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BLCK (05-0997)44065 Mariposa Ct 05-0997 Tdf 4.4-a" 504 ,LE TAMPICO CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760),777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 UU BUILDING PERMIT M &R J 212005, _ Plsr t ' S►ber0 5"0"0 0'0 0 9 9 h Dat•e 3/21/05 Pro e .. M, 44065 MARIPOSA CT APN: 604-091-008-8 -22982 Application description . WALL/FENCE Property Zoning LOW-DENSITY RESIDENTIAL Application valuation . . . . 750 Owner Contractor. FLORES STRZELCZK, EDWARD J. 44-065 MRIPOSA 82231 EAST HELIO COURT LA QUINTA CA 92253 INDIO CA 92201 (760) 578-0201 WCC: STATE FUND WC: .1641435 .05/16/05 CSLB: 439904 05/31/05 CCC: B -C10 -C29 ----------------------------------------------------------------------------- •Permit . . . . . . WALL/FENCE PERMIT Additional desc Permit Fee . . . . 21.00 Plan Check Fee .00 Issue Date . . . . valuation 750 Qty Unit Charge Per Extension BASE FEE r`. 15.00 3.00 2.0000 HND BLDG 501-2;000 ''6.00 Special Notes and Comments REPLACE WOOD FENCE WITH BLOCK WALLS (ORCO SYSTEM) 3/21/05 8:20:02 AM JJOHNSON Fee summary Charged -Paid Credited Due Permit Fee Total .21.00 ..00 .00 21.00 Plan Check Total' .00 .00 .00 .00 Grand Total 21.00 .00 _0,0 21.00 Y P.O. Box 1504 • VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: O 5- Date: .a ' OJ Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS 131A LICENSED CONTRACTOR'S DECLARATION I 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 Professionals Code, and my Li c �fo�e a t. /License Class v % d /Q G2 cense No. M / OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).): U 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 or 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.). U 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.). U 1 am exempt under Sec. , BA P.C. for this reason Date Owner WORKERS' 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 w cers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is u 6. w rs' pensatio 'sirance carrier aj� fi y b re: crier Policy Number l/) _ 1 certify that, in the perfo ce of the work for which him s 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 shall forthwith comply with those provisions. / ate WARNING/ FAILURE TO SECURE WORKERS' OMPENSATION 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. 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 Lenders Address j1 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 rect. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre entatives of this county to enter u the above-mentioned property for inspection purposes. Date ��� e o Sigma nature (Applicant or Agent): Building Address Owner 7. .x. es .•' r.i _ P.O. BOX 1504 No. 05181.. 78-105 CALLE ESTADO , - Ha 3. p,sa Court, LA QUINTA, CALIFORNIA 92253 . Mailing Address 43-$75 Wasbingt City Zip Psalm Desert 92260 Contractor Address - State Lia " & Classif. 4. Arch.; Engr.' Designer ' Address BUILDING: TYPE CONST. • OCC: GRP. AL1 S1C: A.P. Number i aCtUs "lover Tel. . 345-!7541- Legal Description Project DescriptionY Phage L. Plan 4A, Lot S .Corp. City Lic.# 1231 Tel. City - Zip State I I Lic. # • LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect:. SIGNATURE - " •' , DATE OWNER -BUILDER DECLARATION. 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, or repair any, structure, prior to its. issuance also requires the applicant for such permit to file a signed statementthat he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of ° . Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violationof Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500) - Sq. Ft.1€°i y No. No. Dw. Size. .Stories - Units. New ❑. Add10 Alter ❑ Repair ❑: Demolition ❑ Estimated Valuation 4 ;An PERMIT, AMOUNT Plan Chk. Dep. O I, as owner of the property, or my employees with wages as their sole' compensation, will Plan Chk. Bal: S -356.68 ' do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not .apply to an owner of property who Const. i. - - 430.'00 4 3 y w 00 - builds or improves thereon and who does such work himself or through his own employees,- ' Provided that such. improvements are not intended or offered for sale. If, however, the building Mech . -.- - n • or brrprovement is sold within one year of completion, the owner -builder will have the burden . o1 proving that he did not build or improve for the purpose of sale.) _ Electrical - - - R _89 • ,❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing , -92 • struct the project- (Sec. 7044, Business and Professions Code: The Contractor's License Law _ 00 does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I.- ,M.I.-such 90_ suchprojects with a contractor(s) licensed pursuant to the Contractor's -License Law.) A Grading O 1 am exempt under Sec B. & P.C. for this reason ' Driveway Enc. Date owner Infrastructure g WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self•insure,.or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) • • ,. Policy No. Company ' O' Copy is filed with the city. • ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM' REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (5100) valuation ' - r ` Sn+"'3•' {` 1. j` •- 3^d*'i •• -.n&'a.-da c+ua }`riv ii•r..,^'.' - .•.r .m ••s ' Or less-). .' . I certify that in the performance of thg work for which this permit is issued, I shall not . ter: J employ any person in any manner so as to become subject to the Workers' Compensation Laws of California - " Date Owner l NOTICE TO APPLCANT: If, after making this Certificate of Exemption you should become 'Workers' ZONE: ^ BY: - subject -to the Compensation provisions of the Labor Code, you must forthwith . comply With Such Provisions ofthis permit shall bedeemed revoked. _ • • Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY , - Side Street Setback from Center Line ' I hereby affirm that there is a construction lending agency for the performance of the - . _ work for which this permit is issued. (Sec. 3097, Civil Code.) .. - Side Setback from Property Line `- Lenders Name Lenders Address - This is a building permit when properly filled out, signed and validated, and is subject to `expiration FINAL DATE, INSPECTOR + it work thereunder is suspended for 180 days. ` 12129/88 . I certify that I have read this application and state that the above information is correct. ' Issued by: Date"v Permit I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of .this -city to enter the -above-.- mentioned property for inspection purposes. Validated by: ` Signature of applicant Date' Mailing Address -,Validation:' - City,. State, Zip _ _. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE /LR UGH PLUMB. YARD SPKLR SYSTEM 2ND FL SQ. FT. @ HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) DRAINAGE PIPING CAR P. I SO. FT. ® GAS (FINAL) TEMP. POLE WALL SQ. FT. DRINKING FOUNTAIN. GROUT WATER HEATER URINAL SQ FT ® FINAL INSP. ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation GRADING cu. yd. plus x$ FLOOR DRAIN MECHANICAL FEES FRAMING �G �' FINAL INSP. G WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® t+/. c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ec HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK OUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE /LR UGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPVC A K ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) �(�� ETER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM • WATER SYSTEM $ GRADING cu. yd. plus x$ -$ LUMBER GR. FINAL INSP.S'/ FRAMING �G �' FINAL INSP. G ROOFING VENTILATION FIRE ZONE ROOFING:((/err// FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING G G 10) MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. cuirc cuiwi /W-7 / REMARKS: INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL