10-0410 (BLCK)e
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/10/10
Application Number: 4d=10. 0.0"OA4.1�0.' Owner:
Property Address: 53� AVENIDA RAMIREZ HAMM RESIDENCE
APN: 774-121-024-12 -000000- 53735-AVENIDA RAMIREZ
Application description: WALL/FENCE LA QUINTA, CA 92253 O
Property`Zoning:. COVE RESIDENTIAL
Application valuation: 525
Contractor. _
Applicant: Architect or Engineer: SINCOMB CONSTRU IO-1O�
O
C/%??�✓ P; O. :BOX 925 C/r�
MORONGO VALLEY, CA
760) 250-9071 :it`'9•
Lic-.. No.: 681349
.. - LICENSED CONTRACTOR'S DECLARATION - - WORKER'S COMPENSATION DECLARATION
.I hereby affirm under penalty of perjury that I am licensedvnder,provisions of ,Chapter 9 (commencing with 1 hereby affirm under penalty of, perjuiy. one of .the following declarations:
Section 7000) of'Division 3 of BusinessandProfessionals Code, -and License is in full force and effect. _I have and will maintain a certificate of consent ta,seIf-insure for workers' cortipensa[ion,as provided ..
Licensee Class:. 'B' ,,t "License .681349. , for by Section 3700 of'the Labor.Code, for ihe'performance of the work for which-this permit is
issued:, - -
Contra _ 1 have and will maintainlworkers' compensation insurance, as required by Section 3700 of the Labor
y- - - Code, for the performance of the work for which this permit is issued. My workers' compensation
*. OWNER-BUILDER DECLARATION insurance carrier and policy number. are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law _ Carrier EXEMPT - 'Policy Number EXEMPT "
following reason (Sec. 7031.5;-Businessand Professions Code;`Any city 6r 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,
permitto file a'signed`statement that.he or she is licensed pursuant to t;e provisions of the Contractor's State - and agree that; if I should become'subject to the workers', compensation provisions of Section -
0ic nse'Law (Chapter!9-(commencing with Section 70001 ofDivision'.3 of the:_Business and. Professions,Code) or, 3700 of the Labor Code, I shall forthwith comply with tfio rov ions. .
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 hot .more than five hundred dollars (5500).:. r oat Applicant: - -
( ) 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 WARNING:, FAILURE TO SECURE WORKERS' 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, 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
improvements are-not 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 proving that he or she'did not build or
improve for the purpose of sale.). APPLICANT :ACK NOWLEDGEMENT y .
- 1 1 6•as owner, ofahe.property, am exclusivelyxontracting.with,licensed,contractors'to construct the project (Sec. •IMPORTANT Application is hereby made to the Director of-Buildirid find Safety4or a permit subject to the
7044, Business and 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.thisapplication 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 permitto cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the 1 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 building construction, and hereby authorize repres ntatives
of this county to enter upon the above-mentioned property for inspection purposes.
Lender's Name:+
.Dz � ate.�� Signature-(Applicant
Lender's Address:
LQPER111IT
Application Number . . . . . 10-00000410
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee17.00 Plan. Check Fee
.00
Issue`Date Valuation . . .
. 525
Expiration Date 11/06/10
". Qty Unit Charge Per
Extension
'BASE FEE
.15.00
1.`00 2.0000 HND BLDG 501-2,000
2.00
=. --------------------------------------------
Special Notes and Comments
--------------
INSTALL 21 LN FT X6..:Ft:. HT GARDEN -WALL;
-- — --- - -- -- .. - - _...:21- .LN ,FT...X --2 4 " HT,. _ .-PER' AP.PROVED.. PLANS' & -_
ORCO STANDARDS'APPROVED 'PER S.T._ -
--
:Other Fees. .. . . ... . . BLDG STDS ADMIN (SB1473).1.00
----- - - --
Fee 'summary Charged Paid Credited
Due
Permit Fee Total 17.00 .00 .00
17.00
Plan - Check Total 00. .00 .00
.00
Other Fee Total,1-:00:. OD. 00
1.00
Grand :total, 18. 00•` .00 00..
18.00
LQPERMIT '
6�JjM.AV
. y
lye V2 S
i
R
N
f
Y
i
i
i
's
4-11d
on1
Bin #
. ,
Qty of La Quinta
Building 8E 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: r'
'Owner's Neme:ADP,4
A. P. Number:
Address:
`� 735• 6¢,�t: �� D� R��7i � � Z
Legal Description:
Contractor: 5'/ NC' O M L? (OIVSr
City, ST, Zip:'
ty P
Telephone:.hYfi r{ y: Via' . y
Address: fg'o 06 Q25
Project Description: Z z
n
City, ST, Zip: /ifoleo r o y lle Pq fe Z�6
6
Telephone:q 7 >;:
State Lic. # : S / 3. % City Lic., #; L� 7Y50
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:Project
'
•;'„:
;�,,. al•'% ��
x 4`.';. Ns<,w i../%(%%�lf•$}r •.til•
'
uctonType:onsOccupancy:
'`-type (circle one): New Add' n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value . Project: .�{ 0 6
APPLICANT: DOrNOT WRITE BELOW;THIS LINE
#
Submittal
Req'd
Recd
TRACKING,
PERMIT FEES
Plan Sets
Plan Check submitted-
Item
Amount
Structural Caics.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cities.
Called Contact Person'
Plan Check Balance .
Tide 24 Cities.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
s
Mechanical
Grading plan
2°" 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:
71d 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