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13-0892 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00000892 Property Address: 55101 MONROE APN: 767 -580 -015 - Application description: WALL/FENCE Property Zoning: LOW DENSITY Application valuation: 26800 ST -000000- RESIDENTIAL Applicant: Architect or Engineer: •4 ���ININ VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING;& SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 7/16/13 Owner: MONTERRA PROPERTIES 55075 MONROE STREETS LA QUINTA, CA 92253 (760)578-3491 D;FINANCE Contractor: 16 2013R P M VENTURES INC 55075 MONROE STREET �.AQUINTALA QUINTA, CA 92253 DEPT. (760)578-3491 Lic. No.: 980734 --------------------------=---------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, an y Ll nse is in fu1 force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License CI s: B rise3 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Date: %% 1 tractor: _ 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EXEMPT Policy Number EXEMPT following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the wor ' com fsation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, all fc hwi omply rhos r visio that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by .7f `r any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 1 Date: ` -0— �pplicant: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and sssss����� 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 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: LQPERM[T 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 applicationis 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 orrect. I agree to comply with all city and county ordinances and state laws relating to building construction, a hereby a thorize representatives of this cou to enter upon the above-mentioned property or ins c n pu Date: �/ ;,Signature (Applicant or Agent): Application Number . . . . . 13-00000892 Permit . . . WALL/FENCE PERMIT 2013. Additional desc . . Permit Fee . . . . 404.69 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 26800 Expiration Date 1/12/14 Qty Unit Charge Per Extension 1.00 47.1900 LS MISC WALL, FIRST 100 LF 47.19 25.00 14.3000 EA MISC WALL, ADDL 50 LF 357.50 ---------------------- ----------------------------------------------------- Special Notes and Comments BLOCK WALL - INSTALL 1,340 L.F. PER ATTACHED APPROVED ROUGH GRADING PLAN, PLAN SET #13011. 2010 CALIFORNIA BUILDING CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 PLAN CHECK, WALLS 60.06 Fee summary Charged Paid -------------------- Credited -------------------- Due ----------------- Permit Fee Total 404.69 .00 .00 404.69 Plan Check Total .00 .00 .00 .00 Other Fee Total 61.06 .00 .00 61.06 Grand Total 465.75 .00 .00 465.75 LQPERMIT ©i -A CITY OF LA QUINTA'SUB-CONTRACTOR IST JOB ADDRESS 10 l I - t?- PERMIT NUMBER OWNER q6,J BUILDER This form shall be posted on the lob with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or ti heir employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or.the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. sification Contractor :> State,:Contractot's License Workers:Com ensatwnansuiance �. City Business License. Trade / Clas -_ p. Company Name Classification License Number Exp. Date Carrier Name Policy Number Exp. Date License Number Exp. Date (e.g. A, B, C-8) (xxxxxx) (xx/xx/xx) (e.g..State Fund, CalComp) (Format Varies) (xx/xx/xx) (xxxx) (xx/xx/xx) EARTHWORK 1C7121 CONCRETE (C-8) .077 FRAMING (C-5) STRUCT. STEEL (C,51) 2 MASONRY (C•29) L- b 140 w C4ae., QCs- i16trobif PLUMBING (C-36) LATH, PLASTER (C.-35)'; DRYWALL (C-9)` HVAC (C-20) - ELECTRICAL. (C-10) :. . ROOFING'.(C-39):..._ SHEET METAL (C-43) FLOORING (CAM:.:., GLAZING (C-17)''` : 4 INSULATION (C-2): SEWAGE DISP (G-42) PAINTING (C-33) CERAMIC TILE (C-54) CABINETS (C-6) FENCING (C-13) LANDSCAPING (C POOL (C-53)