06-1602 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: ' I 06-00001602
Property Address: 51565 AVENIDA RUBIO
APN: 773-1217010-1 -000000-
Application description: WALL/FENCE
Property Zoning: COVE RESIDENTIAL
Application valuation: 2467
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DANELSON BRIAN L
51565 AVENIDA RUBIO
LA QUINTA, CA 92253
Contractor:
Applicant: Architect or Engineer:_ FEDOR MASONRY, JAMES
P.O. BOX 1397
LA QUINTA, CA 92247
(760)772-3036
Lic. No.: 823181
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: C29 License No.: 823181
Date: Contractor:
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 (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 cons ct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does n pply to an owner of
' property who builds or improves ther ,and w o contra for the projects with ontractor(s). licensed
pursue t to th Contractors' Stat icense Law .
(_ 1 1 am exe pt and Sec. , B.&P.C. for is reason
t '
Date: Owner:
NSTR TION LEN NG AGEN Y
I hereby aff' m and penalty of perjury that th a is a c nstruction le ding agency or the performance of the
work for which this permit is issued (Sec. 30 , Civ. .1.
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/21/06
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AARR 1 ?006
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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 WORKFORCE INC Policy Numb 2422436
,vc I certify that, in the Performa the work for wAh,chh,seA,,I shall not employ any
person in any manne as to come subject tthekion laws of California,
and agree that, if hould be me subject to thcrovisions of Section
3 0/_of [he Lab r Code, all forthwith compsDater 6 (Applicant:WARN G: AILURE TO SECURE WORK ' COMPENSATI N COVER GL, AND SHALL
SUBJ CT A EMPLOYER TO CRIMINA ENALTIES A O CIVIL FINE P TO ONE HUNDR —
DOLLARS ($100,000): IN ADDITIO O THE COSTO TO,
DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CO E, 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 wor eing
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and v ' if work is not he(
/nenced
within 180 days from date of issuance Aabov
cessation o wor for 180 swill subject
permit to cancellation.
I certify that I have read this application and state thation is corr I agree t omply with allcity and county ordinances and state laws relating toon, and here authorize presentativesof this cou y to nter upon the above-mentioned pron purposes.
Dat P& Signature (Applicant or Agent)*
T7V
Application Number 06-00001602
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 54.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 2467
Expiration Date 10/18/06
Qty Unit Charge Per
Extension
BASE'FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
-----------------------------------------------------------
Special Notes and Comments
80 LF 6' BLOCK WALL & 20 LF 5' BLOCK
WALL Q EXTERIOR SIDE YARD & FRONT YARD
PER ORCO STANDARD.
Fee summary Charged _ Paid
-----------=----------------
Credited
Due
----------
Permit Fee Total 54.00
----------
.00
----------
.00
54.00
Plan Check Total .00
.00
.00.
.00
Grand Total 54.00
.00
.00
54.00
LQPERMIT
B'° #
City of La Quinta
Building 8I 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: Sr — �j ALE 2u !3t lb
Legal Description:
Contractor:
City, ST, Zip: Z— t,.- I,J`A C'/
Telephone: ISI
Address:
Project Description:
City, ST, Zip:
Telephone:LA
State Lie. # : City Lia
Arch., Engn, Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
[Sq.
Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING _
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2°" Review, ready for correctionsrssue
Electrical
Subcontactor. List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval:
Plans resubmitted
Grading
IN HOUSE:-
3n° Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
ORO DAfiftson COASTRUCTIOA SeRvices
P.O:SOX 607
PALM DeSeRT, CA 92261
STATe LUAU 40. 82496
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