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12-1371 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: ` Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 12-00001371 77355 CALLE`POTRERO 774-292-033-24 -000000- WALL/FENCE COVE RESIDENTIAL 1440 T&t BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: RYBAK 42760 MADIO STREET INDIO, CA 92201 Architect or Engineer: Contractor: CORONEL ENTERPRISES' 42760 MADIO STREET VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/20/12 Dw U hOV .. 12012 INDIO, CA 92201 (760) 775-1234 CITY ©FLAQUINTA Lic. No.: 727199 FINANCEDEpT------------------------------------------------------------------------------------------ LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that am lice nde rov ions of Chapter 9 (commencing with Section 7000) of Division 3 of th iness nd Prof ssionals ode, nd my License is in full force and effect. License Class: B Li ense o:: 727199 ZDate*.k!%._0 \ ontractor: ' 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 ($500).: (_ 1 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 (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 1, 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: f\ LQPERMIT WORKER'S COMPENSATION DECLARATION 1 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 9033452-2012 I certify that, in thLperformnce the work for w his permit is issued, I shall not employ any person in any ecom subje to the orkers' compensation laws of California, and agree that, e bj t t the wor ers' compensation provisions of Section 3700 ofthe Lafo hwith cVh those provisions. date: \\— , V �,fplican WARNING: FAILURE TO SECURE WORKERS' COMPENSATION C VERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,0001. 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 them ion is correct a to comply with all city and county ordinances and state laws relating ucti n, and her auth ze representatives of tthis county to enter up the above-mentioned p pion urpose Oata: re (Applicant or Agen Application Number . . . . 12-00001371 Permit . . . WALL/FENCE PERMIT Additional desc . . Permit Fee 35.00' Plan Check Fee 00 Issue Date . . . . Valuation . . . . 1440 Expiration Date 5/19/13 Qty Unit Charge Per Extension. BASE FEE 15.00 10.00 2.0000 HND BLDG 501-2,000 20.00 -----------------------------------------------=---------------------------- Special Notes and Comments 90 L.F.314" RETAINING WALL @ SOUTH SIDE OF PROPERTY, ORCO SYSTEM. 2010 CODES. -------------=-------------------------------------------------------------- Other Fees . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ---- Due ----------------- Permit Fee Total ---------- 35.00 .00 .00 35.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 36.00 .00 .00 36.00 LQPERMIT ONRY WALL 'LAS. FIN. BM. FLAT � J/ J— I H I J_ �• LLa"NCONCEPTS IpS • a••bwL1 •n0 C.mma[IJ • PI[mlNp mS DW[bpm[nl NI[DM1.EU°e p41x /P.IIS ..CA912516t[. I43 E. °w,u.. cnwpsl 15[LI ovIL[AItt-C'11DII IIlOGN! Y� h OIII[. 114PI4M�la/Pu(mal Sp1�P33 [YLL W M1.G I N .—� .•va•n[[Pt•..mm mm - It -�L'�' --JECT TITLE • _ D °ip1Z 11 uiwa'wu �E' roposed Single ,tinily Residence �/ � rol o'- , � j ' , , -—rw°ra� Ia[[ �I .•I,bu rua n ro nlf & Deborah Ellltl[ ypylyyE I ��M1 E� Ia[IaM� .• ,� .[/' (_\^A.Ilmn C[LLE W 1'U4111 a [v' W CIL I )Na r----la,e:,--=----�--- -77-0 29 u• - 'III .' : 2-U33 -..� I a,I �....-------•i I JL--n'-D--- R-- mn d _ pl� - - _ — m� _ 10 IIS°® II ICII : 3 I CD I I. 1 'It W F.} yy� [�1 I I•^I I y. I _ °ti, :•mom Iw --� I I ------------- I I°IIWIu[ua[(— ClOn-- -y-- .. sly ,Ne I.•niou nelell�.vuu IF. 7]�((! .=F_� __m_—___��//' uuenu eD f•pM1 [Ill elwPam a IH�, °~ �''� ° .Hanan rta„� SITE PLAN SCALE: I/8' • I'-0' NORTH .o-dI m� Plel¢IMm — ,.� I-� , �.•Iw II..4�m. / 4JlL rtA41il - - .� [ Ail ���� �m rI . 3140 � W L ®OL . _. ../�/I�� - I Slephen R. Niel° Data Dale: 7!1$41012 Bin.# Permit # 1 J Project Address: -7-7- 5 Clay of La Quinta Buiidw & Safety Division P.O. Box 1504,78-495 Calle Tampico La.Wnta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet ` , �� r r v Owner's Name:. \ ,rev- A. P. Number. Address: . Legal Description: City, ST, Zip: Contractor. ` Telephone: -?Go 7 Z S -1 M1,ai?' -• ;s>`^ Address: - -'7 U NL, , o 3� Project Description: City, ST, Zip: � \,'oCA 9act'' Telephone: 76 0 - S _ ( .' £•° State Lie. #: 7p -7 1• 12. City Lic. #; 5 Arch, Engr., Designer. ' Address: City., ST, Zip: Tele hone:` p State Lic. #: Name of Contact Person: Y � .; ' Construction Type: , Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: %66 - 57,3 - 3Y yj- Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd 'Rec'd TRACKING PERMIT FEES- Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit, Truss Cates. Called Contact Person Pian Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Pians resubmitted, . Mecharilcal Giading plan V Review, ready for corrections/issue Electrical Subcoutactor List Called Contact Person Plumbing Grant Deed Plans picked up SALL H.O.A. Approval Plans resubmitted Gradiag IN ROUSE:- '^` 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