07-1053 (BLCK)P.O. BOX 1504
' 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07-O 00 53
Property Address:
78"575 SAGEBRUSH AVE
APN:
646-311-007-7 -000000-
Application description:
WALL/FENCE
Property Zoning;
MEDIUM DENSITY RSS
Application valuation:
3325
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CO RAC T R'S DECLARATION
I hereby affirm under penalty of perjury that I am lic ed un provisions of er 9 (commencing with
Section 7000) of Division 3 of the Business and fession s Code, an icense is in full force and effect.
Licens9 Glassy 9 Lice o.: 805698
-Dale: 'Contract
:
- OWNER -BUILD LARATION
I hereby affirm under penalty of perjury a am pt from the Contractor's State License Law for the
'following reason (Sec. 7031.5, Business n ofessions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or e u any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement th 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):
(_ I 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.). '
(_ I 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.).
1 _ 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: f
t
Lender's Address:
LQPERMIT
Owner: '
DEBBIE BLAINE
78575 SAGEBRUSH
LA QUINTA, CA 92253
Contractor:
PENSANTI MASONRY, FRANK
74041 EL CORTEZ,WAY
PALM DESERT, CA 92260
(760)272-0554. ••
Lic. No.: 806698
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/05/07
v
--—————————————————————————————————————————————
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 re ' y Section 3700 of the Labor
Code, for the performance of the work for which this pe is iss d. My workers' compensation
insurance carrier and policy number are:
Carrier EXEMPT Policy Numb EXEMPT
I certify that, in the performance of the wor r which this mit is issued, I shall not employ any
person in any manner so as to beco subject to the rkers' compensation laws of California,
and agree that, if I should beco subject to thew ers' co nsa[ion provisions_ of Section
0 of the Labor Code, 1 s forthwith corn ose provisions.
WARNING: FAILURE TO SECURE WORKERS' PE ION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PEN ANO CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS IS 100,000). IN ADDITION TOT OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, IWEREST, 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.
I certify that I have read this application and state that the above information is rract. I agree to comply with all
city and county ordinances and state laws relating to building construction, hereby authorize representatives
of this Foynty,.tgol Ater upon the above property for inspecti urposes.
+.
Application Number . . . . . 07-00001053
Permit . . . WALL/FENCE
PERMIT
•Additional desc .. .
Permit Fee 63.00
Plan Check
Fee
.00
Issue Date•..
Valuation
. . .
. 3325
Expiration Date 10/02%07
-
w Qty Unit Charge Per
Extension
BASE
FEE
45.00'
2.00• 9,0000 THOU BLDG_2,00.1,25,,000,_
19,00
Special Notes and Comments
- -- -------------------------
133 LF 6' BLOCK WALL ALONG REAR
& EAST
P/L PER ORCO DETAIL..
Fee summary Charged
-----------------
Paid.
Credited
Due
-------------------
Permit Fee Total 63.00
----------
.00
----------
.00
63.00
Plan Check Total .00
.00
.00
.00
Grand Total 63.00
.00
.00
63.00
Gia #
Gity of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit.#
pj
1
Project Address:' ? f ? S G Y✓S
Owner's Name:. S ;
A. P. Number:
Address:
Legal Description:
Contractor: /�
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City, ST, Zip:A,,� 5` s
Telephone:-
elephonerAddress:
Address:rl ((O.L(/
Project Description:
City, ST, Zip:
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Telephone: %11'.-01�
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State Lie. # : C)
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City Lie. #:
6� ` _ : 6 SC /1
Arch., Engr., Designer:
CC
rclAddress:
City, ST, Zip:
Telephone:
P
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Construction Type: Occupancy:
Project type (circle one): New Add'n . Alter Repair Demo
State Lie. #:
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 Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
'Construction
Flood .plain plan
Plans resubmitted
Mechanical
Grading. plan
V 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 correctionstiissue
Developer Fact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees