14-0177 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 14-00000177
Property Address: 54170 AVENIDA CORTEZ
APN: 774:-192-008-17 -000000-
Application, description: WALL/FENCE
Property Zoning: COVE RESIDENTIAL
Application valuation: 1825
T-vy 4 4 00 &
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
Z�
AJ�1_
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that l am licensed under provisions of Chapter 9 loommencing with
Section 7000) of Division 3 of the Business and.Professlonals Code, and my License Is in full force and effect.
License class: C29 License No.: 713276
Date: Contractor: t _ , r
OwNER-eu LDFJI DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State.License Law for the
following reason (See. 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 (Chapter9 (commencing with Section 7000) of Division 3 of the Business and Professions .Codel;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.applicam toe Civil penalty of not more than five.hundred dollars ($500).:
(_) I, as owner of the property, or my employees with wages as theVeole 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'hls.orher 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 ofsaie:).
1 _) 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 ownerof
property who builds or improves thereon, and who contracts for the projects with a contractorls)licensed
pursuarit.to the Contractors' State License Law.):.
1 _ 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:
LQPERMLT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby aArm'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 EXEMPT Policy Number EXEMPT
_ I. certify that, in the performance of the work for whichthis 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
37 .
00 of the Labor Code, I shall forthwith comply with those provisions.
Date: Z 4 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINESUP TO ONE HUNDRED THOUSAND
DOLLARS (8100;000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 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,applicartt each agrees to, and shall defend, indemnify and hold harmless the,City
of La duinta, its officers, agents and employees for -any actor omission related to the work being
performed under or following Issuance of this permit.
2. Any permit issued as a result of this application beeomes,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 Inspection purposes.
/
Date: 'L /' Signature (Applicant or Agent):
Date: 2/20/14
Owner:
AUERBACH EZRA_
54170 AVENIDA CORTEZ
LA QUINTA, CA 92253
(
D
Contractor:
2 2014BAGWELL
GD
D
MASONRY.
56105 PUEBLO TRAILE
YUCCA VALLEY, CA 922
CITY OF LAQUINTA
(760)369-7139
FINAKE DEPT:
Lic. No.: 713276
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby aArm'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 EXEMPT Policy Number EXEMPT
_ I. certify that, in the performance of the work for whichthis 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
37 .
00 of the Labor Code, I shall forthwith comply with those provisions.
Date: Z 4 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINESUP TO ONE HUNDRED THOUSAND
DOLLARS (8100;000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 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,applicartt each agrees to, and shall defend, indemnify and hold harmless the,City
of La duinta, its officers, agents and employees for -any actor omission related to the work being
performed under or following Issuance of this permit.
2. Any permit issued as a result of this application beeomes,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 Inspection purposes.
/
Date: 'L /' Signature (Applicant or Agent):
v
Application Number . . . . . 14-00.000177
Permit. . . . WALL/FENCE PERMIT 2013
Additional desc .
Permit Fee . . . 47.19 Plan Check Fee
.00
Issue Date . . Valuation . . .
1825
Expiration Date 8/19/14
Qty Unit Charge Per
Extension
1.00 47.1900 LS MISC WALL, FIRST 100 LF
---------------------------------------------------------------
.47.19
--- -
Special Notes and Comments
71 LN FT X 5 FT HT BLOCK WALL WITH
(2)COLUMNS 6 FT HT PER ORCO
STANDARDS.APPROVED PER AJ.BLOCK WILL BE
COVERED WITH..STUCCO, PAINT, OR TEXTURED
COATING WHERE VISIBLE FROM. OUTSIDE THE
PROPERTY.'2G13 CBC.
-----------_-------------------------------------------------------
-------.--
Other Fees . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, WALLS
60.06
Fee summary Charged. Paid Credited
Due
----------------------- - - ------------- ---- - - - - - - ----------
Permit Fee Total 47.19 .00 .00
47.19
Plan Check Total .00 .00 .00
.00
Other Fee Total 61.06 .00 .00
61..06
Grand Total 108.:25 .00 .00
108.25
LQPERMIT
BlnifCray of La Quin a -
Builaing 8T Safety Divislon
Permit # P.O. Box 1504, 78-495 Calle Tampico
La Qulnta,,CA 92253 - (166),777-7012
Building Permit Application and Tracking Sheet.
Project Address: Owner's Name:
A..P..Number. - Address:
Legal Description: City, ST, Zip: Q-
Contractor. '2,n„ , / ] ►nn e n Teleohone: '
Address: 6
Project Description: %o G '�
City, ST, Zip: t.
Telephone:
I
L1 U
Stan Lic. # : ']
City Lic. #;
Arch., Engr., Designer,
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type:
Occupancy:
Projecttype (circle one):
ew Add'n Alter Repair Dano
Name of Contact Person:
Sq.'Ft::
# Stories:
#Units:
Telephone #,of Corriacx'Person:
Estimated' Value of -Project:
APPUCANTr 00 NOT WRITE UEL'OW THIS UNI:
#
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
PlanSets
Plan Check submitted.
Item
Amount
Structural Calm
Reviewed, readyefor corrections
Plan Check Deposit
Truss Cala.
Cailed.Contact Person
Plan Check Balance.
Title 24 Cala.
Plans picked up-
Coustracfion
Flood plain plan.
Plan's -resubmitted
Mechanical
Grading.,,plan
2"' Review, ready for correctionslissue
Electrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked,np
S.M L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''.RcAcw,'ready for corrections/Issue
Developerdmpact Fee
Planning Approval
Called=Contact Person,
A.I,P.P.
Pub..Wks. Appr
Date of permit issue
School Fees
'
Total'Permtt Fees