08-0166 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
O'8000s00166 '
Property Address:-511.50'-Cy-ALLE-eBI=SPO
APN:
770-142-003-93 -000000-
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
650
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
4 VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/18/08
Owner:
TRYON TERRY C
51150 CALLE OBISPO
LA QUINTA, CA 92253
I hereby affirm under penalty of perjury that I am licensed underprovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of. the Business and Professionals Code, and my License is in full force and effect.
License Class: License No.:
Date: Contractor: '
OWNER -BUILDER 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, of 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.Sdction 7000), of Division 3 of the Business and Professions ode) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any -violation of Section 7031.5 by
an 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 orimproves thereon,
and who does the work himself or herself through hisor 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 am exempt under Sec. , B.&P:C. for this reason
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address: Pr
LQPERAIIT
Contractor:
Owner
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 workfo(which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier Policy Number
XI certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner sous to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 oftheLabor Code, I.sh rthwith com ose provisions.
oe� l 'ant:
WARNING: FAILURE TO SECU 01 RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER CRIMINAL 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 andSafety 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 1 have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and stat aws relating to building construction, and hereby authorize representatives
of this county to enter upon the ove-mentioned property for ins purposes.
a'D tq` ture (Applicant or Agent):
Application Number . . . . . 08-00000166
Permit . . . WALL/FENCE
PERMIT
Additional desc . .
Permit Fee 19.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 650
Expiration Date 7/16/08
Qty Unit Charge Per
Extension
BASE
FEE
15.00
2.00 2.0000 HND BLDG
----------------------------------------------------------------------------
501-2,000
4.00
Special Notes and Comments
30 L.F. 5' GARDEN WALL, CITY STANDARD.
WILL CLEAR CODE CASE #08-221.
Fee summary Charged
-----------------
Paid Credited
Due
--------------------
Permit Fee Total 19.00
----------
.00
----------
.00
19.00
Plan Check Total .00
.00
.00
.00
Grand Total 19.00
.00
.00
19.00
LQPERMIT
Bin #
�. .
Gty of La .Qul lta,
Building Safety DiVision
P.O. Box •1504,. 78=495 Calle Tampico ,
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 5Jk
Owner's Name
A. P. Number:
Address: �` JS; �` '. e- A IJ -i . C's " 5 Q
Legal Description:
Ci h,ST,.ZiP:.L� , .:,�A A.-
Contractor:
Tele'"phone:• ? b D `� O. / s '•a
NO
Address:
Project Description: .
City, ST, Zip:
431CCIZ.. -LAZI/!Ir'�
Telephone:
fC9 X . J,O .,L- O AJ
State Lic. # :
City Lic:
Arch., Bngr., Designer:.
Address:
City, ST, Zip:
Telephone:
State Lic. #:s
Name of Contact Person:
Constructwn'Type.: . . Occupancy:
Project;type (circle one): New . Add'n Alter Repair Demo
Sq. Ft::
# Stories:-
# Units:
Telephone # of Contact Person:
Estimated Vaiue 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 ContactTerson
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°d Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans, picked up
H.O.A. Approval _
Plans resubmitted
Grading
IN HOUSE:-
'`" Review, ready for corrections/assue
Developer Impact Fee
Planning Approval"
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
J .l
OZI
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by:property owners unless .they are personally performing their
own work. If your work is: beingperformed by someone other than yourself,: you may protect yourself from possible
liability if that person applies for the properpermit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law. to put their license number on all permits for which they
apply.
If you plan to do your own, work,' with the exception 'of various, trades that you.plan to subcontract, you should be
aware of the following inforination-for-your benefit-and.protection:
If you employ or otherwise engage any; persons other than your immediate family, and the `work (including materials
and other costs) is $200.00,or more for the entire `.project, and such persons are not licensed as contractors or
subcontractors, then you may be; an employer.
If you are an employer, you must register with the State and Federal Government as,an;,employer.and you are subject
to several obligations include State .and -Federal income tax° withholding, federal social' security taxes, worker's
compensation insurance, disability: insurance. costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry but, these. obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations; under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For"more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, 'property owners; who, are.not licensed contractors are, allowed to perform their
work personally or through their own employees, without a licensed contractor or'subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be. contractors is to secure an "Owner/Builder" building
permit, erroneously implying: that., the property, owner4s, providing his• or: her own' labor and material personally.
Building permits are'not required to be signed by property, owners unless they.'are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at .1020 N. Street; Sacramento, California` 95814. '
Please complete and returnthe enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building: permit will not be'issued until'the verification'is returned.
Very truly yours,
CITY.OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760) 777-7011
R'S S ATURE/DATE
ISmA.
PROPERTY ADDRESS
OP -�(pla
PERMIT NUMBER(S)
M
L•�a GA 9oio2S�