08-1878 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: ,;!o-�OOOOI878�
Property Address:
49125 AVENIDA FERNANDO
APN:
658-280-014- -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3248
Tiht 4 4Q"-- -
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __!_ _ _ _ - _ - - - - _ _ _ _ _ _ _ _ _ _ _ _ - - - _ _ _ _ _ _
LICENSE CONTRACTOR'S DECLARATION
I hereby affirm under penalty of per' y; at I am I' ensed u der provisions of Chapter 9 (co mencing with
Section 7000) of Division 3 of the in s and ofessional Code, and my License is in f 11 rce and effect.
License Class: B i Lic s' No.: 662631
Date:/ 2G ^ ontracfor: 1
WNER-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.).
(_) 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:P
LQPERMIT
Owner:
AL & CAROLE BACKMAN
P.O. BOX 630
LA QUINTA, 'CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/20/08
Contractor:
BIRDSELL BUILDER- C
P O BOX 630 If
LA QUINTA, CA 9 2 `yam' f� 1-00
)
(760)409-7070 C/T,
Lic. No.: 86263 FQF
-----------------------------------
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.
YI 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 - y Number 1894068-08
1 certify that, in the performance, -f th work for which this permit is issued, I shall not employ any
person in any manner so as 'bec a subjec to the workers' compensa n laws of California,
and agree that, if I shout b Com subject to th 'workers' compensation pro 'ions of Section
ZDate:
��%%//''��3700 of th abor ode, all ith comp, with tho a pr visions.
-�-CJ ^ plicant:
WARNING: F ILURE TO SECURE WO S' C PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPUCANT 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 suc mit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that t above informatioh is correct. I agree to comply with all
city and county ordinances and state laws relating to b 'f ' g cos
o struction, nd'hereby authorize representatives
oft county to ent upon a above-mentioned ope r ' ion pur sas.
ate:/ tel,\ i
-Ly nature (Applicant or Age: i�
Application Number . . . . . 08-00001878
Permit . .
. WALL/FENCE
PERMIT
Additional desc .
.
Permit Fee . . .
. 63.00
Plan Check
Fee
.00
'Issue Date . . .
.
Valuation
. . .
. 3248
Expiration Date
5/19/09
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
2.00 9.0000
THOU BLDG
2,001-25,000
18.00
----------------------------------------------------------------------------
Special Notes and
Comments
150 L.F. 5' GARDEN
WALL, CITY STANDARD,
AT FRONT P/L
Fee summary.
Charged
Paid Credited
Due
-----------------
Permit Fee Total
---------- ----------
63.00
----------
.00
_----------
.00
63.00
Plan Check Total
.00
.00
.00.
.00
Grand Total
63.00
.00
.00
63.00
LQPERAIIT
Bin #
Permit #
Project Address: 2
City of La Quinta
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
v Owner's Name: l3 -,-j eye",4-/J
A_ P. Number:
Address: Nltil �—
Legal Description: City, ST, Zip:
Contractor: � &-rL 13, 4,�)�, Telephone:
Address: >�� 3�,
, 3 Project Description: 2v G I 2 z --
City, ST, Zip:`i9QL! I'N 7iJ Z,o <�? Z
Telephone:7Z6 4((j9 -jai O
State Lic. # :
Arch., Engr., Designer:
City Lic. #:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circ`/le', one): New Add'n Alter Repair Demo
Name of Contact Person:
`� �� � Sq. Ft.: Ij^v #Stories: #Units:
Telephone # of Contact Person:
Estimated.Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Cates.
Reviewed, ready for corrections Plan Check Deposit
Truss Calcs.
Called Contact Person Clan Check Balance
Energy Cales.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2wd Review, ready for correctionsfissue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:
3- Review, ready for correctionstissue Developer Impact Fee
Planning Approval
Called Contact Person A.I.Y.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees