11-0291 (BLCK)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760)'777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING.&-SAFETY.DEPA•RTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT' -
Date: 3/22/11
Application Number:11-0000.02-91 Owner:
Property Address: 78633 PEERLESS PL. IRWIN FAMILY TRUST
APN: 770=310-022= - 19450 COUNTRYWOOD DRIVE.
Application description: WALL/FENCE YORBA LINDA, CA 92886
Property Zoning: LOW' DENSITY RESIDENTIAL.
Application valuation 272 ilk
Contractor:
Applicant: Architect or Engineer: LINDLY IS POOLS OF CALIFORNIA MAR22
30325 DESERT PALM DRIVE p( 2 ��,.
THOUSAND PALMS, CA 92276
/1- a (760).
343-0600.
CITY OF lA QUINTA
�'•/" Lic. No.- 833313 FINANCEtlEPT
LICENSED CONTRACTOR'S. DECLARATION WORKER'S COMPENSATION DECLARATION.
...I hereby affirm under penalty of perjury that I am. licensed•Underprovisions of Chapter 9'(commencing with I hereby affirm under penalty of perjury, one of. the following declarations: '
• Se�tion'7000) of Division 3.of the Businessland Professionals Code, and my License is in full.force and effect. -• I have and will maintain a: certificate of consent to self=insure.foi.workers' compensation,�as provided
License Class: C53-- __ " . License.No:i. 833313 - - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
:.
issued:,
Date: 1 tractor r/�i °y=�7 •I (? _ J 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
- - OWNER -BUILDER DECLARATION .. 'insurance _carrier and'policy number are:
T hereby affirm under penalty of'peijury that) am exempt. from the Contractor's State License Law for the . ' C_ arrier DELOS .INS -CO "Policy, Number `0.009172010-02 -
following reason (Sec. 7031.5, Business and Professions Coder Any. -city -or county that requires a permit to. -.I certify that, irf:the performance of the worle for which -this permit is issued; l shall not employ. any
P alter, improve, demolish, or repair any structure, prior to its•issuance;.also requires the applicant for the • ..person in any manner so as tobecome subject' 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 1 should become subject to the workers' compensation provisions of Section .
License:Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 3700 of the Labor Code, I shall forthwith comply.,iriththose provisions.
that hebr she is exempt therefrom and the basis for'the alleged exemption. Any vlolation'of Section 7031.5 by - 2 - ..
-adi applicant.for:a permit subjects the applicant to a civil penalty of not more than five hundred dollars. (5500):: ate: 3 `ZZ' _ plicant: ,� l`?1 rV• •�? /I/.r aZ -
- (_) l; 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License 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
and who does the work himself or herself through his or.her own employees; provided that the DOLLARS*($100,060). 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.
=builder will have theburdenof proving that he or shedid not buildor
one.year of compleiion,the owner
q:improve for the purpose!of sale ). - APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property 'am -exclusively contracting with licensed contractors to construct the pioject'(Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to.the
7044, Business and Professions Code: _The Contractors' State License Law' does not apply to -an owner of conditions and restrictions set forth on this: application.
' property -who builds or improves'.thereon, and who contracts for the projects with a contractor(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 Law.).' - _ - whose benefit work is performed under or pursuant to any permit issued as a.result ofthis application;
1—) *1 am exempt under Sec. B.&P.C. for this reason 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.
Date: -Owner: 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 dayswillsubject
CONSTRUCTION LENDING AGENCY permit to cancellation.-
I hereby affirm under penalty of perjury that there is a construaion*lend'rng agency for the performance of the I certify that I have read this application and state that the above information incorrect. I agree to comply with all .
work for which this permit is issued (Sec. 3097, Civ. C.). - city and county ordinances and state laws relating to building construction„and hereby authorize, representatives .
- -of is county to enter upon the above-mentioned property for inspection purposes. - -
Lender's Name: % 1w
•Date: -ZZ'/) gnature (Applicant or Agent):-- T•trC' Q
Lender's Address:
LQPERMIT
Application Number . . . . . 11-00000291
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . 15.00
Plan Check Fee
.00
Issue Date
Valuation . . .
. 272
Expiration, Date 9/18/11
Qty Unit Charge .Per
Extension
BASE. FEE
-
15.00
----
---------=-----------------------------------
' Special Notes and Comments'
----------------
----------
ADD:`ADDITIONAL .17. L.F. 41. A/C. 'SCREEN
gTTY-_'STANDARD. 201:0.CODES..,. ...
---.---'----------- ---------------.-----.------------------------------_-------.--
_ ..
Ot'her Fees.. BLDG.STDS ADMIN (SB14.73.).'.
1.00 .
Fee summary Charged Paid
----------------
. Credited
Due
Permt.Fee'Total 15..00:.
.00 :00
15.00 .
PlanCheck. Total. :00
.00 .00
.00
'Other: Fee' �To.tal 1.00'
..00, . 00;
1.00
Grand-Total 16:'00
.00. .00
16:00
LQPERMIT
Bin #
City of 'La Q utnta
Building ff Safety Division
P.O.. Box 1564,',16-495 Calle Tampico
La Quinta,• CA 92253 - (760) 777-7012.
Building Permit Application.and,Tracking Sheet
Permit #
Project Address: g— j33 121.
Owner's Name:. f ie j IW; (2tYf/e1-46t
A. P. Number:
Address-.''.
Legal Description:
Contractor:L°+ is 0>t? f o
1 �. f'`
City, ST, Zip: L-*,JrW
``'>;:<:»>:;;»:<::z}::;;::;:>:.}•:«•<.>:;<:.:::
Telephone:
Address: 10,1ST ^�}^`—..: pp . .
i,j (�1'j/1� P/L '
Project Description:
City, ST, Zip: ' n Vo A'•Q
J a..
Telephone:
,,/
State Lic. #
CityLic.
-A47 f&e—
Arch., Engr., Designer:
t
Address:
, !' l SMA 04a,0
City, ST, Zip:
Telephone:
< -; ;.<-- k>.
� r<
,;construction Type: Occupancy:
circle one
tyPe. ect Proj' ): New Add'n Alter Repair Demo
(
State Lic. #:
Name of Contact Person:
Sq, Ft.:'
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value.of Project:
APPLICANT: DO,-NOT WRITE'BELOW NNIS LINE
# Submittal Req'd I.Rec'd TRACKING. PERMIT FEES
Plan Sets
Plan Check submitted.
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cities.
Called Contact Persou.
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°d Review, ready, for correctiops/issue
Electrical
Subcontactor List
Called Contact Oersbn
Plumbing.
Grant Deed
T11ans picked up:,,,,.,
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready _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