10-0372 (BLCK)a
•
P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
�.
Application Number: 10-00000372 Owner:
Property Address: 5.4-2 2-0 AVENIDA RAMIREZ CONYERS RESIDENCE
APN: 774-212-011-14 -000000- 54220 AVENIDA RAMIREZ
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL
Application valuation: 1050
Contractor:
Applicant:` Architect or Engirieer. A <1,'.:POOL CONCEPT
P.O. BOX 623
liA QUINTA, CA 92253
(760)275-5740
Lib. Nb.,-. 746662
10.0
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
D � a 10 .
APR 2 9 2010
GITY �F I.A
_U1
i1EPT.
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LICENSED: CONTRACTOR'S DECLARATION - - - WORKER -S COMPENSATION DECLARATION _
I`hereby' affirm -under penalty of -perjury that 1 am licens uhderprovisions of Chapter 9'(commencing with _ 'I hereby affirm under penalty of perjury one-of..the following declarations:
Section 70001 of Division 3 of the Business and Profes 'ovals Cade; and License is in full force and effect.. f have and will'rtiaintain a certificate of consent to self.'insure for workers' compensation, as provided
License Cla C 2,C53 ' . License No.:' (746662 for, by Section 3700 of the Labor Code, for the.performanceof the work which this'permit;is
_ - issued. .;
I have and. will maintain workers compensation insurance, as required by Section 3700 of the Labor
Date:.."``-
-- :Code, rfor the performance 6f -the work for which this permit is issued. My workers' compensation -
OWNER -BUILDER DECLARATION ,; - insurance carrier and number ire:
I hereby affirm underperialty of -perjury that am'eicempt from tlie:Contractor's State'License_Lawfor the Carrier STATE"FUND P611cy Number -1576693-2009:. -
following reason ISec..7031,.5;. Business and Professiohs Coder Any city orA:county that requires a::pe?mit to _ I certify that;';imthe performance of the work.for which this permit is'issued; I. shall not employ any
. construct,- alter, improve demolisl ,,'or repair any. structure; prior to'its issuance also requires the -applicant for the _ - person ircany manner so as to became subjecvto & workers' compensation laws of California,
permit to file a sighed statemGnf thatlie'or she is Gcensed,pursuanf to the pro'visions.of'fhe Con4ractor's'State and ag_iee that, if'I should become subjecrlo the workdrs`compensation provisions of Section
License Law (Chapter 9 (commencing, WA Section 70001 -of Division 3 of.the Business and* Professions Code) or
that he or sheds exempt therefrom and,the basis for the alleged*exemption. Any violation of.Section 7031.5 by
any applicant for a permitsubjectsthe applicantto a civil penalty of not more than five hundred dollars ($500).:
1' I, as owner of 1l 6e liroperty,-or my.employees with yvages is their sole compensation,.will .do,the .work, and
the structure is not•intended or offered for sale 7044,Business and Professions.Code: The
Contractois: State License Law does not apply to-.amowner of.property who bui6s'or improves thereon,
and who does the work himself'or herselCthrough`his:or'her own eriiployees�,provided.that 'the .
improvements awri& intendedror offe'red.for.sale. If, however; the building.drimprovement is sold within
:one year,of completion, the owner -builder will haveithe burden of proving that he or she did-notbuild.or ,
., improve:for.`the purpose of sale.).-
(_ 1 I,.as owner of the property; am exclusively contracting with hcensed,wntractors 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; an&who contracts for the projects witha contractor(s) licensed
pursuant'to the, C_ontractors'.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 ISec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
I;QPERMIT
WARNING: ,FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FINES UP:TO'ONE-HUNDREO THOUSAND
DOLLARS m1'66;000)., IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 370B'OF'THEILABOR 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:b'enefif work is performed,underor'pursuant t6 any permitissued as a result of this application,
h
the owner,-and.the applicant, eacagrees to,-,aand .shalbdefend, indemnify and hold harmless the City
of_La Quinta, its officers, agents and employeesforlany act oromission 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) have read this application and state that the above information incorrect. I agree.to comply with all
city and county ordinances and state.laws relating to building construction, 'andhe"uthorize representatives
of this counyj to egrer upon the abo ned proDert f ns cfion purposef
w Y
LQPERAIIT
Application Number . . . . . 10-00000372
Permit. . . . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee'.. 27.00 Plan Check Fee
..00
Issue Date . . . . Valuation . . .
. 1050
Expiration Date 10/26/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
6..00 2.0000 HND BLDG 501-2,000
=
12.00
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Special Notes and Comments
42�LN FT X 6 FT HT BLOCK WALL PER CITY
-- - ---- -- -- -- — -- __.._ ......._-S;TANDARDS....& APPRCQVED :PLANS ... _ ._... ....-....._.-------------
_
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Other Fees . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summa-ry `.. Charged Paid Crredited*.
Due
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Permit..Fee. Total 27.00 .00 .00.
27.00
" Plan Check .-Total .,. .00 00" :00.
.00
Other. Fee Total` 1.00 .00 .00
1. 07d.
Graihd'Total 28.00 .00 .00
28.00
LQPERAIIT
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Bin #
City of La Quinta
Building 8r Safety Dh*lon
P.O. Box 150.4;;78-495 Ca11e Tampico
La Quinta, CA 92253:- (760).777-7012
Building'Permft Application and,Tracking Sheet
,
'
Permit # , /
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Project Address: --aav ��'ri(P%Lle
Owner's Name:
A. P. Number:
Address: ol�cD•
Z
Legal Description:
Contractor:'
City, Si, Zip:
'Telephone:
Project Description:.
Address: �.v
City, ST, Zip: -
Tele hon r`<
:-� ..'..•<�-
CIO
State Lic. # : °'�e
6 Z City�Lic. M.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:<k
State Lic. #:
Name of Contact Person:
,Dj�,C`� rLy1 of
Cons'huction Type: p cy:
•l
\Project.type (circle one . New) Add'n Alta Repair
Demo
ASq. Ft.: "
#Stories:
#Units:
Telephone # of Contact Perso 'Fly-9-fa
8. Estimated Value of Project:
APPLICANT: DO;NOT WRITE BELOW THIS LINE.r
#
Submittal
Plan Sets
Req'd
• Reed
, IRACK NGs
Plan Check aubmitted
PERMIT FEES
Item
Amount
Structural Cales.
Reviewed, reacty. for corrections
N
Plan Cheek Deposit
Truss Coles.'
Called.: Contact Person. ;
Plan Check Balance
Title 2/ Calcs.
Plans picked up
Construction
Flood plain pian
Plans resubmitted
Mechanical
Grading pian
2'' Review, ready.for correctioosiisiue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
''' Review, ready for correctionsiissue
Developer Impact Fee
Planning Approval
CalledContact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees