BLCK (05-2346)54450 Avenida Martinez
05-2346
l
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00002346
Property Address:
54450 AVENIDA MARTINEZ
APN:
774-254-010-9 -000000-
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1624
Applicant: IIMN /A I I I hitect or Engineer:
JUN 15 2005 UU10 140(
CITYOF LAQUINTA
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
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 Busines nd Professionals Code, and my License is in full force and effect.
License Class: B icen : 778280
'/ Daontracto
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 (5500).: /
1 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
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, 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 lam exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
I 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
Owner:
BILLS RANDALL
P O BOX 1053
LA QUINTA, CA 92253
Contractor:
LEGACY HOMES
P.O. BOX 696
LA QUINTA, CA 92253
(760)777-8317
Lic. No.: 778280
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/15/05
7 ----------------------------------------------
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.
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 046133020405
_ 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 shop ome subject to th gg workers' compensation provisions of Section
3/7-00 of the abor C e, I s II forthwithN wit ose provisions.
-! Applica .
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
cRy and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to `e/nter upon the above-mentioned ppro pf fo• r inspectio roses
IB3te: a✓ ignature.lApplicant oitfgyE►_
Application Number . . . . 05-00002346
Permit
WALL/FENCE
PERMIT
Additional desc .
Permit Fee
39.00
Plan Check
Fee
00
Issue Date . . .
.
Valuation
1624
Expiration Date
12/12/05
Qty Unit Charge Per
Extension
BASE
FEE
15.00
12.00 2.0000 HND BLDG
501-2,000
24.00
----------------------------------------------------------------------------
Special.Notes and
Comments
75 L.F. 5- GARDEN
WALL, CITY STANDARD
Fee summary
-----------------
Charged
--------------------
Paid
Credited
----------
----------
Due
Permit Fee Total
39.00
.00
.00
39.00
Plan Check Total
.00
.00
.00
.00
Grand Total
39.00
.00
.00
39.00
LQPERMIT
Bin #
City of b 'Quinta
Building 8i Safety Division
Permit #
P.O. Box 1504, 78-4 95 Calle Tampico
La Quinl:a, CA 92253 - (760) 777-7012
.
Building Permit APPlication and Tracking Sheet
Project Address:
(/
Owner's Name:
A. P. Number:
• Address: 1 f a ► /!G(
1%6 Z
Legal Description:
City, ST, Zip:
Contractor:
/
Address:
ess:
Telephone: p —
(D to
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City, ST, Zip:
Project Description:
Vdle--L, OCQQ
Telephone:
P
..Crty.Lic.
I
State Lic. # :
#::;::.:
Arch., Engr., Designer: .
Address:
City, ST, Zip:
Telephone:
Sta teU. •
c #. Z
d v
Construction tru ct '
0 n T}•Pe. Occ an c•
uP :
-
Name of Contact Person:
'
Pr •
oJe c t t}Pe(circle one):. New Add'n Alter Repair Demo
Telephone # of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
SubmittalRcq'd
Recd
TRACKING
Plan Sets
PERMIT FEES
Plan Check submitted
Structural Calcs.
Reviewed, read'
}• for corrections
Item
Amount
Tt uss Calcs.
Plan Check Deposit
Called Contact Person
Title 2'4 Calcs:
Plan Check Balance
Plans picked up
Flood plain plan
Construction
Plans resubmitted
Grading plan
2"' Review, ready for corrections/issue
Mechanical
Subcontactor List
Called Contact Person
Electrical
Grant Deed
Plumbing*
Plans picked up
H.O.A. Approval
Plans. resubmitted
SALI.
IN HOUSE:-
Grading
34
Review, Beady for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
A.I.P.P.
School Fees
Total Pcrmit Fees