10-0048 (BLCK)P.O. hOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00000048
Property Address:
77933 CALLE COLIMA
APN:
774-134-012-2 -000000-
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
6495
I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
ACKERMAN TERRY
77933 CALLE COLIMA
LA QUINTA, CA 92253
Contractor: '
Applicant: Architect or Engineer: GUTIERREZ MASONRY/CONRETE,
31695 AVENIDA DEL PADRE
DIU CATHEDRAL CITY, CA 92234
(760)770-3388
A 4
Lic. No.: 725297
CENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjur t t I m lic nsed under ovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the B i ss d P ssionals de, and my, cense is in full force and effect.
LicenseClass: ]C8 -C29 e
Date1 ' � � ` Cont racto "
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 70001 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—) I, 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 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.).
(_) 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.).
(_ 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 (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPER111IT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/19/10
WORKER'S COMPENSATION DECLARATION
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.
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
insurance carrier and policy number are:
Carrier STATE FUND Policy Number WS100322501
_ I certify that, in tAperforfof the work for which this permit is issued, I shall not employ any
person in any e ome jest to the rkers' compe ation laws of California,
and agree thate sub' t to thew rs' compens n provisions of Section
3700 of the Lforth ith comply rhos3
DatJ 0 ApplicanWARNING:FAILURETO SEC COMPENSATION COVERAGE IS UNLAWFUL, D HALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 s null and void if work is not commenced
within 180 days from date of issuance of s perm' , or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that t e ab e i r Jonec'
Iagrecomplywithall
city and county ordinances and state laws relating to bu di co tr obs autho representativesof thisscountttyy to antter upon the above-mentionedgrape f sp ion
Date( `�'l ` T �✓ Signature (Applicant or Agent
Application Number . . . . . 10-00000048
Permit . . . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee . . .
. 90.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 6495
Expiration Date
7/18/10
Qty Unit Charge
Per
Extension
BASE FEE
45.00
5.00 9.0000
THOU BLDG 2,001-25,000
45.00
----------------------------------------------------------------------------
Special Notes and
Comments
300 LN FT X 5 FT HT GARDEN BLOCK WALL
PER CITY STANDARDS
& APPROVED PLANS.
APPROVED PER K.K.
=
-----------------------------
Other Fees . . .
----------------------------------------------
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
-----------------
Charged Paid
--------------------
Credited
--------------------
Due
Permit Fee Total
90.00
.00
.00
90.00
Plan Check Total
.00
.00
.00
.00
Other Fee Total
1.00
.00
.00
1.00
Grand Total
91.00
.00
.00
91.00
LQPERMIT
Sin #
Cit}/ Of La Q uin to
Building t- Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
o '
Project Address: Owner's Name: -/
A. P. Number: v �J O/� Address: 7/ 3 ` e7�js��
Legal Description: City, ST, Zip: P' . 4::!�2 0v/
Contractor: �• .y�
7' Tel hone:
Address:Ab 7 AV-e C(49 Project Description:
City, ST,
Telephone:
State Lic. # :-72-S Zq7 City Lic. #•: '
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: ; Construction T an
State Lic. #: �>' '""` Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. FL: . DD a # Stories: # Units:
Telephone # of Contact Person: Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Plan Sets
Req'd
Recd
TRACKING PERMIT FEES
Plan Check submitted Item Amount
Structural Calcs.
Reviewed, ready for corrections Plan Check Deposit
Truss Coles.
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2'! Review, ready for correction0i sue Electrical
Subeontaetor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.OA. Approval
Plans resubmitted Grading
IN HOUSE:-
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
111
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PROGRESSIVE DESIGN CONCEPTS
- Architectural Design
• Residential and Cornniei°ciai
• Planning and Development
78-115 Calle Estado, Ste, 105
La Quinta, CA 92253
Office (760) 554-4707 Fax (760) 564-49
www.swconcepts.com
PROJECT TITLE
AdditionAddition& Remodel
for
Terry Ackerman
77933 Calle Colima
La Quintal CA 92253
AX.N.: 774-134-012
Date/ Description
Number
f
I
Drawn By
Approved By
Project Manager
Date: 1 /13/2010
51TE-FLAN
SCALE: 1/8" =1' - m"