12-0442 (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
Date: 4/23/12
Application Number: x,,12=00000442" Owner:
Property Address: 81435 COLUMBUS WY JLS PROPERTIES LLC/J. STRAUSS
APN: 767-690-008- - - 5956 SHERRY LANE #1275
Application description: WALL/FENCE DALLAS, TX 75225
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6083
Contractor: 0d
Applicant: Architect or Engineer: RAS MASONRY INC
16780 CRESCENT GLEN
RIVERSIDE_ CA 92503
(760)774-0090
APR 23
1011
LiC. No.: 678140 CITY
OF f' FIN N E � �
EPT,
-
------------------------------------------------------------------------------------------ - - - - --
LICENSED CONTRACTOR'S DECLARATION
1 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.: 678140
ate: N J-12 tor: Z.
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 10
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 Ilk
LQPERMIT
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 ICW / EXPLORER Policy Number TBDO1012012
_ 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 comply with those provisions.
ate: -2 — z plicant:
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 consactiand hereby authorize representatives
of this county to enter upon the above-mentioned property r iesposes.
Dare: ? z-)�igna re (Applicant or Agent):
I."
LQPERMIT
Application Number . . . . 12-00000442
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit -Fee . . . . 90.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 6083
Expiration Date 10/20/12
Qty Unit Charge Per.
Extension
BASE FEE
45.00
5.00 9.0000 THOU BLDG 2,001-25,000
45..00
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Special Notes and Comments
50 L.F. 5' RETAINING WALL, CITY
STANDARD, 100 L.F. 6' GARDEN WALL, CITY
STANDARD & 100 L.F. 6' GARDEN WALL, ORCO
SYSTEM. 2010 CODES.
-------------------------------------------------------------7--------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
------ - - - - ------ - - - - ------ - - - - ----
Due
-- - - - - - -
-- - - - - - - - - - - - - -
Permit Fee Total 90.00 .00
.00
90.00
Plan Check Total 00 .00
.00
.00
Other Fee Total 1.00 .00
.00
1.00
Grand Total 91.00 .00
.00
.91.00
Bin.#
City. of./Ld Quitlta
Building U Safety Division
P.O. Box 1504,78-495 Calle Tampico
U.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project.Address: 8 — "7�3f
Owner's Name:.
A. P. Number.
Address: V357. t. z'
Legal Description:
City, ST, Zip:
Contractor:'1`'~
.�
Telephone:
?
Address:
Project Description: f
City, ST, Zip: .
TeleP hone:
r�a..y
a ��'�
'
S �_-
5
`
State Lie. # :
City Lie. #;
Arch., Fngr., Designer
(9 •
Address:
rao tAldil -
).
City., ST, Zip:
Telephone:
State Lic. #:
?a 7
; , ,w�..
-Construction Type Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:Sq.
FL: # Stories:
# units;
Telephone # of Contact Person:
Estimated Value of Project:
# Submittal Req'd
APPLICANT: DO NOT WRITE BELOW THIS UNE
'Reed TRACICTIVG PERMIT FEES
Plan Sete
Pian Check submitted
Item Amount
Structural Calm
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cales.
Called Contact Person
Plan Check Balance.
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mecharilcal
Grading plan
2`J Review, ready for correctionsrtnue
Electrical .
Subcoutactor List
Caped Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"Wview, ready for torreetio'Wiissae
Developer Impact Fee
Planning Approval.
Called Contact Person
Ad-P.P.
Pub. Wks. Appr
Date of permit Issue
school Fees
Total Permit Fees
C, S ,
orco .