05-4818 (BLCK)P.O. 90X.1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05, 00
90
PProperty Address:OMA CT
APN: 770-096-005-76
Application description: WALL/FENCE
-000000
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1425
Applicant: Architect or
kAJ
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
- . 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 Divisio_n'3 of the Businessand Professionals Code, and my. License is in full force.and effect.
License Class: (i/� Liranse No.:
teil� Contratkor. rr" '
O SER -BUILDER DECLARATION
I hereby affirm underpenalty of perjury that I .am'e rapt from'the Contractor's State License Law for the
- following reason,(Sec. 7031.5;: Business and;Professions Code: Any city or Couniy that requires a permit to
construct, alter, improve demolish, or repair any structure prior;to its issuance; also iequires,the.applicant for the
permit to'file a signed.statement'that he'or she is licensed pursuant to the provisions
of.theContract
or's State
LicenseLaw 1Cha ter9 lcommencmg with"Section70001 of Dwi ion 3 of the -business 'Business andPr ssions .
Codel,or
that he or she is exempt therefrom and the'basis foi,the alleged exemption.. Any violationof Section:7031 5. by. '
any applicant for a permit subjects the applicant to a.civil penaltyof not more than five Hundred dollars (5500).:-•
as'owner-of.the property, or my employees;, with wagesas-theirsole compensation, will do the work, and'
the structure is,notlintended or'offered foGsale (Sec. 7044, Business and ProfessionCCode:. 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 herselfthrougnhis or:her own•'employees, provided that the
improvements ire notintended or,offered for sale. If, however; the building or improvement is sold within
one.ye;r'of completion, the owner -builder will have the burden of proying'that he or, she did not build or
improve for the purpose of sale.). r '
1 _ 1, 1, as'owner.of.the,propgrty, 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 1 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 (Seca 3097, Civ. C.)..
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
ALBERTINE
50900 PALOMA COURT
LA QUINTA, CA 92253
Contractor:
SABOR MASONRY
WCC: STATE FUND
WC: 0026187.
CSLB: 649905
7 -
VOICE (760) 777-7012 "I
FAX (760) 777-7011
INSPECTIONS (760) 777-7153.
04/01/0'6
07/31/06
Date:10/28/05
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following;tleclarations: ,.
_ I have and will�maimain a certificate of consent to self -insure for workers' compensation, as provided
for by Section3700 of.the'Labor Code, for the performance of the work;,for which this permit is
issued. 1' _ - ...
Ihave and will maintain workers'.compensation insurance, as required by Section'3700 of.the Labor
Code':for.the-performance of=ihe•work for which this permit is issued: My workers'•compensation
insurance carrier and policy number,ere. -
Carrier C29Policy Number - - - - -- - -
_ I -certify that,, in the performance'of,the work.forwhich this permit is;issued, I shall not -employ any
person Wany manner so as to;become subject to the'workers' compensation laws of California,
er
and agreethat, if I shou becomesubject to the'workers�compensation provisions of Section
3700 of the Latior Cod Isnalrforthwith com ly:with those provisions.
a
O Ce:10-off 5X6 I cant. .
WARNING: FAILURE TO SECURE WORKERS', COMPENSATION COVERAGE IS UNLAWFUL, AND;SHALL
SUBJECT AN.EMPLOYER TO; CRIMINAL PENALTIES ANbtlVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS.J$100,000). "IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE; INTEREST.,ANDATTORNEY'S FEES:.
APPLICANT ACKNOWLEDGEMENT
.::IMPORTANT r Application is hereby made -to the -Director of- Building -and�Safety for 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, 5irborize representatives
of this county to enter upon the above-mentioned Drop ty for inspection pu
Datee� gnature (Applicant or Age
•
Application Number. . . . 05-00004818
i!
Permit . . . WALL/FENCE PERMIT
Additional desc .
' Permit Fee . . . 35.00 Plan Check
Fee
.00.
Issue Date Valuation
1425
"•
Expiration Date 4/26/06
Qty Unit'Charge Per
'Extension
'
BASE, FEE'
15.00
10.00. 2..0000:. HIND BLDG 501-2,000
20::00
`'
---------.----------------------- -------
Special Note's' and Comments'
5-7 L.F. 61 -BLOCK WALL, &:TWO 16"X16" 6'
E:
COLUMNS; ALL :ORCO.SYSTEMS.
'
Fee'.summary. Charged. Paid -Credited
==.-=----=---=----='---'--=-.--
Due
-- --
Permi.t Fee Total 35.00 00 _
. 00.
35 ._�00
Plan Check"Tot'al .00 .00
.00
..00
'
Grand Total 35.00 - .0.0.
00
35.00
r
LQPERMIT ..
01/13/2004 TUE 21:16 FAX 760 777 7112 Bldg & Saftey
A
X
A
x
10001/001
BTR +#
City of La Quints
Building B Safety Division
P.O., Box t SO4, 78-495 Cabe Tampico.
La Quinta, CA 922S3 •..(760) 777-70.1.2
Building Perm' it Application and Tracking Sheet
Permit #
Project Address -:5'j (i b 1e, o of c;—t— OwTer's Name: �N�
6 A ,ef
A. P. Number. Address: �t5 oj'o O P �=•z G `�
Legal Description City. ST. 4: L, A L ,`h
Contractor s` j'` M a S D W A 1tFeiepliorte _Z6C -- :'t•t
Address % L2 5 C 71-- 4jut Description: %N o J�
City, ST, Zip: P a ► ,� D s�,�-r-c� � 6o A r,.. Ca .S � C a 1 U /..Js
Telcphone-1(,o- 6 7g_C> 6 GG
State Lit. m t1 City Lic. d: ., ' fi"1;`, ' �S / /•-f i'
Arch.. Brig. Designer.
Address: �` C Q W
City, ST, Zip:
Telephone:,.. , ra; :, v -s`': _ `:: Construction Type:Occupancy:
Stan Lie. q: T x' c- _ '" - Project type (circle one): New Add'n Alter ' Rc *w Demo
Name of contact Person: e, �,L r- A Sq`Ft : 0 Stories: N Units:,
Telephone N of Contac Person: �% �, ,6 Value of Project:
APPLICANT: 00 NOT WRITE BELOW THIS LINE.
0 Submitral Req'd Reed TRACKING, .•PERM1IiT FEES
-pias Sets
plan Cbe:k submitted
Item Amenat
Structural Glee.
Reviewed, ready for cormeioas
plan Check Deposit
Truss Cala.
Called Contact Peron
pias CMett Salaoce
Energy Calm
flans jueked.up .
Consttroctioa
Flood plaie'plea
Plans resubmltled
AietAaaicsi
Grading plan
2" Itevled, ready for turvectiowessue
Electrical
Subcontactor List
Called Contact firspe •
f)ombiag
Grant Deed
Plain picked up
S.M1I.I:
'H.O.A. Approval
Plias resubmitted
Grading
IN HOUSE:-
''e Revit�v; really for cormlionvInae
Developer impace Fee
Planning Approval
- —Called—Contact—Verson
A,I,p,p,
Pub. Win. Appr
Date of persaltissue
Sc" Fen
Toea1 Permit Fea
Hous e
Q� el = ll
06� p Pa�cd
z �
wqnk I ( q N c� Co I uMn►.S
CITY OF LA QUINTA
BUILDING $ SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE o BY S%
<7 FL