13-1213 (BLCK)"z
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property. Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
13-00001213
57600 SALIDA DEL
762-240-014-53
WALL/FENCE
RL AG/EQ OVERLAY
7876
A11,10-, Ve�_
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LICENSED CONTRACTOR'S DEC TION WORKER'S COMPENSATION DECLARATION
tat I am licensed under provisions of Cha er 9 (commencing with I hereqaffirunder penaltyof perjury one of the following declarations:
!ss and Professionals Code, a d my License � in full,force and effect. ave and will maintain a certificate of co tsent.to self -insure for workers' compensation, as provided
License 969219 for by Section 3700 of the:Labor Code, for the performance of the work for which this permit is
issued.ve and .will maintai" workers compensation insuiance.-as required by Section 3700 of the Labor
•' Code,,for the pert &mance of `the work for which this permit is issued. My workers' compensation
OWNER -6 DER DECLARATION .insurance camera _d policynumber are: -
I herebyaffirm under penalty of perlury.thav! m exempt rom the Contractor's'Stete License L w for: the Carrier. STATE FUND Policy Number 90 063:4 0 '
I hereby ffirm under penalty of pe
Section' 000) f Division 3 of the
Licese lass:
.i 4� 1 -
SOL
-34243 -
Architect or
M
G
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MADISON 58TH LA QUINTA, LLC
1282 PACIFIC OAKS PLACE
ESCONDIDO, CA 92029
Contractor:
ALTA.VERDE BUILDERS, INC.
71905"HIGHWAY 111, SUITE G
RANCHO MIRAGE, CA 92270
(760)776-1111-
Lic. No.: 969219
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/25/13
following reason (Sec. 7031.5, Business and ofessions Code: Any city or county thatrequi a permit to
construct, alter, improve, demolish, or repair y structure; 'or to its issuance, also ' s the applicant for the
permit to.;file a-signed.statement that he or- a is licensed pursuan .visions of the Contractor's State
License L'aw.(Chapter 9 (commencing with:Section 7060) 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 fora permitsubjects the applicantto a civil penalty' of not more than five t u dr&d,dollars ($500).:.
( 1 I, as owner.of the property, or my employees with wages as their solecompensation, will do the work, and
' the'structure is hot intended'or offered for sale (Sec. .7044, Business and.Professioni Code:.The
Contractors; State License Law does not.apply to an;owner-of property who'buildsor'improves thereon,
and who does the work himself orheiself through his or her own employees, *provided that the
iniprovements,are not intended or offered for sale. If, however, -the building or improvement is sold within
one year of completion,.the owner -builder will have the burden of proving that he orshe did not build or
.improve for the purpose of sale.).
(_) I, as owner of -the property, am exclusively contracting with licensed contractors to construct the"project (Sec.
7044, Business and Professions Code: The Contractors' State License Law.does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
I _ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: —
Lender's Address:
LQPERMIT
I certify that, in the pe, 4r
person in any mann so
and.agreethat, ii I sul
( 3700 of-theLabor
Daie�:� ro. X�Applicaant
WARNING:.FAILURE TO'SECURE WORK
SUBJECTAN EMPLOYER TO'CRIMINAL
DOLLARS ($idO,000)� IN ADDITION TO
SECTION 3706'0F THE LABOR CODE, If
ante of the work for which this permit is issued,. I shall not employ any
as to become subject to,the N.&kers' compensation laws of.California,
become subject to the worker ompensation provisions of Section
I shall forthwith comply with t revisions. -
COMPENSATI - COVERAGE IS UNLA)NDD-THOUsAND
AND'SHALL
LTIES AND: IL'FINES.UP TO ONE HU
COST OF OMPENSATION, DAMAGESOVIDED FOR IN
:ST, AND TTORNEY'S FEES.
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 an employees for'any act or omission related to the work being
performed under or following issuan e�of this permit.
2. Any permit issued as -a result of this a lication becomes null and void if work is not commenced,
within 180 days from date of issuan- f such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state th a above information is come t. I a ee. to comply with all
city an coun ordinances and state laws relating to i ing construction, and herebt author representatives
of t is c un o enter upon the above-mentioned pr rt for inspection purposes.
Da:j� =.' Sign at�('Appical nt or Agent):
i+
Application Number . . . . . 13-00001213
Permit WALL/FENCE PERMIT 2013
Additional desc .
Permit Fee . . . . 75.79 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 7876
Expiration Date 3/24/14
Qty .Unit Charge Per
Extension
1.00 47.1900 LS MISC WALL, FIRST,100 LF
47.19
2.00 14:3000`EA MISC WALL, ADDL 50 LF
28.60
- -----------------------------------------------------------
:, ,. :..... SpeciaL.No.tes. and..Comments, .. '..: • .._ _....• y•
BLOCK WALL .- 179.: -LF OF 6 ft..HIGH GARDEN
'WALL,.ON:,,NORTH PROPERTY LINE (DI.FFERENCE
'. SPLIT,: BETWEEN-NE-IGHBORING PROPERTY) AND: '5
FT.'•HIGH FRONT _FACING'.. WALLS [PER
ATTACHED APPROVED PLAN`& ORCO:-.
-SPECIFICATIONS]• PRECIS ION -,CONCRETE BLOCK
• SHALL•�BE COVERED- WITH STUCCO,f(,`-PAINT, _ OR .
TEXTURED COATING.. WHERE �.�VIS:IBLE•:•FROM
_
OUTSIDE-THE:4PROPERTY'.'2'010•.CALIFORNIA
BUILDING-• CODES .'
--------------------------------
Other:*-Fees "BLDG STDS ADMIN (SB1473)
----
1..00
• .,; PLAN- CHECK, -WALLS ...
60.06
Fee summary Charged`. Paid. Credited
Due
Fee`Total 75".79 00 00 ----,75
79
.,Per
Plan Check ;Total. 00 :00. _ 00;
00
- Other Fee -.Total 61.:06. .00 00.
61:06
Grand Total" 136.85 .00 .00
136.85
LQPERMIT