BLCK (07-2781)78165 Masters Cir
07-2781
P.O. BOX 1504
78'495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
.07-00002781
Property Address:
78165 - MASTERS _ CIR
APN:
770-350-010- -
Application description:
WALL/FENCE
Property Zoning:
LOW" DENSITY RESIDENTIAL
Application valuation:
1875
T,iht 4 4 Q"
Applicant: Architect or Engineer:
Iv
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT .
I hereby affirm under penalty of perjury that I am Ii ensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Pr fessionals Code, and my License is in full force and effect.
Licen:;0 4comr.ct.r:
C27 C29 License No.: 656128
W NER-BUILDER. DECLARATION
I hereby affirm under penalty of perjury at I am exempt from the Contractor's State License Law for the
following reason ISec. 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, 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 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 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:
Lender's Address:
LQPERMIT
)ICE (_1<0) 777-7012
FAX (60) 777-7011
ONS ( 60) 777-7153
-i- Da' 10/17/07
Owner: Cl
SCHLEISMAN STEPHAN A ry2
PMB 10
774 MAYS BLV `
INCLINE VILLAGE, NV 89451 _ - 1v
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
-----------------------------------------------
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 SEA.BRIGHT Policy Number BB1070510
1 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 bec a subject to the workers' compensation laws of California,
and agree that, if I should become ubject to the the
compensation provisions of Section
13770000 of the Labor Code, II fo with comply with those provisions.
,.Date: 4!7 w'TApplicant:
WARNING: FAILURE TO SECURE WOR ' COM ENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL ENAL 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 4build'c
cessation of work for 180 days will subject
permit to cancellation.
1 certify that I have read this application and state thmation is correct. I agree to comply with all
city and county ordinances and state laws relating toction, and hereby authorize representatives
of this county to enter upon the above-mentioned prion purposes.
Data: ignature (Applicant or Agent):
Application Number . . . . . 07-00002781
r
Permit .. . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 43.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 1875
Expiration Date 4/14/08
Qty Unit Charge Per
Extension
BASE
FEE
15.00
14.00 2.0000 HND BLDG
501-2,000
28.00
--------------------------------------------------------
Special Notes and Comments
--------------------
BLOCK WALL PER CITY STANDARD 6'
X 75'
L.F.
Fee summary Charged
Paid Credited
Due
-------------------------------------
Permit Fee Total 43.00
----------
.00
--
.00
--------
43.00
Plan Check Total 00
.00
.'00
.00
Grand Total 43.00
.00
.00
43.00
LQPERMIT
Bin #
Coty ®f La Quints -
Building 8L Safety Division
Permit #
zq I
P -O. Box 1504, 78-495 Calle Tampico
I
S
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
a +
' i ,
Y
Address: sox Z5 G Project Description:
City, ST, Zip: rb eUet
CA— z.3 GCA STD
Telephone:
State Lie. # : (s.S ,
City Lic. #: U t
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:-
State Lic. #:
Pro'ect type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
2- Sq. Ft.;
#Stories;
#Units:
Telephone # of Contact Person:
" Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed TRACKING .
PER11'II'T 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
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading.plan"
2nd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.Y.
Ii.O.A. Approval
Plans resubmitted
Grading.
IN DOUSE:-
drd Review, ready for corrections/issue
Developer Impact Fee
-
Planning Approval
Called Contact Person •
A.LP.P.
Pub. Wks, Appr
Date of permit issue
School Fees
Total Permit Fees
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