11-1271 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11-00001271
Property Address:
77153 CASA DEL
APN:
773 -360 -014 -
Application description:
WALL/FENCE
Property Zoning:
MEDIUM DENSITY
Application valuation:.
4375
Applicant:
Tjht 4 4 Q"
SOL
RES
Architect. or Engineer:
alp
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
ROGER ADAMS
77153 CASA DEL SOL
LA QUINTA, CA 92253
Contractor:
ANTHONY & ASSOCIATES,
80591 TANGELO COURT
INDIO, CA 92201
(760)578-6441
'Lic. No.: 845082
VOICE (760) 7774012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/23/11
=_A0
r 2011, �
JOHN L
G Cf r 6 T
------------------------------ ---- --
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION; DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed underprovisions of Chapter (commencing with
1 hereby affirm under penalty of periury 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.
— I have and will maintain a certificate of consent to self -insure -for workers' compenaetion, as provided_
Lice ass: B 6 nfgNo.: 845082
for by Section 3700 of the Labor Code; for the performance of the work,for which this permit is
~
issued.
I have and maintain by Section 3700 of the Labor
ate: C actor:
_ will workers' compensation ,insurance, as required
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER=BUILD ECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State.License Law for the
Cartier EXEMPT Policy Number EXEMPT
following reason. (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit tocertify
that, in the performance of the work for which this permit is Issued; I shell not 'amploy any
construct, alter,'improve, demolish; or repair any structure, prior to Its issuance; also'requires the applicant for the
person in.any manner sous to become -subject to the workers' compensation laws of California,
permit to file a signed statement that he.or she; is, licensed pursuant to the provisions of the Contractor's. State
and -agree that, if I should become subjectto the workers' compensation provisions oftSection
License Law (Chapter 9 (commencing with Saction 7000) of Division 3 of the Business. and Professions Code) or
3700 of the r C d for with oo piy„kvith those: provisions.
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 (9500)::
.��)
ec pllcam:
(_) I, as owner of the property, or my employees with wages as their sole compensation .will do the work, and
r7
the structure is notintended or offered for sale Mac. 7044, Business and Professions.Code: The
WARNING: FAILU TO SECURE ORKERS' COMPENSATION VERAGE IS UNLAWFUL, AND SHALL
Contractors' State.Liconse Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE'HUNDRED THOUSAND
andwho does the work himself or herself through his or her own employees; provided that the
DOLLARS (9,100,0001. IN ADDITION TO THE COST OF:COMPENSATION, DAMAGES AS PROVIDED FOR_ IN
improvements are not,intended or offered for sale. If, however,>the building or Improvement is sold within
SECTION 3706 OF THE.LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
oneyear of completion, the owner -builder will have the burden of proving that he or she did not build or
Improvefor the purpose of sale.).
APPLICANT ACKNOWLEDGEMENT
(_ ► 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety fora permit subject to the
7044, Business -and, Professions Code:, The Contractors' State License Law does not apply to: an owner of
conditions and restrictions setforth on this application.
property who builds or. improves thereon, and who contracts for the projects with a oontractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Lew.).
whose beoefit_work is performed under or pursuarrtto any pe mit Issued as a resutt of this application,
( _') Item exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant; each agrees to, and shall defend, Indemnity and hold harmless the City
Date:.
Owner:
CONSTRUCTIONLENDING AGENCY
1 hereby,afffrm under penalty of perjury that there is°aconstruction lending agency for the performance of.the
work for which this perrnit.is Issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPSRMIT
of La Ouinto, its officers,.agents and employees for any act or omission related to the wo—aing
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 Issuence'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. 1 agree to comply with all
city and my ordinen - end a laws relating to,bufiding.coni truction, and hereby authorize representatives
of till OU to ter upon t .above-mentioned pro r15 criorypurpo a �
te: � t SI urs (APPllcant or Agent)
0 - 'V
Application Number . . . . . 11-00001271
Permit . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 72.00 Plan Check Fee .
Issue Date . . . Valuation . . . .
Expiration Date . . 5/2.1/12
.00
4375
Qty Unit Charge Per
Extension
BASE
FEE
45.00
3.00 9.0000 THOU BLDG
2,001:25,000
27.00
----------------------------------------------
Special Notes and Comments
175 L.F. 6' GARDEN WALL AT SIDE
P/L &
FRONT COURTYARD. 2010 CODES.
--------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN
--------------
(SB1473)
1.00
Fee summary Charged
---------- ----------
Paid Credited
-- - -- --
Due
- ----------------
Permit Fee Total 72.00
.00
.00
72.00
Plan Check Total .00
.00
.00
.00
Other Fee Total 1.00
.00
.00
1..00
Grand Total 73.00
.00
.00
73.00
LQPBRMIT
City of La. Quints
Bung 8T Safety. DW(kn
P.O. Box 1504, 78-495 Ca11e Tamploo
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1
Project Address: C*O- Owner'S Name: oz- T*k-#^A
A. P. Number: 7 60D O Address: 7 56 L
Legal Description: City, ST, Zip -:Zz
Contractor Telephoner -
Address: , % - 9 & do CAr Proled Mscnptron: 7 L • FT Mew -
City, ST, Zip: rDftrl0 2 Zd
Telephone:'j6o
State Lic. # : V2- City Lic. #;
Arch., Engr., Designer. ;
Address:
City, ST, Zip:
Telephone: Conshvdion Type: Occupancy:
PF
State Lia #:Project type (circle on Add'n Alter Repair Demo
Name of Contact Person: J O N.N Sq. Ft: #Stories # Units:
Telephone.4 of Contact Person �6 6 — ::1 Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
ReCd
Recd
TRAC]MG
PRRMIf FEES
Plan Sets
Plan Cheek submitted
Item Amount
Structural Coles
Reviewed, ready for corrections
Plan Cheek Deposit
Tans Cales.
Caped Contact Person
Plan Cheek Balance
Titre 24 Cake.
Plans picked rap
Construction
Flood plain plan
Plans,. es bmitted
Mechanical
Grading plan
2" Review, ready for correetions/issue
i kebial
Subeontaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.KL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'''`Review, ready for cormcilonWigsue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fen
Total Permit Fees