08-1351 (BLCK)rr _t �f • ��j �
P.O. BOX 1504 4^' VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
_Date: 8/11/08
Application Number: 08-0000_1351 Owner:
Property Address: 57205 PENINSULA LN ROGER ANDERSON
APN: 762-150-024- - 57205 PENINSULA LANE
Application description: WALL/FENCE 'LA QUINTA, CA 92253
Prooerty zoning: LOW DENSITY RESIDENTIAL
Application valuation: 4575
Contractor:
Applicant: Architect or Engineer: ELLINGTON MASONRY, S
68.675 PANAROMA ROAD
I CATHEDRAL CITY, CA 92i �}r i 1 203
l (760)320-9481
Lic. NO.: 497804 CITYOFLAQUINTA
FINANCE DEPT.
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LICENSED CONTRACTOR'S DECLARATION I I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
Li s Clas C29 License No.:.497804
o�
ate' tractor:
OWNER -BUILDER DECLARATION
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 ($500).:
(_) 1, 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 fSec. 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_) 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
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.
V I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
l� Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier ENDURANCE REIN Policy Number WEN003681601
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 to the workers' compensation laws of California,
and agree that, if I should ecome subject to the workers' compensation provisions of Section
37700 of the Labor Code, all forthwith comply with those provisions.
Kate: 4P plicanC
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 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 formation is correct. I agree to comply with all
city and county ordinances and state laws relating to building c struction, reby authorize representatives
of t/his �pplicant
bove-mentioned property for spection urpo
t05 e: or Agent):
Application Number
. . . ... 08-00001351
Permit
WALL/FENCE PERMIT
Additional desc .
Permit Fee .
. 72.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 4575
Expiration Date
2/07/09
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
3,00 9.0000
THOU RTnh:,2;nni-?5
nnn,
27.00....
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Special Notes and
Comments
183 L.F. 6' GARDEN
WALL, CITY STANDARD .
Fee summary
-- - - - - - - - - - - - - ---
Charged
---- - - - - ----
Paid Credited
-- - - - -
Due
Permit Fee Total
72.00
- ----- - - -
.00
- ----
.00
-- - - - - - -
72_.00
Plan Check Total
.00
.00
.00
.00
Grand Total
72.00
.00
.00
72.00•
ME
Bin #
City of La Quinta
Building, BE Safety Division -
Permit # P.O. Box 1504, 78-495 Cage Tampico
La Quinta, CA 92253 - (760) 777-7012
- -------- Building Permit Application and Tracking Sheet
Project Address:_,;wm5)�4mj'zlla za.0ye, Owner's Name: X '00
A. P. Number: h A, L)�)
Legal Description:
Contractor: Paz
Address: y.
City. ST. Zip- K
Telephone:
Address: y
7e�mqji4q /e2/
Project Description:
City. ST. Zip:
Telephone: y
ss
State Lic. #
City Lic.
Arch.. Engr.. Desigg
Address:W
ap OVA,
54q:5
City. ST. Zip: 40W
Telephone:
X'..
Construction Type: Occupanc%-
StateLic. ft:
Project type (cimle one): New A:id*n Alter Repair Demo
Name of Contact Person: x
Sq. FL*.A
'M Stories:
Units
Telephone 4 of Contact Person: _-
Estimated Value of Project: Y,
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal
Rcq'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed. ready for corrections
Plan Check Deposit
Truss CaIcs.
Called Contact Person
1plan
Check Balance
Title 24 Cafes.
P12"S picked up
Construction
Flood plain plan.
Plans resubmitted
Mccharical
Grading plan
2" Review. ready for correctionslissuc
Electrical
Subcontactor List
Called Contact Person
Plumbi-rig
Grant Deed
Plans picked up
SAM.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review. readv for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P,
Pub. Wks. Appr
Date of permit issue
School Fees
•
Total Permit Fees