
.
Telephone:
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Co tructAn Ty[Fen.
e. O
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: (ire P/L
Sq. Ft.: : '
# Stories:
#Units:
Telephone # of Contact Person: 7466
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
+
H.O.A. Approval
Plans resubmitted
Grading
^
IN HOUSE:-
'^' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
1 DO
School Fees
Total Permit Fees