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10-0046 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application, valuation: Applicant: X10-00000046 52965 AVENIDA RUBIO .773-312-024-11 -000000- WALL/FENCE COVE RESIDENTIAL 288 c&'4t 4 4y -4" Architect or Engineer: BUILDING & SAFETYDEPARTMENT BUILDING -,,PERMIT Owner: CARLOS PERAZA 52965 AVENIDA RUBIO LA QUINTA, CA 92253 Contractor: HENRY'S,MASONRY, VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/19/10 P.O. BOX 5185 JINN 19 2010 LA,QUINTA, CA 92248" (7.60)775-6807 :,No, 704'270 GITY.OFLAQt)INTA I FINANCEIaEPT:' UCENSED,CONTRACTOR'S DECLARATION. WORKER'S COMPENSATION DECLARATION 1 hereby.affirm under penalty of perjury that I a licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the foliowing declarations: Section 7000) of Division 3 of the Busines a 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; C29` - License No.: 704270 - for by Section 3700 of the Labor Code, for the performance of the.work for which this permit is ssued. e: I ntiactor:' have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor . .. Code,.for'the performance:ofthe.work for. which this"permibis issued. My workers' compensation �ae BUILDER DECLARATION insurance carrier and policy number are:, - I hereby affirm under penalty of perjury thfrom the Contractor's State.License Law for the Carrier DELOS INS • CO Policy Number 02DKRM12002701 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 th 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 ob omesubject to the workers' compensation laws of California, .permit to file s signed statement tliat he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should' ec a 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 theiabor Cod all forthwith comply with those provisions. that he or she is exempt therefrom and the,pasis for ttiealleged-exemption. Any violation of. Section 7031.5 by / Y 016/640 � /p . .. any applicant for a permit subjects the applicant,to a civil penalty of not more than five hundred dollars ($500).: ate•//-(% �` AD' icanr. (_) 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 ProfessionsCode: The WARNING: FAILURE TO SECURE WORKER COMPENSATION COVERAGE -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 PEALTIES,.AND CIVIL FINES UP TO ONE HUNDRED THDUSAND and.who does the work'himself or herself. through his 'orr her *own employees; provided that the DOLLARS ($100,006).' IN ADDITION TO THE COST.OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are.not,intended or.offeredforI 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 proving that he or she did not build or improve for the.purpose oII sale.). - - - APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of. the property, amexclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director. of Building and Safety for a permirsubject to the 7044, Business and Professions Code: The Contractors' State License Law,does not apply town 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 Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, 1 ) 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 abov rmation 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 building truction, and hereby authorize representatives of this unty t�tef upon the above-mentioned property r spection purposes. Lender's Name: !!// e: Si ture (Applicant or Agent): Lender's Address: LQPERMIT Application Number. . . . . . 10-00000046 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date Valuation . . . . 288 Expiration Date . 7/18/10 Qty Unit Charge Per Extension BASE FEE 15.00 Special Notes and Comments 18:L.F COMBO WALL, 11 RETAINING & 3' GARDEN^'STUCCO-FINISH .TO"`MATCH HOUSE`: _CITY.. STANDARD. 2007 CODES. --- ------------------------------------------------------------------ ----------- ----------------------------------------------------------------- OtherFees . . . . . . BLDG STDS ADMIN (SB1473) Othet.:Fees V.00 Fee summary' Charged Paid'. Credited Due . Permit:, Fee Total 15.00 ;.0.0 ':. .00 15-:00 . Plari_.,Chedk..Total. .00 '.00 :. .00, .00 Other. -,Fee Total 1.'00 .00 .00 1.00. Grand Total' 16.00 00 00 16..00 LQPERMIT OWNjffP.S NA'If coNrncr ��SON PHONE fod c2� bs ,Avg"M Bin # City of La °Quints B617ding J9 SafetyDivision P.O. Box 1504; 78-495 Calle -Tampico •. La Quints, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet i Permit # `O Project Address: J 96 � Avfwdt� kV �► ® Owner's Name: �.�0"S . L' le 11-21 A. P. Number: Address: 5A96 Auercicllra Aub It 0 Legal Description: City, ST, Zip: Contractor NQ S h'�/9 Sor��1 Telephone: y o M 'h 7S s : �•. Address: � 16 J. Cie Project Description: City, ST, Zip: i\bJ�.ti oly 411 ,.o h0 Telephone:60 —2.0 �2?;: City I ic. #c..j.yJ1 ,p State Lic. # : 0 y 1) 0 . +6 .tiau sr- Arch., Engr., Designer e fi ' A co '✓ Address: City, ST, Zip: Telephone:. r. State Lic. #: �Apy Y 'N ` Name of Contact Person: -.Construction-Type: Occupancy: Pro's ryee circle one): New Add'n Alter Repair Demo Sq. FL: # Stories:. # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Pian Sets Req'd Recd TRACIO NG PERMIT FEES. Plan Cheeksubmitted ' Item Amount Structural Calcs. ,Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called. Contact Person Plan Cheek Balance Tide 24 Calcs. Plans picked up construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review; ready for correctionsfissue Electrical Subeoutactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review, ready for correctionsTssue Developer Impact Fee Planning Approval 'Called Contact Person "A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees