09-0446 (BLCK)P.O. BOX 1504.
78-495 CALLE TAMPICO
- LA QUINTA, CALIFORNIA 92253.
Application Number: 09-00000446
Property Address: 46112 ROUDEL LN
APN: 649-040-007-15 -31816 -
Application description• WALL/FENCE
Property Zoning: MEDIUM DENSITY RES
Application valuation: 303
C&tyl 4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7.153
Date: 5/11/09
Owner:"
DURKEE BRUCE
46112 ROUDELL LANE
LA QUINTA, CA 92253
(760)393-8321•
Contractor:
HENRY'S MASONRY, INC. Q
P.O. BOX 5185 r�
LA QUINTA, CA 92248
(760)775-6807 Zt7�g
1
Lic. No.: 704270 GlT
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
' LICENSED CONTRACTOR'S DECLARATION
- _—� .,
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
- I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business a rofessionals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C29 License No.: 704270
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: � Contractor:-
_ 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: -
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier DELOS INS CO Policy Number 02DKRM12002701
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any -
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California, ;
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should be me bject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I al r with comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
ry
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
;-Date: Ao41 Applicant: /
(_ 1 1, as owner of.the property, or my employees with wages as their sole compensation, will do the work, and
-" -
the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
' and who does the work himself or herself through his or her own employees, provided that the
- DOLLARS ($100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). -
APPLICANT ACKNOWLEDGEMENT
1—) 1, as owner of the property, am exclusively contracting, with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed
1 . Each person upon whose behalf this application is made, each Berson at whose rPnllPst and fnr ,
mirsuant to rha r'nntrartnrr' ct.,tq Llovnvv Loy:,).
-. whose benefit work is performed under or pursuant to any permit issued as a result of this application,
1 _) I am exempt under Sec. , B.&P.C. for this reason
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.
'
Date: Owner: -
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
CONSTRUCTION LENDING AGENCY
permit to cancellation. '
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above info mation is correct. I agree to comply with all
work for which this permit is.issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to buildin n uction, and hereby. authorize representatives ,
of this county to enter upon the above-mentioned propert pection pu oses.
Lender's Name: _
,_
Date: Signature (Applicant or Agent):
-
Lender's Address: � -
i� - - -
LQPERMIT
LQPERMIT "
Application Number . . . . . 09-00000446
Permit . . . WALL/FENCE PERMIT
Additional desc.
Permit Fee . . . . 15.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 303
Expiration Date 11/07/09
Qty Unit Charge Per
Extension
BASE FEE
15.00 -
-----------------------------------------------------------------------------
Special Notes and.Comments
14 LN FT X 5 FT HT GARDEN BLOCKWALL TO
CITY STANDARDS & APPROVED PLANS.
----------------------------------------------------------------------------
Other Fees . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
Credited
Due
Permit Fee Total 15.00
.00
.00
15.00
Plan Check Total .00
.00
.00
.00
Other Fee Total 1.00
.00
.00
1.00
Grand Total 16.00
.00
.00
16.00
LQPERMIT "
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gin #
City Of LaQ uinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-70.12
Permit Application and Tracking Sheet
Permit #
��.LWBuilding
Project Address: �611kau DE' w-e.
Owner's Name: ev irPe
A. P. Number: •
Address:
Legal Description:
City, ST, Zip: t /'U
Contractor: pp 5
Fy A Od��`9
Telephone: �� ._�
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Address: a �6� vl �'� � 1-4 w 0-,'�
Project Description:
City, ST, Zip: �� ()
Y
Telephone:•�>;<%•:';;:�
'
State Lic. # :
City Lic. #:
G J'Al. A0 `o
Arch., Engr., Designer:.
Address:
City., ST, Zip:
Telephone:
Yy ,..::.;;.: ••.,.;.,:::.<>;.
Construction T e: Occupancy:
State Lic. #:
ne . New. Add'n Alter Repair DemoProJect tYPa circleo
Name of Contact Person:.
Sq. Ft.:
#. Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Chee:c Balance
Title 24 Cafes..
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical.
Grading plan
2nd 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:-
'"' 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