10-1036 (BLCK)Alice s
P.O. BOX 15044
78-495 CALLE TAMPICO VOICE (760) 777-7012
LA QUINTA, CALIFORNIA 92253BUILDING &SAFETY DEPARTMENT FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number:`10-00'00.103.6 Date: 10/05/10
Property Address: e54-765 AV'ENIDA RAMIREZ Owner:
APN: BROWN FRED
774-295-013-1 -000000- 54765 AVENIDA RAMIREZ
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL
Application valuation: 3107 (714)204-1603.
Applicant: 'Contractor, O p
Architect or Engineer: HENRY'S MASONRY, INC
C� P.O. BOX 5185 T
LA,-QUINTA, ' CA 92248, OCT O `� 2010
(760.)`775-6807
Lic. No.: 704270
CITY 3FI A'QUINTA
FSEIAt.�E
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 6f the Business nd Professionals Code, and rtiy License.is Sri full force and effect.
License Class:' C2 9 - - _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
q n LicenseNo.: 704270 for by Section`3700 of the Labor Code, for the performance of the work,for which this permit is
Date: .(J'— �r�Con' t� or: .. issued.
I have and will'maintain workers'.compensation insurance, as required by, Section 3700 of the Labor
OW R=BUILDER DECLARATION Code, for.•the performance'of the work for which ihis permit is issued. My workers' compensation '
I herebyaff, m under penalty of perjury that I am exempt from the Contractor's State License Law for the insurance'carnerand policy number are:
following reason (Sec: 7037:5, Business and Professions Code: Any City arbounty that requires a permit to Carrier EVEREST' NATL. ' :" Policy Number 7600004798101
construct, alter;. improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the — l cert�ty. that, in the performance of the work for which this permit is issued, I shall not employ any
permit to file a signed, statement that he or she is licensed pursuant to the provisions of the Contractor's State person.in any manner so as to become subject to thew" orkers' compensationlaws of California,
License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or and agree that, if I should be a subject [o the workers' compensation provisions of Section
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of. Section 7031 .5 by 3700 of the Labor Coil all forthwith comply with those provisions.
any applicant fora permit ropects the applicant to a civil penalty of not more than, five hundred dollars ($5001.: t�/y-- �y``�
(_ 1 I, as owner of the property, or my employees with wages astheir sole compensation, will do [fie work, and Date: _ ^^ a;Apphcant:
�.ti._
the structure State[ intended or does n for sale (Sec. 7044, Business and Professions Code:- The WARNING: FAILURE TO SECURE WORKERS' C MP SATION 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 PENAL I'llAND CIVIL FINES'.UP TO ONE HUNDRED AND
SHALL
and who does the work himself or herself through his or Fier own employees; provided that the DOLLARS IS 100,0001. IN.ADDITIo - To THE;C ST OF COMPENSATION, DAMAGES D PROVIDED AOR IN
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 heor she'did not build or SECTION 3706, OF THE LABOR CODE,INTEREST, AND ATTORNEY'S FEES.
improve for the purpose of sale.). -
(_ 1 I, as'o'wner of the property, em:ezclusively contracting :with licensed contractors twconstruct the project (Sec. IMPO gpplication is hereby made.ta the Director APPLICof Bui dO g antl SaMENfora permit 7044, Business and Professions Code: The Contractors' State License law does n6tapply to;an owner of. Y q subject to the
property who builds or improves.thereon, and who contracts for the projects with a contractor(s) licensed conditions and restrictions set forth`on this application.
pursuant to the Contractors' StateLicense Law.). 1 .. Each person upon whose behalf this application is made, each person at whose request and for
am exempt under Sec. , 8.&P.C. for this reason whose benefit work is performed under or pursuant to any permit issued as a res Itf h'
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:
LQPERMIT
the owner, and the applicant; each, agrees to, and shall defend, indemnify and hold harmlessthe Cityn
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 �ale
hthe above info, ation is correct. I agree to comply with all
city and county ordinances auildingc s coon, and hereby authorize representatives
of thisscount to enter upon terty f tion pur ses.
�24/u—Sgnaurppcant-or-Agent:
Application Number . . . . . 10-00001036
Permit . .
. WALL/FENCE PERMIT
Additional desc .
.
Permit Fee . . .
. 63.00 Plan Check Fee
Issue Date
Valuation
.00
3107
Expiration Date .
. 4/03/11
Qty Unit Charge Per
Extension
BASE FEE
45.00
2.00 9.0000
----------------------------------------------------
THOU BLDG 2,001-25,000
18.00
Special .Notes and
Comments
-----------
68 LN FT X 6 FT HT
BLOCK WALL ; 65 LN FT
X 5 FT HT BLOCK WALL BOTH ORCO STANDARDS
AND 4 COLUMNS 16"
SQUARE. PER APPROVED
PLANS & A.J..
-------------------------------------
Other Fees . . .
----------------------------
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
-------
Charged Paid Credited
----------
Due
Permit Fee Total
---------- ---------- ----------
63.00 .00 .00
63.00
Plan Check Total
.00 .00 .00
Other Fee Total
1.00 .00 .00
.00
1.00
Grand Total
64.00 .00 .00
64.00
LQPERMIT
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Bin #
City of La. Quinta
Building aT Safety Mision
P.O: Box 1'504; 78=495 Calle Tampico
La°Quinta;;CA 92W,- (760) 777=7012
Build,'ng„Permit Application and Tracking Sheet
Permit #
�b -^ 10
Project Address: S i &eN (vk • kAk , lee
Owner's Name:•
Heb y a Ro w - w
A. P. Number:
Address: �OA C,
Legal Description:
Contractor: 60/2 S M 19Sa /YA
Address: g0160 �� c�. � h1 ►�.e
� City, ST, Zip:
Telephoner : a : '•�a, r•;
ProjectDescni tion:
City, ST, Zip:
f 1 l. /Vl ASO tJ
Telephone:76()"))5 —6W
r!sy"f%
�AIQ 0j 4,(i •S'f0(,C6
state Lie. # : 76 )'5
CityM1Lic- #:
fAS0 xj (L 66 l uwwS 16 �� S'
Arch., Engr., Designer.
.6 r C te(/
SfU c O .
Address:
City., ST, Zip:
Telephone•Y.}"
; a
4 x�
”'%�
Construction Type: Occupancy:
State Lic. #:'y;w
Project a circle one New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
,Estimated Value of Project:
APPLICANT DO;NOT WRITE;BELOW THIS LINE
#
Submittal
Req'd
Rec'd.
TRACKING}`
%PERMIT FEFS
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs:
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact -Person .
Plan Check Balance
Tide 24 Calcs.
Plans picked up _
Construction
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
god Review, ready for correctionsftne
Electrical .
Subcontector List
Calied Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted`
Grading -
IN HOUSE:-
''d Reyiew,:ready,for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date o(permit issue
School Fees
Total Permit Fees