10-1354 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
10-00001354
51200 AVENIDA CARRANZA
773-061-009-14 -000000-
WALL/FENCE
COVE RESIDENTIAL
1025
T-ity 4 *fPQ"
Architect or Engineer:
aux
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 fcommencing with
Section 7000) of Division 3 of the Business and ProfessionalCode, and my License is in full force and effect.
Licpnse Class: D06 C53 Li ense No.: 745278
Date: ) ° ontract _
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).:
(_) 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 1Sec. 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 1, 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:
LQPERn1IT
Owner:
KELLY PERRY
51-200 AVENIDA CARRANZA
LA QUINTA, CA 92253
Contractor:
COMMON GROUND SWIMMING PC
72877 DINAH SHORE DR #103
RANCHO MIRAGE, CA 92270
(760)799-9174
Lic. No.: 745278
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/13/10
— — — — — — — — — — — — — — — — — — — — — — —
WORKER'S COMPENSATION
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, asprowiled
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 EXEMPT Policy Number EXEMPT
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 wor�ters' compensation provisions of Section
3700 of the abor Code, shall forthwith comply with those pr visions.
/: pplic
WARNING: FAILURE TO SECURE WOR ERS' 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 agrr� to comply with all
city and county ordinances and state laws relating to building construction, and herebyLthce representatives
of this county to enter upon the above-mentioned property for ' spection purposes.
Kate: )Si ture (Applicant or Age00,
f
Application Number . . . . . 10-00001354
Permit . . . . .
WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . .
27.00
Plan Check Fee
00
Issue Date . . . .
Valuation . . .
. 1025
Expiration Date
6/11/11
Qty Unit.Charge
Per
Extension
BASE
FEE
15.00
6.00 2.0000
----------------------------------------------------------------------------
HND BLDG
501-2,000
12.00
Other Fees . . . . .
. . . . BLDG
STDS ADMIN (SB1473)
1.00
Fee summary Charged.
---------------------------
----------
Paid Credited
Due'
Permit Fee Total
27.00
--------------------
.00 .00
27.00
Plan Check To
.00
.00 .00
.00
Other Fee*Total
1.00
.00 .00
1.00 .
Grand Total
28.00
.00 .00
28.00
LQPERMIT
Bin#
City of La Quinta
Building &Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # ���
Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: 14
Telephone -.
Project Description:
Contractor:
Address:
City, ST, Zip: ii-aae-13A Ogg 7A
Telephone:
S I I h i.
State Lie. # : City Lie. #:
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person: -
Construction Type: Occupancy:
Project type ,circle one): New Add'n Alter Repair Demo
Sq. Ft.: #Stories: #Units:
Estimated Value of Proj
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACIMG PERMIT FEES
Plan Sets
Plan Check submitted {O Item Amount
Structural Cala.
Reviewed, ready for corrections Plan Check Deposit
Truss Cala.
Called Contact Person Plan Check Balance.
Title 24 Cala.
Plans picked up Construction
Flood plain plan
Pians resubmitted Mechanical
Grading plan
2'' Review, ready for corrections/issue Electrical
Subcootactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Pians resubmitted T Grading
IN HOUSE:-
''' Review, ready for correctionstissue Developer Impact Fee
Planning Approval
Called Contact Person A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
IFT
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
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