11-1010 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4'!t aF4Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/19/11
Application Number:
-'11-00001010
Owner:
Property Address:
52420 ROSS AVE
HARNISH KEITH
APN:
767-670-003- - -
7305 SOUNDVIEW DR #602
Application description:
WALL/FENCE
GIG HARBOR, WA 98335
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1375
`
OContractor:
Applicant:
Architect or Engineer:
MONARCH HOMES DESERT DIVSN INS
2011 L�
49950 JEFFERSON ST, #130-134
INDIO, CA 92201
ce;P 1
(760)413-8863
CITY nFLA-QUINTA
PIA
Lic. No.: 457228
rnod ,Nllrn"T
----- - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
SED CONTRACTOR'S DECLARATION
I hereby affirm under enalty f perjury that m licensed under provisions of Chapter 9 (commencing with
Section 7000) of Divi 'on 3 f the Busine a d Professionals Code, and my License is in full force and effect.
License Class: B License No.: 457228
/
te: '041 4 n ctor. CD GV S/ 0
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 ISec. 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 70001 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 _ I 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 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:
Lender's Address:
LQPERMIT
--------------- - - -
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.
1 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 719000322
I certify that, in the pert a of the work for which this permit is issued, I shall not employ any
person in any in ner so ome subject to the workers' compensation laws of California,
and agree that, f I s uld beco subject to the workers' compensation provisions of Section
3700 of the Labo I orthwith comply with those provisions.
pplicant G S %` (A V"a
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 the above rmation is correct. I agree to comply with all
city and county ordinances and state laws relating build; co ruction, and hereby authorize representatives
of this county to enter upon a above-mentione property f sped/i�o�tn�plur/poses. r
of
/S' nature (Applicant or A ent): i" W s/ a
Application Number . . . . . 11-00001010
Permit . . . WALL/FENCE PERMIT
Additional desc . ..
Permit Fee . . . . 33.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 1375
Expiration Date . . 3/17/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
9.00 2.0000 HND BLDG 501-2,000
18.00
------------------------- --------------------------------------------------
Special Notes and Comments
50 L.F. 6' GARDEN WALL & (2) 30" X 30"
PILASTERS TO CREATE FRONT COURTYARD,
CITY STANDARD. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 33.00 .00 .00
33.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1:00
Grand Total 34.00 .00 .00
•34.00
LQPERMIT
Bin #
City of La Quints
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: SZ' YZ D 45s- E
Owner's Name:
A. P. Number: -7(P 7- (o7o — . r 0 3
AddressC/ MOwI ►7-Li % r—r
Legal Description:
Contractor:
City, ST, Zip:
Gv3 •�
Telephone. r .;
Address: ,&-36,J S U
Project Description:
City, ST, Zip: d q �f'Z201
so (� �/-1% .
Telephone.,:/'S� (p3T'�3�i7
u• 'ff:<:> `;;y><fi
City Lic. #;
State Lic. # :
3p L4.3
Arch:, Engr., Designer:
Address:
City, ST, Zip:
Telephone: ; "``
`�qr�'< x•,
State Lic. #:
Name of Contact Person:
Construction T an
Type: Occupancy:
ecttype icircle one . wAdd'n Alter Repair Demo
Sq. Ft.:
# Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
ii
Submittal
Plan Sets
Req'd
Recd
TRACMG
Plan Check submitted
PERMI[T FEES
Item Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Cala.
Plans picked cep
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2•! Review, ready for corrections/issue
Electrical
Subcoutector List
Called Contact Person
Plumbing
Grant DeedPlans
picked up
S.M.1.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
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
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