12-1385 (BLCK)"`10.0.7$0X 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
'12-00001385 >
Property Address:
53680 EISENHOWER DR
APN:
774-131-009-16 -000000-
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1375
Applicant:
Architect or Engineer:
p1Pr
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and rofessionals C e, and my License is in full force and effect.
Lic se Class: C29 L' nse No.: 790349
Date)'`) X.ntractor:
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 CodO 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 1$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 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 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 ISec. 3097, Civ. C.).
Lender's Name: n/
Lender's Address: W
LQPERMIT
Owner:
CHRIS KERLEY
53680 EISENHOWER DRIVE
LA QUINTA, CA 92253
Contractor:
TLC MASONRY
74562 GARY AVENUE
PALM DESERT, CA 92260
(760)668-7867
Lic. No.: 790349
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/27/12
ti0V 2 7 2012
CITY OF LA QUINTA
FINANCE 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 EXEMPT Policy Number EXEMPT
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 become subject to a workers' compensation laws of California,
and agree that, if I should beco a su ' t to th orkers' compensation provisions of Section
3700 of t Labor Code, 1 II for th co ly witgthose provisions.
Date/ v . L pplicant:
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 Ouinta, 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 the above infor tion is co ect. I ree to complyrepresentawith all
city and county ordinances and state laws relating to building con tion, a ereby thorize tives
oLthis county to enter upo he above-mentioned property for ' ction oses.
Dat nature nature (Applicant or Agent):
Application Number . . . . . 12-00001385
Permit
WALL/FENCE PERMIT
Additional desc .
Permit Fee . . .
. 33.00 Plan Check
Fee
.00
Issue Date . . .
. Valuation
. . .
. 1375
Expiration Date
5/26/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
9.00 2.0000 HND BLDG 501-2,000
18.00
--------------------------
Special Notes and
--------------------------------------------------
Comments
55 L.F. 6' GARDEN
WALL @ SOUTH P/L. ORCO
SYSTEM. 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
-41 -
Bin.#
Oty* of La Qulllta
Bullding 8L Safety Division "
Box 1504,78-495 Gaffe Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application" and Tracking Sheet
Permit #P.O.
0
ProjectAddress: 5 3 — 90 euO dtv.0ilp
Owner's Name:.
A. P. Number.
Legal Description:
City, ST, Zip:OA C4
ati�'
TeI hon
Contractor -7-4
Address: — 6 L 6 A(L AO e,
Project Description:
City, ST, Zip: (� G ZZ
Telephone�(�_� �'� �'G✓ :z.,
State Lic. #: C --.L City Lic. #• 1. b K
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
v �1`
y
Construction Type: " Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL: # Stories: # Unity:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACE NG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Contraction
Flood plain plan
Plans resubmitted "
Mechanical
Grading plan
2i6 Review, ready for correctionsfiissue
Electrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
M HOUSE:-
7n° Review; ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.U.P. "
Pub. Wks. Appr '
Date of permit issue
School Fees
Total Permit Fees