12-0029 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: —1� �2- 00,02;9—
Property Address:. 5"4585 AVENIDA RAMIREZ
APN: 774-275-016-4 -000000-
Application description: WALL/FENCE
Property Zoning: COVE. RESIDENTIAL .
Application valuation: 408
Titit 4 4 Qum&
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
FNMA
14221 DALLAS PKWY
DALLAS, TX 75254
Contractor:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
„
JAN 12012
Applicant: Architect or Engineer: SMITH & SONS CONST1fJCTIO131
245 E. DRAKE STREET ITFA44A�>�4Qdq�Jrq
SAN BERNARDINO, CA 92408_96
(909)885-2220
LiC. No.: 810322
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Lice a Class: B License No.: 810322 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
_ issued.
Date:" 2JL ntractor: Yl 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
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
.following reason (Sec. 7031.5, Business and Professions 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 _) 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 improvemenfis 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.).
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.).
I—) 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: J
Lender's Address: 1—
Date: 1/11/12
LQPERMIT
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 4970001007
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 bec me subject to the workers' compensation provisions of Section _
3700 of t e Labor Co , sh II forthwith co ly with those provisions.
e: i Applicant.
WARNING: F LURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, 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 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 county to enter up the above-mentioned property or insp ction pur oses.
ignature (Applicant or Agentl:
Application Number . . . . . 12-00000029
Permit . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee . . .
. 19.00 Plan Check
Fee
.00
Issue Date . . .
. Valuation
. . .
. 408
Expiration Date
7/09/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00 2.0000 HND BLDG 501-2,000
4.00
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Special Notes and
Comments
80 L.F. 6' WOOD FENCE AT NORTH SIDE OF
SFD. 2010 CODES.
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Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged Paid Credited
----------------------------------------
Due
-----------------
Permit-Fee Total
19.00 .00
.00
19.00
Plan Check Total
..00 .00
.00
.00
Other Fee'Total
1.00 .00
.00
1.00
Grand Total
20.00 .00
.00
20.00
LQPERMIT
DATE /-If A- BY
r
Bin # {
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City of Via. Quinta ,
`< Building.6t:SaktyDivislon .
ox t5U4 78-495 Calle Tampico
4 P _,
La Qulnta, CA 92253 - (760) 777-7012
Bu11d1hg Permit Application and Tracking Sheet
Permit #
n
1
Project Address: 1
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OwnerName:
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A. P. Number:
Address; 4z? -J 0441,45 12kWuul
Legal Description:
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Address:
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City Lie. #;-
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State Lie. # : 3.Zy
Arch., Engr., Designer-
esignerAddress:
Address:
City, ST, Zip:
Telephone: !, N�"
State Lie. #: �` ..' �•.:�;.>:�:;;�»,,N�,,<:�, :c:
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Name of Contact Person:.
'`Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact. Person:
I Estimated Value of Project:
APPLICANT:'DO;NOT WRITE:,BELOW THIS UNE
H
Submittal
Req'd
Rec'a
-.4t'
f TAACkNG
PERMIT FEES
Plan Sets
Plan Cbeck.'submitted
Item Amount
Structural. Calcs.
Reviewed, ready for,corrections
Plan Check Deposit
Truss.Calcs.
Called Contact']? erson
Plan Check Balance
Title 24 Calcs. "
Plans picked up
Construction
rFiood plain plan
Plans resubmitted
Mechanical
Grading plan
20° Review, ready for correetions/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:-
''" Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr.
Date of permit issue
School Fees
Total Permit Fees