BLCK (06-0849)2'i
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T44t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
06=00000849
D
Property Address:
52415 AVENIDA MENDOZA
APN:
773-272-019-8 -000000-
Application description:
WALL/FENCE
MAR
Property Zoning:
COVE RESIDENTIAL
02 2®O6
Application valuation:
1026
c
�;OFLA Gun,,.a
Applicant: Architect or Engineer:
I�
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 License is in full force and effect.
License lass: C29 License No.: 809021
ate:2 O ontractor:
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 1, 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.).
(_) I am exempt under Sec. , BAP.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
Owner:
7LAOCH CONNIE
52415 AVENIDA MENDOZA
QUINTA, CA 92253
Contractor:
L & J MASONRY, INC.
P.O. BOX 1172
LA QUINTA; CA 92247
(760)771-6873
Lic. No.: 809021
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/02/06
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 2290025199
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 theL or C/o/de/} I shall forthwith comply with those provisions.
ate
LJ 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 applicati nand state that the above information is correct. I agree to comply with all
city and county ordinances and s e laws relating to building construction, and hereby authorize representatives
of this ounty to enter upon above-mentioned property for inspection
/purposes,
ate:gnature (Applicant or Agent):
Application Number . . . . . 06-00000849
Permit
WALL/FENCE PERMIT
Additional desc .
.
Permit Fee . . .
. 27.00
Plan Check Fee
00
Issue Date . . .
.
Valuation . . .
. 1026
Expiration Date
8/29/06
Qty Unit Charge Per.
Extension
BASE FEE
15.00
6.00 2.0000 HND BLDG 501-2,000
12.00
----------------------------------------------------------------------------
Special Notes and
Comments
40 L.F. 514" WALL,
10 L.F. 4- WALL,
BOTH ORCO SYSTEM
Fee summary
Charged Paid
-----
Credited
Due
Permit Fee Total
-
27.00
--------------------
.00 .00
--_.
27.00
Plan Check Total
00
.00 .00
.00
Grand Total
27.00
.00 .00
27.00
LQPERMIT
Total Permit Fees
Bin #
City of. La Quinta
s
Building a Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
i
;1 La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:
' >
Owner's Name: NN
A. P. Number:
Address:
Legal Description:
City, ST, Zip:(�
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Contractor. n ��� �1 Telephone:
�
Address:1-1-7 (L+,-hgL<nQeJJ
• ,
QL Project Description:
City, ST, Zip: '
`'f
LnTelephone:
State Lie. # : Q City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type;
' 4Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: #Stories #Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd TRACKING PERMIT FEES
Plan Sets Plan.Cbeck 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 2' Review, ready for correctionsrssue 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 .
.
--A —
School Fees
Total Permit Fees