13-0031 (BLCK)il
el
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:13-00000031
Property Address:
53728 VIA BELLAGIO
APN:
772 -510 -066 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2075
Applicant:
- V/
Architect or Engineer:
alp
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 Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C29 license No.: 920321
/ate: ^0 �3 ontractor:
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).:
(_ 1 1, 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:D1--O O `��ner:
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
Owner:
COASTAL REAL ESTATE
53728 VIA BELLAGI
LA QUINTA, C
racto,: u 2013 L
(760) 574FIM "'—
L .: 920321
- VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/08/13
WORKER'S COMPENSATION DECLARATION
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.
V-11"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 Policy Number 1948418-12
_ 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: 01 —0 5 l 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 st to laws relating to building construction, and hereby authorize representatives
offtthh'i� county to enter upon above-mentioned property for inspection purposes.
Oate: "�%� 3 'nature (Applicant or Agent):
Application Number
Permit . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date .. .
. . . . 13-00000031
WALL/FENCE PERMIT
54.00
7/07/13
Plan Check Fee .00
Valuation 2075
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
----------------------------------------------------------------------------
Special Notes and Comments
83 L.F 6' GARDEN WALLS, ORCO SYSTEM.
2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . BLDG STDS ADMIN
(SB1473)
1.00
Fee summary Charged Paid
-------------------------------------
Credited
----------
Due
Permit Fee Total 54.00
----------
.00
.00'
54.00
Plan Check Total .00
.00
.00
.•00
Other Fee Total 1.00
.00
.00
1.00
Grand Total 55.00
.00
.00
55.00
LQPERMIT
eine
Permit N 1
12) 1
1�
Project Address: J 7 2
C[ Of 1.c7 QU" to
Budding U Safety Division
P.O. Box 1504,78-495 Cade Tampico
La.Qufita, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
,
�� i4►j (/� i Owner's Name:. 77
A. P. Number.��
-0
Address: .
Legal Description:
City, ST, Zip:
Contractor.3r1��- r
M P'(.ov h %
Telephone:
Address: IfiveProject
Description: '
' 9 � 131,4
City, ST, Zip:
Telephone: (760
State Lic. # :
City Lic. #;
Arch., Engr''Designe 5 SYi I I yip erl.q.
Address: 0p03z' I`/f
fiml ,z) s /k Z
City, ST, Zip: Lot
ZZ 5 3
Telephone: 70 / 9• Y % Construction Type:. Occupancy:
Statc Lic. #: - - Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. Ft : # Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACIQNG PERMIT FEES
Plan Sets
Pian Check submitted item Amount
Structarai Calfa
Reviewed, ready for corrections Phu Check Deposit. .
Trans Cala.
Called Contact Person Pian Check Balance
Title II Cal&
Plans picked up Construction
Flood plain plan
Pians resubmitted .. Mecharilcal
Giading plan
2'! Review, ready for corrections/issue Electrical
Subeontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked cep ML
H.O.A. Approval
Plans resubmitted Grading
IN ROUSE:-
''+Review; ready for correctlonsfissue Developer Impact Fee
Planning Approval
Called Contact Person A.LP.P.
Pub. Wks. Appr
Date of penult issue
School Fees
Total Permit Fees
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OVER E%GYAN PAD N ACCORDARCE
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CMKCT ALL ROOF DRAWS TD SIZE ' • r - - - LOT 6D .
A ARG DRAIN SYSIEII :
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OVER E%GYAN PAD N ACCORDARCE
7/1N PRO= 5065 ROM PREPARED
EI7 IDT 59 .
nmwN®vi
CMKCT ALL ROOF DRAWS TD SIZE ' • r - - - LOT 6D .
A ARG DRAIN SYSIEII :
_ �-1 _ .102.97 IDT 69 .102.97
• . - O_ ..
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GRAPfiR; SCALE • � � .+--�--� � m\____._PII ;�? � �.
' SECTION A -A
-SECTION B -B ..
- - - - - UNAUTHORIZED CHANGES 8 USES-
. 'EYIIO, N 0Om RTA® DB PJC W qla ImO9!! -
NOTICETOCONTRACTOR: wmp1lp°sm :wJaNnoo lmcimaulm mo"a ' '
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ton9lstmmmisWnuruiailmDnowarwmoluo NOTICE 70 CONTRACTOR
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