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05-3332 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA; CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 05-00003332 Property Address: 52553 AVENIDA MENDOZA APN: 773-302-015-2 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 1250 Lr2 D D Applicant: Architect or Engineer AUG 01 2005 Ini CItYY OF LA QUINTA FINANCE DEPT. 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. Licens .Gass: C27 C29 lei Li enseNo.: 784794 ate: ontracto : 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 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.). (_) 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 ISec. 3097, Civ. C.). Lender's Name: n Lender's Address: >YI LQPER 11T Owner: MCDONALD SHERRY 52553 MENDOZA LA QUINTA, CA 92253 Contractor: MARTIN MASONRY, MARK 78760 RUNAWAY BAY INDIO, CA 92203 (760)345-0977 Lic. No.: 784794 0 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/01/05 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 REDWOOD FIRE Policy Number W5533840 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 shouldcome lect to the workers' compensation provisions of Section 3700 of the Labor Codd. I shall f with comply with those provisions. 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 constru }fon, and hereby authorize representatives of this(�enterthe above-mentioned property or i �on purposes. DaDate: Vre (Applicant or Agent), •� Application Number . . . . . 05-00003332 Permit . . . WALL/FENCE PERMIT Additional desc . . Permit Fee . . . . 31.00 Plan Check Fee 00 Issue Date . . . . Valuation . . . . 1250 Expiration Date . . 1/28/06 Qty Unit Charge Per Extension BASE FEE 15.00 8.00 2.0000 HND BLDG 501-2,000 16.00 ---------------------------------------------------------------------------- Special Notes and Comments 50 L.F. 6' GARDEN WALL, CITY STANDARD Fee summary ----------------- Charged Paid Credited Due Permit Fee Total -------------------- 31.00 ---------- .00 ---------- .00 31.00 Plan Check Total .00 .00 .00 .00 Grand Total 31.00 .00 .00 31.00 LQPERAIIT Bin # City of La Quinta Building &T Safety Division Permit # P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: Owner's Name: A. P. Number: 22�� Address: Legal Description: City, ST, Zip: Contractio:1,, �lo .............................. . .............. ........... .................... ............ : .......... ...... . ........................ ................................ ............................... = ...... .......... ......................... Telephone: ............. .......... ........ ............... . X.. ................. .......... ........................ Addre�ss:7Project Description: C5 K 0 City, ST, Zip: 'P -D r i A "N* Lt r /I — . I - State Lic. # Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lic. #: Name of Contact Person:' Telephone # of Contact Person: # Submittal Re Plan Sets Structural Calcs. Truss Calcs. Title 24 Calc& Flood plain plan Grading plan Subcontactor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees p- 9 r WHO& Total Permit Fees . . . . . Construction Type: -Occupancy:. Project type (circle one): New Add'n Alter Repair Demo Sq. FL: # Stories: # Units: Estimated Value of Project:. APPLICANT: DO NOT WRITE BELOW THIS LINE Reeld TRACKING PERMIT FEES Plan Check submitted Item Amount Reviewed, ready for corrections Plan Check Deposit Plan Check Balance Called Contact Person Plans picked up Construction Plans resubmitted Mechanical 2"" Review, ready for corrections/issue Electrical Called Contact Person ]Plumbing S.MJ. Plans picked up Plans resubmitted Grading 1rd Review, ready for corrections/issue Developer Impact Fee Called Contact Person A.I.P.P.- Date of permit issue Total Permit Fees