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12-1202 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 1-32 - 00 OOr 1 0 "` Property Address: 253035—MERIWETHER WY APN: 767-200-998-80 -330761- Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1039 Applicant: I Tu!t aF e(w4" Architect or Engineer: QIP BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ¢a: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that m licensed under provisions of Chapter 9 (commencing with Section 000) of Division 3 of the Business d Pr 'onals Code, and my License is in full force and effect. Lic a Class: B se No.: 915336 Date: ' C ntra • iy WNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that Iexempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business andfessions Code: Any city or county that requires a permit to ` construct, alter, improve, demolish, or repair 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).: (_) 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.). (_) 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 Owner: EAST OF MADISON LLC' PO BOX 1482 LA QUINTA, CA 92247 Contractor: DBCA INC P.O. BOX 1482, LA QUINTA, CA 92247 (760)393-5271 Lic. No.: 915336 VOICE (760) 77 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/10/12 D D OCT 10 Zp'1 , CITY OF LAOF D I TflI ,qUI Tfll ,qU • 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. KV 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 TRAVELERS Policy Number YJJB282D7797-12 I certify that, in the performa of the work for which this permit is issued, I shall not employ any person in any manner so a beco subject to the workers' compensation laws of California, and agree that, if I should all me s b) o the workers' compensation provisions of Section 3700 of the Labor Code, I II fy0 with co Y with those provisions. WARNING: FAILURE TO SECURE WORKER OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PETIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO TH OST 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 uponwhose 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 aresult of this application, the owner, and the applicant, each agrees to, and shall defend, indemnity 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 pe 1 , or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the abov i mati n rrect. I agree to comply with all city and county ordinances and state laws relating to building co s tion and here thorize representatives of this ounty to en er upo the above-mentioned property for in p p rposes. atPl e: �•Y— �I nature (Applicant or A LQPERMIT Application Number . . 12-00001202 Permit ELEC-MISCELLANEOUS INV FEE Additional desc . . Permit Fee . . . . 33.00 Plan Check Fee 4.13 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 4/08/13 Qty Unit Charge Per Extension BASE FEE 30.00 2.00 1.5000 PER ELEC DEVICE/FIXTURE 1ST 20 ---------------------------------------------------------------------------- 3.00 Permit . . . BLDG POOL PERMIT - ADA INV FEE Additional desc . Permit Fee . . . . 54.00 Plan Check Fee 17.55 Issue Date . . . Valuation . . . . 1039 Expiration Date . . 4/08/13 Qty Unit Charge Per Extension BASE.FEE 30.00 6.00 4.0000 HND BLDG 501-2,000 24.00 ---------------------------------------------------------------------------- Special Notes and -Comments 46 L.F. 5' GARDEN WALL WITH ELECTRIC (2 OUTLETS). INVESTIGATION FEE ASSESSED PER 1997 UNIFORM ADMINISTRATIVE CODE §304.5 FOR WORK BEGUN WITHOUT BUILDING PERMIT.2010 CODES. - -------------------- ------------------------------------------------------- Other Fees . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due 4 Permit Fee Total 87.00 .00 .00 87.00 Plan Check Total 21.68 .00 .00 21.68' Other Fee Total 1.00 .00 .00 1.00 Grand'Total 109.68 .00 .00 .109.68 5 Ic- i t ' Bin. # i ' City. 0f b Qui n- to • Budding 8L Safety Division ' Permit # P.O. Box 1504,78-495 Calle Tampico I La -Quanta, CA 92253 - (760) 777-7012 Permit Building Application and Tracking Sheet Project Address:�•MW 1 er's Name:. A P. Number. Address: Legal Description: City, ST, Zip: i Contractor: O �I 1AIC. Telephone: Address: 2 Project Description: . City, ST, Zip AIN ,77-,r e! Wi . Tele ho p • State Lic. # : City Lia 9.- :Arch., Arch.,Engr., Designer Address: City., ST, Zip: Telephone: Construction Type: Occupancy: State Lic.#: Project type (circle one) ew Add 'n Alter Repair Demo Name of Contact Person: 7' Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Dz ^��j �lJ • /5 Estimated Value of Project: i APPLICANT: DO NOT WRITE BELOW THIS LINE M SubmittalReq'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted item Amoaut i Structural Calm Reviewed, ready for corrections Plan Check Deposit. ' Tri C21cs• Called Contact Person Plan Check Balance Title 24 Cake. Plans picked up Construction ' -_ Flaod plain plea_ _ _Plans-resubcriitted ' --• -Mechanical ---- - Grading plan 2'� Review, ready for corrections/issue - — Electrical -- Called Contact Person Plumbing Grant Deed Plans picked up S.XL MOAL Approval Plans resubmitted Grading BY ROUSE:- 'n° Review, ready for corrections/Issue Developer impact Fee Phtnulog Approval Called Contact Person A.I.P.P. Pub. Wks. Appr ' Date of permit issue School Fees Total Permit Fees :.........--.......... ... .....................