05-4943 (BLCK)* A.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00004943`
Property Address: 81213`RED=ROCK RD
APN: 764-270-999-61 -300233-
Application description: WALL/FENCE
Property Zoning: MEDIUM HIGH DENSITY.RES
Application valuation: 208
Applicant: Architect or Enc
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T,i,Nt 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
NOV 0 7' 2005
CITY.OF LA QUINTA
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I '3m' licensed under p ovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals C , and my License is in full force and effect.
License Class: C53 Licens No.: 786324
te, — / —�S nt tractor.
Otem
-BUI RATION
I hereby affirm under penalty of rju y that I am t from the Contractor's State -License Law for the
following reason (Sec. 7031.5, B i ss and Profs Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any re, 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.:
(_) 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.).
(_) 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—) 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: ft
Lender's Address: 1"
LQPERMIT
Owner:
GIZZI MARIAN
81213 RED ROCK ROAD
LA QUINTA, CA 92253
't Contractor:
ALPINE SERVICES
P.O. BOX 4687
PALM DESERT, CA 92261
(760)346-2350
Lic. No.: 786324
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/04/05
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.
_V1 -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 2290023236
_ I certify that, in the performance of the work for.which his permit is issued, I shall not employ any -
person in any manner so as to become subject to'th workers' compensation laws of California,
and agree that, i uld become subject to the w kers' compensation provisions of Section
3700 of the or Code, I shall '-`�••�+t,=mply h those provisions.
licant: �—
WARNING: FAILURE TO SECURE ORKERS' CO
SUBJECT AN EMPLOYER TO CRI I AL PENALTI
DOLLARS ($100,000). IN ADDI O TO THE CO
SECTION 3706 OF THE LABOR C E, -INTEREST
;ATION CO GE IS UNLAWFUL, AND SHALL
) CIVIL FINES UP—TO ONE HUNDRED THOUSAND
COMPENSATION, DAMAGES AS PROVIDED FOR IN
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 18Q, 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. Ijreeto comply with all
city and county ordinances and state laws relating to buil construction, and hereby aurize representatives
of this county to enter upon t4"bove-mentioned rty for ins rp es.
(Applicant or Agent):
•
Application Number 05-00004943
Permit WALL/FENCE PERMIT
Additional desc
.
Permit Fee 15.00
Plan Check
Fee
.00•
Issue Date
Valuation
. . .
. 208
Expiration Date 5/03/0.6
. Qty Unit Charge. Per
Extension ;
BASE FEE
15.00
Special•Notes and Comments
13 L.F. 4' BLOCK 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
f
LQPERMIT
Bin #
C'+ �f � •
City a Quinta
Building u 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: O ! - 2 3 E (
Owner's Name: t� /
A. P. Number:
Address: O
Legal Description:
Contractor:�h
ALP e U I
Address: h/ ALK <
City, ST, Zip:.
v iv
.` �s
Telephone: � ^?�r
Project Description:
City, ST, Zip: I
t
Telephone: 76
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
Construction Type: Occupancy:
City, ST, Zip:
Telephone:
State Lic. #: 79 4 3 2
Name of Contact Person:
Project Pro a(circle
j type cone):e Add'n Alter Repair Demo
Sq. Ft::
#Stories:
#Units:
Telephone #.of Contact Person:
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 Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7rd 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
t