BLCK (05-2807)78700 Maracas Ct
05-2807
P.O. BOX 1504 '
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00002807
Property Address: 78700 MARACAS CT
APN: 646 -050 -024 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1750
Applicant: Architect or E
/A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and , rofessionals Code, and my License is in full force and effect.
License Class: B C10 C29 License No.: 439904
ate4 tractor:
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 Cade: 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 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 1-1
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.).
(_) 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: '11
Lender's Address: N
LQPERA9IT
Owner:
MIKE DIENER
78700 MARACAS COURT
LA QUINTA, CA 92253
Contractor:
STRZELCZK, EDWARD J-
83420 SHADOW HILLS WAY
INDIO, CA 92203
(760)347-0399
Lic. No.: 439904
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS '(760) 777-7153
Date: 7/08/05
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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 STATE FUND Policy Number 1641435
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 become subject to the workers' compensation provisions of Section
^ 3700 of the Labor Code, I P11 fort with comply with those provisions.
/bate: I' plicant:
WARNING: FAILURE TO SECURE WORKERS' 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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building con ' tion, and hereby authorize representatives
of this coup4 01,!! 2 !r _,gnamre
y tonter upon the above-mentioned property fo ' spectio p poses.
pate:(Applicant or Agent):
Application Number . . . . . 05-00002807
Permit . .
. WALL/FENCE
PERMIT
Additional desc .
.
Permit Fee . . .
. 41.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
1750
Expiration Date
1/04/06
Qty Unit Charge Per
Extension
BASE
FEE
15.00
13.00 2.0000 HND BLDG
501-2,000
26.00
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Special Notes and
Comments
70 L.F. 6' GARDEN
WALL, ORCO SYSTEM
Fee summary
-----------------
Charged
--------------------
Paid Credited
----------
-------_--
Due
Permit Fee Total
41.00
.00
.00
41.00
Plan Check Total
.00
.00
.00
.00
Grand Total
41.00
.00
.00
41.00
LQPERMIT
Total Permit.Fees
City of La Quints,
Pefr"rf`
Building tai Safety Division
P.O. BOX 1504, 78-495 Calle Tampico
T
La Quints, CA 92253 - (760) 777-7012
Building PermApplication and Tracking
racking Sheet
'
Project Address:
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Owner's Name:
A. P. Number:
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Address:
. Legal -Description:
Contractor:
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Address -
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Telephone: Gi
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Project Description:
Cit}, ST, Zip:
Telephone: o
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State Lic. # :.
City Lic.
Arch., Engr., Designer: .
Address:
1, 0 /,
City, ST, Zip:
--------------
Telephone:
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C 0 n s tru ction Type:
c:State'Ltc. Oc cu P a nc v:
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Name of Contact Person:
r 0j ect type (circle one:. N
P e« Add'n Alter Repair Dim o
Telephone # of Contact Person:
Sq. Ft.:
t! Stories:
#Units:.
Estimated Value of Project
APPLICANT: DO 'NOT WRITE BELOW THIS LINE
#Submittal
Req'd
Rec'd
Plan Sets
TRACKING
PERMIT FEES
Plan Check submitted
'
structural Calcs.
Reviewed, readv for
Item
Amount .
.
Trass'Calcs.
corrections
Plan Check Dcposi(
.Called Contact Person
Title 2'4 tales.
Plan Check Balance
Plans Picked 'up
Flood plain plan
Construction
Plans resubmitted
Grading plan
htechanical
Subcontactor List
2" Revien•, read} for corrections/issue
Electrical
Called Contact Person
.
Grant Deed
Plumbing
Plans picked. up
II.o.A. A pp'roral
S.M.I.
Plans. resubmitted
IN HOUSE:-
Grading
Planning Approval
Review Cady for corrections/issue
Developer Impact Fee
Called Contact Person
Pub. Wks. Appr
A.I.P.P.
Date of permit issue
School Fees
Total Permit.Fees