11-1239 (BLCK)P.O. BOX" 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant: .
=:;=z1-00_0_0-1 32 9=:z;
54645 AVENIDA RAMIREZ
774-275-019-7-000000-
WALL/FENCE
COVE RESIDENTIAL
510
Architect -or Engi
4 stP Qum&
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of,perjury,that.l am licensed:under•provisi ns of Chapter 9 (commencing with
Section 7000)"of Division of the Business"and'Professionals Code; • d y'License is in full force and effect.
.Licens"e Class: 536247 - we 1640018-2011
Date 1L,/G : // ntractor
OWNER- L E ECLARATION
I hereby. affirm under penalty of perjury that I"am:ezempt fro e'Contractorts State License Law for the
followingyeason (Sec. 7031 5'Business_and,Professions Code: Any. city orcounty. tnatrequires a permit to
•conany struct; alter, improve, demolish; or structure_; pnor,to'its issuance,-'elso requires the applicant for the
per mit,to file a signedstatementthat,he or sheislicensed pursuantto the provisions of the Contractor's State
License Caw (Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code) or
that he, or she 'is axempt therefrom and ihe.basis,for the alleg6d 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 _ Ir I, as owner, of theproperty, or m'y employees'with wages as,theirsole compensation; will do the work, and
_.the stricture 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,wh'o does the work himself or herself through his or•her own employees,'piovided that the
improvemenis.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 ownerof the property, am exclusively contracting with licensedcontractorsto construct the,project (Seca
:7644;'Business and Professions Code:. The. Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, andwho contracts for the projects with a contractor(s) licensed
pursuant, to the.Contractors' State License Law.). -
(_) 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: PIK
LQPERMIT
Owner:
JOHN SHRUANCE
54645 AVENIDA.RAMIREZ
LA QUINTA, CA 92253
Contractor:
FERNiS'FENCE 'COMPANY
OUTSIDE CITY LIMITS
40586 CLARK DRIVE
HEMET, CA 92544 "
Lic..No.: 1640018-2011
,VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/16/11'
-------------------------------------------
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 I have and will maintain workers' compensation insurance, as required by Section 3700.of theLabor
Code, for the performance of the -.work for•whioh this permit"is issued: My % orkers' compensation
.insurance"carrier and policy number.arer
Carrier 5033. ",Policy, Number STATE FUND
I certifythat, in`theperformance•oPthe,work.forw�thlsper1• issued, I shalF not:einploy; any
persominany.manner so as to became subjecttmpensafidn'lawsof California,
and`agree.thaLif fsfiould become subect'to#h�nsation provisions of Section3700of the•Labor Code; I shall forthwith isions.
WARNING: FAILURE TO SECUREWORKERS'-00. _ _ li -COVERAGE-IS UNLAWFUL; AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANO I L'FINESUP TO ONE�HUNDRED THOUSAND
DOLLARS ($100;000). IN ADDITION TO THE COST OF. PENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND TORNEY.S:FEES:
APPLICANT :ACKNOWLEDGEM ENL
IMPORTANT Application.is hereby made.to the Director of Building and Safety fora permit subjecttothe
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 Quint.), 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 da s -will subiect
permit to cancellation:
1 certify that I have read this application and state that the above information is correct. I ree y with all
city and county ordinances and state laws relating to building construction, and he oriz representatives
of thi ounty to enter upon the ove-mentioned propert - for inspection purpos
ate:�< G / Sig ure (Applicant or Agent):
Application.Number . . . . . 11-00001239
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 17.00 Plan Check Fee
.00
Issue Date . . Valuation . . .
. 510
Expiration Date 5/14/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 2.0000 HND BLDG 501-2,000
2.00
Special Notes and Comments
TOTAL-OF 60.L.F. 61'WOOD FENCE AT REAR
P/LAND 5 L.F. RETURNS AT,SIDES,..,2010
CODES'. 'PER D : SAWYER APPROVAL
_
r•------------ ----.--- _ -----------------
Other Fees . . . . . . .. BLDG STDS'ADMI'N (SB1473)
1.00
Fee :summary `Charged Paid Credited-
redited=---
-_---------------------------------------
-------- -
Permit-,.Fee Total 17.00 ..00 .0.0
17.00
Plan: Check Total . 00 00 i00
00
:Other -Fee -Total 1.00 `' 00: .'.00
5:.=00
Grand Total 18.00 00 00
18:00
LQPERMIT
tc77
CITY OF LA 'QUI NTA
BUILDING i-SAFOY*DEPT.
APPROVED
FOR CONSTRUCTION*
DATE
C?
V
-,V:.
Bin #
.,.. // ,�, .
CI of La : Qu�n 1 Q
Building.8r. Safety.:Dkislon
P.O. Box 1504,78495- Calle Tampico 0
La Quints, CA'92253-(766)'-777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 1J Q
. Owner's Name:73/V
J0o . 5110. A/;
A. P. Number:
Address: 3GG%C mid �66�� f2- d
Legal Description:
City, ST, Zip:
Contractor:
Ca
Telephone: 2 7,& 2/G D
Address: L `>
Project Description:
City, ST, Zip: �/� . L'%t. ✓. �'�
TeleP '�GD honer.
y,%%..;;::>•:>:>.:::�.....3
State Lic. # :/ 27 City Lic. #a
Arch., Engr.,' Designer:
Address:
City., ST, Zip:
Telephone:
P
;; <:u ;
;�E
Construction Type: Occupancy:
Protect type (circle one): New Add'n Alter Repair Demo
Sq. Ft : # Stories: # Units:
State Lic. #:,,
Name of Contact Person: /
Telephone # of Contact Person: 7 > 3 5_0 3 3,
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd.
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cates.
Reviewed, ready for corrections
Pian Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
15de 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
:20° Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans, picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd 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