13-0122 (BLCK)4 P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number:
13-00000122
Property Address:
52970 DEL GATO DR
APN:
770-330-023- -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
5131
Applicant: Architect or Engineer:
------------------
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 and Professionals Code, and my License is in full force and effect.
License Class: C29 ~: License No.: 920321
Date: y •G 13 '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, 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).:
(_) 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.).
(_) 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.).
(_) I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
011C�iv.
U
I hereby affirm under penalty Of perjury the.con
work for which this permit is issued (Sec. C.).
Lender's Name:
Lender's Address:
LQPERMIT
LENDING AGENCY
in lending agency for the performance of the
Owner:
Forrester
52970 DEL GATO DRIVE
LA QUINTA, CA 92253
IBJ
Contractor:
DE LA HERRAN, MIGUEL A
80589 SHEFFIELD AVENUE
INDIO, CA 92203--0
(760)574-3313
Lic. No.: 920321
Date: 2/06/13
;FB o6zo,3 ---]I J1'
CITY OF LA QUINTA
FINANCE DEPT
-----------------------------------------------
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 STATE FUND Policy Number 1948418-12
_ 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 become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comm Iy' wyi'th/thhossee provisions.
Dater 13 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO 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 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 correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for iinspeectionn�puurrp�oses.
Date: ( 3 Signature (Applicant or Agent): I ' /r//t-f/ r
Application Number
. . . . 13-00000122
Permit . . . WALL/FENCE
PERMIT
Additional desc . .
Permit Fee . . . .
81.00
Plan Check
Fee
..00
Issue Date . . . .
Valuation
. . .
. 5131
Expiration Date
8/05/13
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
4.00 9.0000
THOU BLDG
2,001-25,000
36.00
--------------------------------------
Special Notes and Comments
--------------------------------------
89' LINEAR FEET OF 2'
RETAINING
WALL,
36' LINEAR FEET TOTAL
FOR 7 SEPARATE
SECTIONS OF 6' GARDEN
WALL BUILT
TO ORCO
STANDARD. 2010 CODES.
Fee summary Charged
----------
Paid Credited
----------
----------
Due
---------------------------
Permit Fee Total
81.00
.00
.00
81.00
Plan Check Total
.00
.00
.00
.00
Grand Total
81.00
.00
.001
81.00
LQPERMIT
City. of' La Quinta
Bidding a Safety Duron
P.O. Box IS04, 76-49S Calle Tampico
L4.Qutnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
(L i_14tfeiAC thma'sName:. .;fAx i i
. � � �.,. Address: (t j ,�►:. * � U "
City, ST, Zip.
:p.. #er r r� Tdephona
/ fj LA Pmjed Description:I.,
City Lir. 4; f r_,P I
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Of <�
Construction Typc:. Oocnpaacy:
Project type (circle one): New Add'n Alta Repair Dean
Sq. Ft: A Stories: p Units:
— - - Estimatod Value of Project: 4f 0,<1- 2: S �,
APPUCAl11T- 00 NOT VJRf F RR nW T311A I INF
N
SabmlWl Req -4
Plan Sets
Permit #
PERbUT FEES
Item Amount
Project Address: Y' YQ
A. P. Numbcr. Dr
Legal Description:
Contractor. < a< j Gt
Address: d . r E
City, ST, Zip:
Telephoae: 26,0G
State Ur- 3t�
Arch•, EW, Designs:
Aridness:
City. ST,
Telephone:
State Uc. B:
Name of Contact Person:
Telethon i of Contact Person:
City. of' La Quinta
Bidding a Safety Duron
P.O. Box IS04, 76-49S Calle Tampico
L4.Qutnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
(L i_14tfeiAC thma'sName:. .;fAx i i
. � � �.,. Address: (t j ,�►:. * � U "
City, ST, Zip.
:p.. #er r r� Tdephona
/ fj LA Pmjed Description:I.,
City Lir. 4; f r_,P I
vt LL
Of <�
Construction Typc:. Oocnpaacy:
Project type (circle one): New Add'n Alta Repair Dean
Sq. Ft: A Stories: p Units:
— - - Estimatod Value of Project: 4f 0,<1- 2: S �,
APPUCAl11T- 00 NOT VJRf F RR nW T311A I INF
N
SabmlWl Req -4
Plan Sets
'Reed TRACKING
Plan Check submitted
PERbUT FEES
Item Amount
StMdahl Cola.
Reviewed, ready for corrections
Plan Check Deposit.
Mass Cala.
Called Contact Pena
Man Cberk Salaace.
Tote 24 Cala.
Plans picked up
Construction
Flood plain pias
Plans resubmttted
Mabarikai
C -dine pian
2" Review, ready for corm-donsame
Metrical
Subeostador List
Called Contact Person
Grant Deed
Mans pIcked up
SAU
ILO•A. Approval
Mans resubmittedGradinIN
HOUSE:-
'' Revltw; ready for correctlonshme
Develofunding
Approval
Called Contact PersonPub-
jFe.cs
Wlo• Appr
Date of permit Issue
Stbodl Fen
Tocol