10-1231 (BLCK)P.O. BOX 1504 4 ^�
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: `_ 10-00001231 Owner:
Property Address: 54283 AVENIDA RUBIO SMITH MARILYN
APN: 774-234-016-4 -000000- •54283 AVENIDA RUBIO
Application description:' WALL/FENCE LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL
Application valuation: 4515
Contractor:
Applicant: Architec or E ineer: AA MASONRY
N „/ 77530 DELAWARE PL
PALM DESERT, CA 92211
(760)360-7388
Lic. No.: 804168
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 Cla
ss: %��
C29. License No.: 804168
Date: ,� e /
j / Contractor.
_BI In DECLARA>eatls,
I hereby affirm under penalty of. perjury that I am exempt from the Co ctoa License Law for the
following reason ISec. 7031 .5, Business and Professions Code: A city or Co.that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior t 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 1, 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 I, 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. , BAP.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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/10/10
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 ARCH INS . Policy Number 03DKRM12003
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 workers' compensation provisions of Section
3700 of the Labor Code, 1 shall fort ith mply with th 'cions.
Date/ 10 4) 'Applicant:
WAR ING: FAILURE TO SECURE WOR RS' COMPENCATTORR RAGE IS UNL AND SHALL
SUBJECT AN EMPLOYER TO CRIMINA PENALTIES AN UP TO ONE HUNDR THOUSAND
DOLLARS 1$100,0001. IN ADDITION TO THE COST OFION, DAMAGE OVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND -
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.
1 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 construction, and hereby authorize representatives
of this coun to n[er upon the above-mentioned property for inspe on rposes.
-Date: Signature (Applicant or Agent):
Application Number . . . . . 10-00001231
. . . WALL/FENCE PERMIT
.Permit
Additional desc .
Permit Fee 72.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 4515
Expiration Date 5/09/11
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
27.00
----------------------------------------------------------------------------
Special Notes and Comments
90 LN FT X 6 FT HT BLOCK WALL; 100 LN FT
X 5 FT HT BLOCK WALL WITH 3 COLUMNS 16"
X 16" X 6 HT PER ORCO STANDARDS &
APPROVED PLANS.
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 72.00 .00 .00
72.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 73.00 .00 .00
73.00
LQPERMIT
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CITY of ca QU.,'TNTA*
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Bin #
Oty of La Quin
Building 8r 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:
e✓\ ' l c
Owner's Name:
A. P. Number:
Address: 5 r 2
c
Legal Description:
Contractor:
City, ST, Zip: C -A 9 ,�
Telephone:
7
sA.4 j
Address:
Project Description:
City, ST, Zip:
Tel.
ephone• 1. 0 J FSJ
G4 9 31 1/
c.�y�vl�
-JF -
i
State Lic. # :
Arch., Engr., Designer:
Ci Lic. #
ty � �
+ r rr
1
t ,
Address:
City., ST, Zip:
Telephone:
K
'ivSv
:zk •... ''.
Construction Type: Occupancy:
State Lic. #:]
Project a circle one): New Add'n Alter Repair
type ) p
Demo
Name of Contact Person:
Sq. FL:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
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