05-4427 (BLCK)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO 4FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/03/05
Application Number: C-0-5!'010:0=0442'7 ftrtOwner:
Property Address: 52840 AVENIDA RUBIO JERRY NISTA
APN: 773-313-005-22 -000000- 0 52840 AVENIDA RUBIO
Application description: WALL/FENCE d LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL
,` Application valuation: 4 1773 O^T
C/ . C•/ ��j 99 Contractor:
Applicant: Architect or ine�'0 !Q LOZANO PROF POOL CONST, MIKE
/aqC OO Of,. P.O. BOX 11272
PALM DESERT, CA 92255
'4
'(760)342-77.46
Lic. No..: 840397
LICENSED CONTRACTOR'S DECLARATION _ ' WORKER'S COMPENSATION DECLARATION
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:-
' �h1 Section, 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. I have, and will maintain a certificate of consent to self -insure for workers' compensation, as'provided
.License Class: C53 License No.: 840397 :for by:Section 3700 of the Labor Code, for the performance of the -work for which this permit is
`issued -,..4.'
`Date ..��e'3—�n� Contractor. - _ I have and will maintain workers'. compensation insurance, as requiredby Section 3700 of the Labor
''? - Code, forthe performance ofthework; for which this.permiYis issued. My workers' compensation
Ovid
DECLARATION " ' . insurance carrier and policy number are:'
r, 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
s' 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'dsigned statement that he or,stie is licensed pursuantto the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation 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, I shall'forthwi t comply with those provisions.
that,he or she is.exempt therefrom and the basis for the alleged exemption. Any. violation of Section 7031.5 by
any applicant for-&Oermit subjects the applicant to a civil penalty: of not more than five hundred dollars ($500).: Date: JJ1— 3 -CF- Applic—a—m—M"? _
(_) I, as owner of the property, or my employees with wagesastheir sole compensation, will ado the work, and '
the structure isnot intended or offeredforsale (Sec. 7044, Business and Professions Coder The . WARNING: FAILURE TO,SECURE WORKERS' COM NSATIONCOVERAGE IS UNLAWFUL, AND SHALL
• Contractors'State License Law .does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP. TO ONE'HUNDRED THOUSAND
"and. who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION.TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvementsarenot intended or offered for sale:'. If, however, the.building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
_ one year of completion, the'.owner-builder will have the burden of pro3ing'that he or she didnot build or,
improve for the purpose of sale.). - APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as -owner of the property; am exclusively contracting with licensed contractors to construct -the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business anis Professions Code:. The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and, who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
'Pursuant to the Contractors' State License Lw.). whose benefit work is performed under or,pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason 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.
Date: 'Owner: 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to bu*Idin constructi n, and hereby authorize representatives
• of this county to enter upon the above-mentioned property r in pecti purposes.
Lender's Name: A
Date: 3 Signature (Applicant orAgentl:
Lender's Address: -
LQPERMIT
�o
`71
LQPERMIT
Application Number . . . . . 05-00004427
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 41.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 1773
Expiration Date . . 4/01/06
Qty Unit Charge Per Extension
BASE FEE 15.00
13.00 2.0000 HND BLDG 501-2,000 26.00
---------------------------------------------------------------'-------------
Special Notes and Comments
38 LF`COMBO 2' RETAINING WITH 5' GARDEN
WALL AND 38 LF 5' BLOCK WALL. ALL PER
ORCO STANDARD.
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Grand Total
Charged Paid
41.00 .00
.00 .00
41.00 .0,0
Credited Due
.00 41.00
.00 .00
.00 41.00
P
Bin #
Oty ,of La. uinta
Building 8Z Safety Division .
P.0. Box 1564, 78-49.5 Calle Tampico
La Quints, CA .922.5,3.- (760) 777-7012
Building Pe rrnit;Appllcation and Tracking Sheet
Permit #
'l
Project Address: j Y1 AVr-. �Ub1 p
Owner's Name: 7�
A. P. Number:
Address: 5 _ Is
Legal Description:
Contractor:r ��1p p
,3z I SSG �1 6tSL J�1/Stra
City, ST, Zip: > d
Telephone: ,
Address: _
t3a
Project Description: 3� i .S .,� a
City, ST, Zip: LN& CA,
V.
L N .0 Ulw� �u� . 3Ff s �.646 6u to
Telephone: X-7 -"i617 w a^.
State Lic. # : �'4 (% 3 Ci Lic.
ty
Arch., Engr., Designer:
J J tC
Address:
City, ST, Zip:
Telephone:
p �f
ca
'a Construction. Type:. Occupancy:
State Lic. #:
Project•type (circle one): ' New Add'n Alter Repair Demo
..Sq. Ft.: # Stories: #Units:
Name of Contact Person:/ b-2,
Telephone # of Contact Person: X'7,S _4 6 y
Estimated Value of Project: 3 /o.t) •)
APPLICANT:
DO NOT WRITE BELOW THIS LINE.
#
Submittal
Req'd
;"Rec'd'
TRACKING .
PERMIT FEES
Plan Sets
:•Plan Check submittedItem
"Amount
Structural Calcs.
Reviewed, ready:for corrections
Plan Check Deposit
Truss Calcs.Ca11ed,Contact;Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
p,I,p,p,�
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees