05-4524 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00004524
Property Address: 512'75—CALL'E—QUITO
APN: 770 -173 -008 -176. -000000 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5000
T414t 4'40"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
------------------------------- - ---- --------------
LICENSED CONTRACTOR'S DECLARATION ,
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: A -B license No.: 751389
at C actor: '
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 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 ($5001.:
(_ 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.).
(_ 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 improyos Ingr9gn, anG W. h9 99nSroqui f9r the Prq*M with a 99n1rocl00 li9ensed
pursuant to the Contractors' State License Law.).
I—) 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/07/05
Owner:
DAN GLAZERMAN
51275 CALLE QUITO
LA QUINTA, CA 92253
Contractor:
nrT 192005
JC CONSTRUCTION
C�'OF
67325 MISSION COURT
QUINT
E
CATHEDRAL CITY, CA 92234
UEP�
.(760)275-6769
Lic. No.: 751389
—----------------—
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 STATE FUND Policy Number 2492805
_ 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 subject twthe workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Cod I shall forthwith comply with those provisions.
cant:
WARNING: FAILURE TO SECURE WORKERS' 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 9erwrl ugon wh95e aehalf this a991ica1i9n is ma4e, ea9h gers9n at w. h9s9 re9vol 0.4!9'r
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 is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives'
Kof this ounty to enter upon the above-mentioned property for i pection purposes.
�(IZoe)
ate: � Signatur Applicant or Agent):
Application Number . . ... . 05-00004524
Permit ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 17.25 Plan Check Fee
4.31
Issue Date Valuation . . .
0
Expiration Date 4/05/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
3.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
2.25
----------------------------- --------------------------------------------
7 --
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit.Fee . . . . 29.00 Plan Check Fee
.00
Issue Date Valuation . . .
. 1126
Expiration Date 4/05/06
Qty Unit.Charge Per
Extension
BASE FEE
15.00"
7.00 2.0000 HND BLDG 501-2;000
14.00
----------------------------------------------------------------------------
Special Notes and Comments
52 L.F. 5' BLOCK WALL WITH GATES &
ARCH. ELECTRIC TO LIGHTS AT ARCH. OTHER
NON PERMITTED WORK INCLUDES FLATWORK &
LANDSCAPING FRONT & REAR.
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 46.25 .00 .00
46.25
Plan Check Total 4.31 .00 .00
4.31
Grand Total 50.56 .00 00
50.56
LQPERMIT
Bin#
:City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA.92253 - (760) 777-7012
Building Permit Application and Tracking, Sheet
Permit #
Project Address: r-J,-Owi
Owner's Name:
A. P. Number:
Address:
lie Quit
Legal Description:
City, ST, Zip: C.4 1�-3
Contractor: Vk'
Telephone: 6117 2-3 6 6
Address: 032 5- M
City, ST, Zip:
C— q11-1Tq
Telephone: 76U z,�o i,?8q
Project Description:
114
J
-27'Ir-0 q,gll q to' en aro.
State Lic. #ty
.3$3
Ci Lic. #:
N rq'Z.f Yrlc. ro is 'kFs
Arch., Engr., Designer:
eAk A4,4a, 16-d wal,
Address:
-J.1"
1.4 IAW/1- 120() d) -4
City, ST, Zip:
Telephone:.
State Lic. #:
Name of Contact Person: u
• 5+0(. la/7e 4
asC4'.0)'A el rolot 14 vt4 r e L, V
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: '790 7 5U <7&
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec.'d
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Feposit
Truss Calcs.
Called Contact Person
Plan Check Ealance
Energy Calcs.
Plans picked up
Construction
onsiructiomFlood
Floodplain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Con . tact Person
Plumbing
Grant Deed
Plans picked up
-S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
I'Developer Impact Fee
Planning Approval
Called Contact . Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
. ....................
Total Permil Fees
60 001
A
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