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07-1840 (BLCK)
P.O. BOX 1504. 4 ..78-495 CALLE TAMPICO L-A QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT. 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 nd Professionals Code, and my License is in full force and effect. License Cla C29 License No.: 704270 Dat Contractor: 4O N R- ILDER 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 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, 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 _ 1 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: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/25/07 U JUN 25-2007 O LA?QFAA AW,,� 479iVTA F 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 REDLAND INS CO Policy Number RPS I -11531- 01 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 the workers' compensation laws of California, and agree that, if I should be me subject to the workers' compensation provisions of Section 3700 -of the Labor Code all forthwith c mply with those provisions. Date: Applicant: WA ING: FAILURE TO SECURE WORKERS' COMPE ATION 9 VERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$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 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 nulland 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 in rmation is correct. I agree to comply with all city and county dinances and state laws relating to building o ruction, and hereby authorize representatives of this co ty ester upon the above-mentioned property f ection purposes. Date: S Signature (Applicant or Agent): BUILDING PERMIT Application Number: 07-00001840 Owner: Property Address: 48700 SAN DIMAS ST HELM RESIDENCE APN: 646-140-023- 48700 SAN DIMAS ST Application description: WALL/FENCE LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 750 Contractor: Applicant: Architect or Engineer: HENRY'S MASONRY, INC. P.O. BOX 5185 L, QA LA QUINTA, 92248 (760)775-6807 �J- Lic. No.: 704270 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 nd Professionals Code, and my License is in full force and effect. License Cla C29 License No.: 704270 Dat Contractor: 4O N R- ILDER 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 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, 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 _ 1 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: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/25/07 U JUN 25-2007 O LA?QFAA AW,,� 479iVTA F 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 REDLAND INS CO Policy Number RPS I -11531- 01 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 the workers' compensation laws of California, and agree that, if I should be me subject to the workers' compensation provisions of Section 3700 -of the Labor Code all forthwith c mply with those provisions. Date: Applicant: WA ING: FAILURE TO SECURE WORKERS' COMPE ATION 9 VERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$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 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 nulland 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 in rmation is correct. I agree to comply with all city and county dinances and state laws relating to building o ruction, and hereby authorize representatives of this co ty ester upon the above-mentioned property f ection purposes. Date: S Signature (Applicant or Agent): LQPERMIT Application Number 07-00001840 • Permit . . . . . WALL/FENCE PERMIT Additional desc . Permit Fee 21.00 Plan Check Fee .00 Issue Date', Valuation 750 Expiration Date 12/22/07 Qty Unit Charge Per Extension BASE FEE 15.00• 3.00 2.0000 HND BLDG 501-2,000 6.00 ---------------------------------------------------------------------------- Special Notes and Comments 30 L.F. X 6' GARDEN WALL CITY STANDARD Fee summary• Charged Paid Credited Due Permit Fee Total 21.00 ..00 .00 21.00 Plan Check Total .00 .00 .00 .00' Grand Total 21.00• .00 .00 21.00 Bin #, City of La Quinta Building 8t'Safety Division F -P.O. Box 1504, 78-495. Calle Tampico La Quinta, .CA 92253- (760) 777-7012 - Building Permit Application and d Tracking Sheet Permitfl �( �1 Project Address:'. 40 J D(m_ Owner's Name: A. P. Number: Address: QV4AJ 01 +/g S Legal Description: City, ST, Zip: Contractor: ^09 Q Address:! ' �1 o I � i(,J/ •e Telephone: ' Project Description: City, ST, Zip: Telephone2k_68-o State Lie. #: a1, d City. Lic. #: RA Arch., Engr., Designer: Address:/17 City, ST, Zip: Telephone: State Lie. #: Name of Contact Person: 1 AJC Z Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: 2 3 ' Estimated Value of Project: APPLICANT: DO NOT. WRITE BELOW THIS LINE # Submittal Req'd :. Reed TRACIONG PERMIT FEES Plan Sets Plan Check submitted t Item Amount Structural Cities. 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 2nd Review, ready for correctionsrssue Electrical Subcontactor List Called Contact Person . , Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- d'd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees p Total Permit Fees ' 5 L Foco, TrAs r cc� S ©eC s C k� OAII CITY OF QUINT BUILDING & S FETY DEP . A16F APPR VED w V.t(� ' FOR CONS UCTIO G iSN0I1d30X3 0 Cons ucti 'is NOT -PERMITTED -'N 1103dSNI onth folio ing Code Holidays: 931nflHOS' d 803 IS 3H1- -.I0 ION 38d 0840 8pr 0 V SNdld No 1v Yea 's Day 3J108dclflH13I 039M 38111M Dr. Marti Luther Ming Jr. -Day, '' ta .�'`�. J0 33J NOII03dS I-38 t! Pr siden s Day` M. .� q � -fc,ALS, M oris Days :� isp'° gra _.9�,. 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