08-1220 (BLCK)P..O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: �� —08 -00001220 -
Property Address: 81888 RANCHO-'SANTANA DR
APN: 767-200-999-8 -312023-
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 224
Td�v 4 4Cl"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licens under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business an role i nals Code, and my License is in full force and effect.
License Class: C53 License No.: 614611
ontractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perj 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 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and Y
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.).
(_ 1 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 contractors) 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: t3 Ly(
LQPERMIT
Owner:
HENDRICKS
81888 RANCHO SANTANA DRIVE
LA QUINTA, CA 92253
(
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/21/08
Contractor: U
MCINTYRE POOLS & S INC.
83695 AVENUE 45 JUL 22:20:08
INDIO, CA 92201
]L
(760)342-3612
Lic. No.: 614611 CITY OF LA QUINTA
------------------
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 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 DELOS INS CO Policy Number OIDKRM12001870
_ 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 sub' t to the workers' compensation laws of California,
and agree that, if I should bec - me subje t the workers' compensation provisions of Section
3700 of the Labor Code, I s II forthw' omply with those provisions.
WARNING: FAILU E TR 0 SECURERKERS' 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 i correct. I agree to comply with all
city and county ordinances and state laws relating to building con uction, hereby authorize representatives
of this county to enter upon the above-mentioned property for i echo oses.
ate: -�i ture (Applicant or Agent):
LQPERMIT
Application Number . . . . . 08-00001220
Permit . . . WALL/FENCE PERMIT
'
Additional desc .
Permit Fee . . . . 15.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 224
Expiration Date 1/17/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
14 L.F. 4' EQUIPMLENT WALL, CITY
STANDARD
Fee summary Charged Paid
-------------------------------------
Credited
--------------------
Due
Permit Fee Total 15.00
.00
.00
15.00
Plan Check Total .00
.00
.00
.00
Grand Total 15.00
.00
.00
15.00
LQPERMIT
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Bin #
Ci o f La Quinn-
Building u Safety Division '
P.O. Box 1504, 78-495 Calle Tampico
U Quinti, CA 92253 - (740) 777-7012'
Building Permit Application and Tracking Sheet
Permit #
1 d�'
Project Address; _ 8
S
Owner's Name: Pn dl C 5l
A. P. Number:
Legal Description:
Contractor:
Address:_
Address: �' g S /7
City, ST, Zip: Cb'- Z Zo S .
Telephone:
Project Description:.
City, ST, Zip:.
Telephone: 347-
Z 764
I
CQ6 L2
State
State Lie. # : 3 - 6146
City Lie.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lit. #:
Name of Contact Person:
z e f .
Construction Type: Occupancy:
P cy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone #. of Contact-Person:
2 G 'A6 Z
Estimated Value.of Project (�
APPLICANT:
DO NOT WRITE BELOW THIS LINE .
#
Submittal
Req'd -
RWd
TRACKING.
PERMIT FEES'
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit .
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
'Construction
Flood plain plan,
Plans resubmitted
Mechanical
Gradingplan
2°" Review, ready for correctiotis/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
GranfDeed
Plans. picked up
UYLL
H.O.A. Approval
Plans resubmitted
Grading.
IN HOUSE:-
7nd 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