14-0299 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
t LA QUINTA, CALIFORNIA 92253
Tiat
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT (t
Application Number: 14-00000299
Property Address: 80778 CASTILLO DEL AREANA
APN: 762-240-014-23 -34243 -
Application description: WALL/FENCE
Property Zoning: RL AG/EQ OVERLAY
Application valuation: 4200
pplicant: Architect or Engineer:
fb,N r n.A- 00.1E N
LICENSED CONTRACTOR'S DECUIRATION
I hereb affi under penalty of;perjury I am licensed under provisions of Chapter 9 (commencing with
Sectio 700 otDjvision 3 of theBusi and Professionals Code, and my License is in full force and effect.
Licen Class Liceng.,.
Dat" � Contractor:
wdN 1.1i E1 hereby affirm underpenaftyof perjury,that I axe from ta License Law for the
following reason (Sec. 7031 5, Buaineu'and Pr fess ns Cade:ty that requires a permit to
construct, altar, improve, demolish, or repair an art or to.its Issuance, also requires the applicant for the
permit to file a signed, statement that he or she s 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 theralleged exemption. Any violation of Section 7031.5 by
anyapplicant for a permit subjects the applicant to a civil penalty, of, not more than five hundred dollars (8500).:
(_ ( 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 ProfessionsCode: The
Contractors' State License Law does not -apply town 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.sole.)
(_) I; as oner of the property; am exclusively contracting with licensed contractors:to construct the project (Sec.
w
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,).
1 _) I am exempt under Sec., B.&P.d. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there'is a construction lerxfing,agenc -for the performance of the
work for: which this, permit Is issued (Sec. 3097, Civ. C.).
Lender's Name.
Lender's Address:.
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
MADISON 58TH LA QUINTA, LLC
1282. PACIFIC OARS PLACE
ESCONDIDO, CA 92029
---------------------------------
Contractor:
Owner
Date: 3/24/14
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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 3 0 of the Labor Code, for the pertormanowot the, work for which this' permit is
issued.
_ I have "and wilfm sin w ars' compensation Insurance, ss required by Section 3700 of the:Labor
Code, for the per r or of the work for which this permit is issued. My workeW.compensation
insurance carrier a polic number are:
Carrier Policy Number
I rtify that, In the P�rfon a e,of the work for which this permit Is issued, I shall not employ any
personin any me ner so to become subject to the wort - - ion laws.of California,
A agree that, if shou oma subject to'the coo nsation pr _ ons of Section
7 of the Labo C , I It forthwith comply tit visions.
Date: ` Applicant:,
WARNI FAILURE TO SECURE WORKERS'
SUBJECT AN EMPLOYER TO CRIMINAL PEN?
DOLLARS (8100,000). IN ADDITION TO THE
SECTION.3706 OF THE LABOR CODE, INTER
COVERAGE IS UN AND.SHALL.
FINES UP TO UNDRED THOUSAND
NW AMAGES AS PROVIDED FOR IN
FEES.
APCANT ACKNOWLEDGEMENT
IMPORTANT Application Is hereby made to the uector'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, ea frees to, and shall -defend, indemnify=and hold harmless the City
of La Quints, its. officers, agents employees for any act or omission related to the work being
performed under or following;issua of'this;permit.
2. Any permit issued as a result of this ap on becomes null and void if work is not commenced
within 180 days from date of issuance o h permit, or cessation of work for 180 days will subject
mit to.cancellation.
I
certi that flays read this application and state t t bove information is correct I comply with all
city a cou yordinances and state laws relating to i i construction,. and hereby i r esentatives
Of ssr) to(``er upon the above mentionedpr f in a ion purposes.
Oats[ t Signature IApplicam or Agent):
Application Number . . . . . 14-00000299
Permit. . . . WALL/FENCE PERMIT 2013
Additional desc . .
Permit Fee . . . . 75.79 Plan Check Fee .00
Issue Date . . . Valuation . . . . 4200
Expiration Date . . 9/20/14
Qty Unit Charge Per Extension
1.00 47.1900 LS MISC WALL, FIRST 100 LF 47.19
2.00 14.3.000 EA MISC WALL, ADDL 50 LF 28.6.0
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Special Notes and Comments
168LN FT X 6 FT HT BLOCK WALL LOT 23
[ORCO SPECIFICATIONS] PRECISION CONCRETE
BLOCK SHALL BE COVERED WITH STUCCO,
PAINT, OR TEXTURED COATING WHERE VISIBLE
FROM OUTSIDE THE PROPERTY. 2013CBC.
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Other Fees . . . . . . .BLDG STDS ADMIN (SB1473) 1.00
PLAN CHECK, WALLS 60.06
Fee summary
-----------------
Permit :Fee Total
Plan Check Total
Other Fee Total
Grand Total
LQPERMIT
Charged Paid
75.79 .00
.00 .00
61.06 .0.0
136.85 .00
Credited Due
.00 75.79
.00 .00
.00 61.06
.00 136.85