13-0200 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000200
Property Address: 79640 HIGHWAY 111
APN: 649-020-014-4 -31143
Application description: WALL/FENCE
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 23750
Applicant:
Architect or Engineer:
ow�
4
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 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C23 License No.: 868142
Date: Z'Z5-43 Contractor: /� L
OWNER-BUILDE DECLARATION
1 hereby affirm under penalty of perjury that 1 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 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, 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 (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address: /V
LQI'IiR\IIT'
Owner:
DUNES BUSINESS PARK/ESF CAP.
3550 W. 6TH ST. 4400
LOS ANGELES, CA 90020
Contractor:
P & A WROUGHT IRO.
1131-E W- BROOKS
ONTARIO, CA 91762
(909)391-3780
Lic. No.: 868142
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/25/13
WORKER'S COMPENSATION DECLARATION
1 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.
A. 0.1 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 SOUTHERN INS CO Policy Number PWC00254512
_ 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 1 should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, II`shall forthwith omply with those provisions.
Date: 2'.2S_f3 Applicant: Ardif� CAit/`l
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 1$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 nstruction, and hereby authorize representatives
of this county to enter upon the above-mentioned property inspection purp `
Date: 2-25--rl Signature (Applicant or Agent):�1J
Application.Number
.. . . . . 13-00000200
Permit . . . . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee . . .
. 243.00
Plan Check
Fee
.00
Issue Date.
Valuation
23750
Expiration Date
8/24/13
Qty Unit Charge
Per
Extension
BASE
FEE
45 b0
22.00. 9.0000
THOU BLDG
2,001-25,000
198.00
----------------------------------------------------------------------------
Special Notes and
Comments
CONSTRUCT 500LF 8'
WALL ALONG THE
NORTH
SIDE OF THE BUILDING
ADJACENT TO
FIRE
LANE. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG
STDS ADMIN (SB1473)
1.00
Fee summary
-----------------
Charged
--------------------
Paid Credited
--------------------
Due
Permit Fee Total
243.00
.00
.00
243.00
Plan Check Total
.00
.00
.00
.00
Other Fee Total
1.00
.00
.00
1.00
Grand Total
244.00
.00
.00
244.00
LOPERMI r
Bin. #
'.
Cit}/ Of La Quinta
Bulkbg a Safety Division
P.O. Box 1504,78-495 Calle Tampico
[a.Quinta, CA 92253 --(760) 777-7012
Building Permit -Application and Tracking Sheet
Permit #
ProjectAddress:7g,/, Dt 7 T a(j I 7q,00 79 700
Owner's Narne:./ S 1� fII��Ss j�/9%L
A. P. Number. 11✓ ///, LA VJVTA ca .
nn
Address: ` i4ol� l Ro L} �� e 'r . $u e 102 -
Legal Description:
Contactor. i',c A ulteovG HT Tp—onr
llT
City, ST, zip: PA (_M 0 f S 9 J&t C A t z -211
Telephone.. Wo- 2,75 6 3 09
Address: q gp01e S
Project Description: IVSTjj L A T I 0,Y 01
city, ST, zip: DNTnP ro Ca . 176 2s7i'�
L •�EA/C f ALo * -INE, -6A c k .
Telephone: 09 -3 9 (3_)Ba:
'. pPE/z r�
State Lic. #: M l4 Z City Lic m l oS 3
X1 S?. / R(C, �g�C oN AST
Arch., Engr., Designer.
5Q7 t. Ft.' X 8' 7A LL
Address:
City., ST, Zip:
Telephone: Construction T.ypo:. %:�FitlCE Occupancy:
State Lic. #: Project type (circle one): Add'n Alter Repair Dano
Name of Cotttact Person: Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: Estimated Value of Project: i 2 8 oelo.°
APPLICANT: DO NOT WRITE 13ELOW TWS LINE
M
Submittal
Req'd
Recd
TRACKING
PERMIP FEES
Plan Sets
Ptah Check submitted
Item Amount
Strudural Cages.
Reviewed, ready for corrections
Plan Check Deposit.
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Pians resubmitted
Mecharikal
Grading plan
2`' Review, ready for correctioneiissue
Electrical
Subcontactor ldst
Called Contact Person
Plumbing
Grant Deed
Plans picked up
ML
li.O.A. Approval
Plans resubmitted
Gradiug
IN KOUSE:-
''` Review; ready for correctionVIssac
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
t
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