07-0651 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: (07'00000651`
Property Address: 46450 CAMEO PALMS DR
APN: 643-182-005-10 -2043
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
+ Application valuation: 1675
Titit 4 4 Q"
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I a licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business a Professionals Code, and my License is in full force and effect.
License Class: C29 License No.: 704270
yDatel�" Contractor
OWNER -BUILDER DECLARATION
Ihereby 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 violatiori 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 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 _ 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—) 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:
LQMRMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760)'777-7153
Date: 3/01/07
Owner:
RECTOR DONALD /WILLIAM CARRINO
46450 CAMEO PALMS DR
LA QUINTA, CA 92253
Contractor: (,
HENRY'S MASONRY, INC. L%&A
pP.O: BOX 5185 WAR � i 2007
LA QUINTA, CA 92248..(760)775-6807 OFLAQUIIIITALic. No.: 704270NCE DEPT.
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.
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 REDLAND INS CO Policy Number RPSI-11531-01
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 ecome subject to the workers' compensation laws of California,
and agree that, if I shout me subject to the workers' compensation provisions of Section
3700 of the Labor Co all forthwith comply with those provisions.
Dat/ G% • Applicant:
WARNING: FAILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL P ALTIES 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.
certify that I have read this application and state that the abov inf mation is correct.I agree to comply with all
city and county ordinances and state laws relating to building o ruction, and hereby authorize representatives
of this county to enter upon the above-mentioned property r ' spection purposes.
Date:_ /—�� Signature (Applicant or Agent):
e.
4
LQPERMIT
Application Number . . . . . 07-00000651
Permit . . . WALL/FENCE PERMIT
Additional desc
Permit Fee . . . . 39.00
Plan Check
Fee
.00
Issue Date
Valuation
1675
Expiration Date 8/28/07
Qty Unit Charge Per
Extension
BASE
FEE
15.00
12.00 2.0000 HND BLDG
501-2,000
24.00
----------------------------------------------------------------------------
Special Notes and Comments
52 LF 6' GARDEN WALL Q SIDE P/L &
15 LF
6' GARDEN WALL RETURN ADJACENT TO
GARAGE.CITY STANDARD.
Fee summary Charged
-------------------------------------
—Paid Credited
--------------------
Due
Permit Fee Total 39.00
.00
.00
39.00
Plan Check Total .00
.00
.00
.00
Grand Total 39.00
.00
.00
39.00
Bin #
Permit #
7�6 J
City Of La Quinita
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:' Ll6 L/ -��
�� CO M er's Name: bow (�e fo 1C w i, I I I C � CC1l i'iJ
A. P. Number
Address: �IGLi�C1 CG 6�1C'O . K/M
Legal Description:
City, ST, Zip:
Contmctor. L'—IVAV_S M#50001_1 Telephone:
Address: (� d b 0 i L
•&jb e Project D=ription:
City, ST, Zip: U.11., }'S
5 �-�� 6 r ��� c�
Telephone:
State Lie. QU X') Q-)
Arch., Engr., Designer.
City Lie. #: NjPC1 tfi sl%0
Address:
City; ST, Zip:
Telephone:
State Lic. #:
of Contact Person:
Construction Type: Occupancy:
-jMProject type (circle one): New Add'n Alter Repair Demo
A.Name # Units:
Sq. Ft.: # Stories: .it
Telephone # of Contact Person:
Estimated Value of Project: .
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal Req'd
Plan Sets
Reed TRACIaMG PERMIT FEES
Plan Check submitted Item Amount.
Stractatral Cales.
Reviewed, r,eidy for corrections Plan Check Deposit
Truss Cates.
Called Contact Person Plan Check Balance
Energy Gla.
Plans �Icked.ap Construction
Flood plain plan
Pians resubmitted Mechanical
Grading.plan'
V Review, ready for eorrectionstissae Electrical
Subcoutactor List .
Called Contact Person Plumbing
Grant Deed
Plans picked up S.WLL
R.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
'"' Review, ready foc eorrectionstissae Developer Impact fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
.Date, of ptrmit issue
School Fres
Total Permit Fees
CITY O1= LA
BUILDING &
APPR
FOR CONS
DAT ' 07
V L