12-0472 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00000472
Property Address:
81681 BAFFIN AVE
APN:
767-200-998-114 -330762-
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
9048
Applicant:
TAt!t44Q
Architect or Engineer:
aIP
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LIC SED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that P
d under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business onals Code, and my License is in full force and effect.
License lass: B icenseNo.: 915336
,�te: Contraaor.LLLLLLBUILDER DECLARATION
I hereby affirm under penalty of perjury that I exempt from the Contractor's State License Law for the
.following reason (Sec. 7031.5, Business and ofessions 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 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 contractors) 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:
LQPERMIT
Owner:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
Contractor:
DBCA INC
P.O. BOX 1482
LA QUINTA, CA 92247
(760)393-5271
Lic. No.: 915336
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/02/12
P
Q 0
F_ MAY 42 2012
CITY OF LA QUINTA
FINANCE DEPT.
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.
Y
X 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 TRAVELERS Policy Number YJUB282D7797-12
_ 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 are
ect to the workers' compensation laws of California,
and agree that, if I should o the workers' compensation provisions of Section
�f I37700 of theLaborCode, 1mply with those provisions.
ate: `1 t l �^WARNING: FAILURE TO SECURE WORKERTION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PEIVIL FINES UPTO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TOOMPENSATION, 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 ab •nfor tion is correct. I agree to comply with all
city and county ordinances and state laws relating to building tru tion, d hereby authorize representatives
of this countyfenter upon the above-mentioned property to i ec on purpo es.
P`ate �lSi ature (Applicant or earl:
_ �i
Application Number . . . . . 12-00000472
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 117.00 Plan Check Fee
.00
Issue Date . . . Valuation . . .
. 9048
Expiration Date 10/29/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
8.00 9.0000 THOU BLDG 2,001-25,000
72.00
----------------------------------=-----------------------------------------
Special Notes and Comments
92 L.F. 3' BLOCK WALLS WITH (6) 3'
COLUMNS & 220 L.F. 6' BLOCK WALLS WITH
(5) 6' COLUMNS (COLUMNS TO BE ORCO
SYSTEM), WALLS CITY STANDARD. 2010
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473')
1.00
Fee summary Charged Paid Credited.
---------------------------
Due.
------------------------------
Permit Fee Total 117.00 .00 .00
117.00.
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 ..00
1.00
Grand Total 118.00 .00 .00
118.00
LQPERMIT
en.#
Ci�jr O Uinta
Building 8t Safety Division
P.O. Box 1504,78-495 Calle Tampico
14.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Perinit #
Project Address: ^J (�I
Owner's Name: .
A. P. Number.
Address: .
Legal Description:
City, ST, Zip:
Contractor.
Telephone-
e! hone:Address:
Address:
Project Description:
City, ST, Zip:ON
Telephone:
y' E` -` y
G (mob W 5
State Lie. 4:
City Lia #;
Arch., Engr., Designer.
0 FT 'g
Address:
_. CO tl,,► A j 47
City,, ST, Zip'
Telephone:
g. :.
f w,rj'. ,� :~
Construction Type:,.Occupancy:
State Lic. #:
Project type (eircle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: # Stories:
[Estimated
# units:
Telephone # of Contact Person: t I ' -gi
Value of Project:
7 %i Z2-Jc— APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIONG PERMIT FEES
Pias Sets
Plan Check submitted Item Amount
Structural Cales.
Reviewed, ready for corrections Plan Check Deposit. .
Truss Calcs.
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plans picked up Construction
Flood plain plan
Pians resubmitted.. Mechanicai
Giading plan
VR I eview, ready for correctionstisissue Electrical
Subeontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S LL
H.O.A. Approval
Plans resubmitted Grading
IN ROUSE:-
3" Review, ready for correctlonsAssue Developer Impact Fee
Planning Approval.
Called Contact Person AJ..P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees