14-0128 (BLCK)'i
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO / FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT / INSPECTIONS (760).777-7153
BUILDING PERMIT
Date: 2/10/14
Application Number: 14-00000128 Owner:
Property Address: 46441 ROUDEL LN ALBERT BRAMBILA
APN: 649-051-005-5 -2667 - 46441 ROUDEL LN p
Application description: WALL/FENCE LA QUINTA; CA 92253 D
Property Zoning: MEDIUM DENSITY RES n
Application valuation: 2952 FEB 1 2014
UMTA
Applicant: Architect or Engineer: STRZELCZYK, EDWARD J. CITY OF LAD
83420 SHADOW HILLS WAY FlN.4NCE0EPT�_..-- '
BERMUDA DUNES, CA 92203
(760)347-0399
Lic. No.: 439904
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 an rofessionals Code, and my License is in full force and effect.
LicensegClass: B C10 C29 icenseNo.: 439904
Date /G _ Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjur 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 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 1, 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, A 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.).
1 _ I I am exempt under See. , B.&N.C. t6f this ieason
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.
Ihave 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 ecome subject to the workers' compensation laws of California,
arid agree that, if I should b rite sub' rkers' compensation provisions of Section
/�//�
of the Labor Cod s I it omply wit ose Provisions.
Date �6 Applicant:
WARNING: FAILURE TO SECURE W KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIM�AL 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 QerfvrfnQ4 under or Qurwant tQ any Qermit issued as a result of this annlicatinn,
the owner, and the applicant, each agrees to, andshalldefend, 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 that the above information incorrect. I agree to comply with all
city and county ordinances and state laws relating to buildingcon ,tion, a hereby authorize representatives
of this
county to enter upon the above-mentioned property fo ' sp c
Dat '- a Signature (Applicant or Agent):
Application Number . . . . . 14-00000128
Permit . . . WALL/FENCE PERMIT 2013
Additional desc .
Permit Fee . . . . 61.49 Plan Check Fee
.00
Issue Date Valuation . . .
2952
Expiration Date 8/09/,14
Qty Unit Charge Per
Extension
1.00 47.1900 LS MISC WALL, FIRST 100 LF
47.19
1.00 14.3000 EA MISC WALL, ADDL 50 LF
14.30
-------------------------------------------------------------.
Special Notes and Comments
72 LN FT X 6 FT HT BLOCK WALL & 72 LN FT
X 4 FT HT RETAINING WALL BOTH TO ORCO
STANDARDS.
-------------------------------- -------------------------------------------
Other Fees .. . . . . . BLDG STDS ADMIN (SB1473)
'1:00
PLAN CHECK, WALLS
119.64
Fee summary Charged Paid Credited
Due
---------------------------------------------------------
Permit Fee Total 61.49 .00- .00
61.49
Plan Check Total .00 .00 .00
.00
Other Fee Total 120.64 .00 .00
120.64
Grand Total 182.13 .00 .00
182.13.
LQPERMIT
Bin #
.0t/ Of La QCdihta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1
Project Address:� axL la,
Owner's Name: gV 44- 4-1
A. P. Number:
Address: �/
Legal Description:
City, ST, Zip: ,a
Contractor:Telephone:
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Address: 0 /!!
Project Description:
City, ST, Zip:
Telephone: D _S' 9—a2_0 t
State Lic. # : 97 Y
City Lic. #:
Arch., Engr., Designer:
Q
Address:
City., ST, Zip:
Telephone::';:•:::;;<;:<:z:::;:s:
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Construction Type Occupancy
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stonei:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: O'er
APPLICANT: DO NOT WRITE BELOW.THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections'
Plan Check Depcsit
Truss Calcs.
Called Contact Person
Plan Check Bala ace
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
200 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 Impa..t Fee
Planning Approval
Called Contact Person.
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
RFy Or LA
QUINTA ,
BUIL SING & SAFETY DEPT.
APPROVED
DATFd IO � �` BY