13-0940 (BLCK)T ihf
P.O. BOX 1504 4VOICE/''''(760) 777-7012
78-495 CALLE TAMPICO �'" / 5 FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING &SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/29/13
Application Number: 13-00000940 Owner:
Property Address: 48750 SANTA URSULA ST TOMERLIN AUDREY
APN: 646-130-009- - - 48750 SANTA URSULA
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (
Application valuation: 1212 D
Contractor: JU 2 9 013
Applicant: Architect or Engineer: SOLOMON ENGINEERING JUL c7
72740 BURSERA WAY
PALM DESERT, CA 92260 CITY OF`AQumu
(760) 773-3686 FINANCE Dept;
Lic. No.: 927567
-------------——---
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury tha I a licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busing a Professionals Code, and my License is in full force and effect.
LicenseClas A License No.: 927567
Date: Con actor•
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury tt 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 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, 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 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
-
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' 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 toself-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 EXEMPT Policy Number EXEMPT )
1 certify that, in the perfornc of the work for which this permit is issued, I shall not employ any
person in any manner s s become subject to the workers' compensation laws of California,
and agree that, if I sho I b orae subject to the workers' compensation provisions of Section
3700 f the Labor Co I all forthwith comply with those provisions.
Date.. 17 pplicant:
WARNING: FAILURE TO SECURE W11%; RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMIlfAL 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 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 employ s for an act or omission related to the work being
performed under or following issuance of this ermit.
2. Any permit issued as a result of this applicatio b/eco null and void if work is not commenced
within 180 days from date of issuance of su per it, or cessation. of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that t e bov information is correct. I agree to comply with all
city and county rdInature
es and state laws relating to bu d ng nstruction, and hereby authorize representatives
oft1�/o u /e/aon the above-mentioned prope for nspection purposes.
Date/ r! (Applicant or Agent):
Application Number . . . . . 13.-00000940
Permit . . . WALL/FENCE PERMIT 2013
Additional desc.
Permit Fee . . . . 47.19 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 1212
Expiration Date 1/25/14
Qty Unit Charge Per
Extension
1.00 47.1900 LS MISC WALL, FIRST 100 LF
47.19
----------------------------------------------------------'------------------
Special Notes and Comments
56 LN FT OF 5 FT HIGH BLOCK WALL ORCO
-
STANDARDS STUCCO FINISH 7 COLUMNS WITH
WROUGHT IRON GATE & WOOD APPROVED PER
J.J.
July 29, 2013 10:40:10 AM pjuarez.
----------------------------------------------------------------------------
Other Fees . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, WALLS
60.06
Fee summary Charged Paid Credited
-------------------------------------
Due
--------------------
Permit Fee Total 47.19 .00 .00
47.19
Plan Check Total .00 00 .00
.00
Other Fee Total 61.06 .00 .00
61.06
Grand Total 108.25 .00 .00
108.'25
LQPERMIT
Bin #
Qty of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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SProject Address: 7rV
Owner's Name: p� r l
A. P. Number:
Address: y'�- 7.5 0 Set
Legal Description:
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City, ST, Zip:la A
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Telephone:
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Address: Q 1�)C
Project Description: i 5• Ca O E C
City, ST, Zip: 06A vv, CJ E±—r
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Tele ho
P ?6 C� Z y ...
.City •Lic.
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State Lic. # : 6 #;
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Arch., Engr., Designer:
ut_'30 f7
Address:
City., ST, Zip:
O2Cd
Telephone:
:
Construction T e: c
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State Lic. #:
ect type (circle one): Nw Add, n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Perso .
I Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rce'd
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
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" 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 correctionstissuc .
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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