14-0383 (BLCK)P.O. BOX 1504
T4ht
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 14-00 0 0 03 83 Owner:
Property Address: 3.540 DEL-GATO DR CLEARWATWER & SPARKS
APN: 770-370-002- - -
Property Zoning: LOW DENSITY RESIDENTIAL D 4
Application valuation: 2965
r
3p'l V r DDERLY & ASSOCIATES
Appli ht:� % Architect or •Engineer: 747 NOPALES ROAD
ClTynFl: P M DESERT, CA 92211
� p�IN7A
P1 760) 773-5205
O---Lic. No.: 762889
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 Professional odg e�nnd my License is in full force and effect.
License Cla : B n € �o.: 762889
Date: Contractor:—
-P .
I OWNER -DER 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 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 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , BAP.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: 4/07/14
RESIDENCE
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 EVEREST INS Policy Number 760000440081
I certify that, in the performance of the work for which this permit is issued, 1 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 became subject to tAworkers' compensation provisions of Section
v� -'3700 of the Labor Code"4.ttall forl"ith cog plJ wjtohose provisions.
Date: // r /.1 T Applicant: /� - /
WARNING: FAILURE TO SECURE WORKERS' COMPEMSKTI COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CfVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). 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 buildin constru n, and y a horize presentatives
of this cou to mer upon the above!mentioned prope f nsp i pu es
Dater Signature -(Appy-- oriorAg:
Application Number . . . . . 14-00000383
Permit . . . WALL/FENCE PERMIT 2013
Additional desc .
Permit Fee . . . . 61.49 Plan Check Fee
.00
Issue Date Valuation . . .
. 2965
° Expiration Date 10/04/14
Qty Unit Charge Per
Extension
1.00 47.1900 LS MISC WALL, FIRST 100 LF
47.19
1.00 14.3000 EA MISC WALL, ADDL 50 LF
14.30
--------------- ------------------------------------------------------------
Special Notes and Comments
15 LN FT X 3 FT HT & 109 LN FT X 6 FT HT
WITH (4)PILASTERS ALL ORCO STANDARDS PER
APPROVED PLANS & AJ. PRECISION CONCRETE
BLOCK SHALL BE COVERED WITH STUCCO,
PAINT, OR TEXTURED COATING WHERE VISIBLE
FROM OUTSIDE THE PROPERTY. 2013CBC.
------------------------------------------------------=---------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, WALLS
60.06
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 61.49 .00 .00
61.49
Plan Check Total .00 .00 .00
.00
Other Fee Total 61.06 .00 .00
61.06
Grand Total 122.55 .00 .00
122.55
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 #
Project Address: 5-35140 net awv I)r-.
Owner's Name: Rov\ "-fa.41-WatW
A. P. Number: .-7.7 o 0 o 2-
Address: 5 2- g� bel a" br
Legal Description: -7
City, ST, Zip: LaL 1Z u� vi trA 612-2-S5
Contractor: Fea&'-1 S
Telephone:
Address: S y S P-d
Project Description: 6"d-a,/L
City, ST, Zip: 1),,Sev+- CAq2-111
1-s-1-F '[3yj� 3H
Telephone:-7 0 - -1 -7 -52-
State Lie. # : 702,99t7 City Lie. qQ 9 -7 1
19 L )r A:-,
Arch., Engr., Designer: -sauw as
lNe-- Pt t&fc-,e
Address:
City, ST, Zip:
Telephone:
...... .. .
..........
..........
Construction Type: Occupancy:
State Lie. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: An V* V&4
0610-
# Stories: TW
Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
ff
Submittal
Req1d
Rec1d
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance.
Title 24 Cities.
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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
A * '
444s"
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