05-3051 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
0,
05-00003051
53709 VIA BELLAGIO
772-510-053- -
WALL/FENCE
LOW DENSITY RESIDENTIAL
3625
Architect
-----------------
LICENSED CONTRACTOR'S DECLARATION
T4hf 4 4 "
BUILDING & SAFETY DEPARTMENT
BUILDING -PERMIT
� p212005 DI
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 N .: 460284
r -Dater ntractor: d
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.).
1 _ 1 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. , 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: 1
L Lender's Address:\�
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/20/05
Owner:
BOYLE JOHN
50 FEDERAL ST. STE. 1000
.BOSTON
SEBRING, FL 02110
Contractor:
DOBBINS MASONRY, LENNY
49579 KIT FOX ROAD
PALM DESERT, CA 92260
(760)567-7540
Lic. No.: 460284
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 STATE FUND Policy Number 0014234-2005
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 workettrs,' compensation provisions of Section
3700 of t e Labor Code, I�s�ha/lel fo/rt�hwItth-c� PI thlfiose Provisions.
• te:._ . ~Applicant: GG////
WARNI G: 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. Ia�qr a to comply with all
city and county ordinances and state laws relating to building construction, and hereb raze representatives
o�f�fs'coounty to enter upon the above-mentioned propert f n purposes
/pyie: /S]VA - OC,grature (Applicant or Agent): /�
Application Number . . . . . 05-00003051
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 63.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 3625
Expiration Date 1/16/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
2.00 9.0000 THOU BLDG
2,001-25,000
18.00
------------7------------------------------
Special Notes and Comm---------------------------------
ents
145 LF. 6' HIGH BLOCK WALLM (ORCO
SYSTEM)
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
1
LQPERMIT
CHRISTOPHER -
a r c h i t e c t
Me FADDEN
May 12, 2005
CITY OF LA QUINTA
DEPARTMENT OF BUILDING AND SAFETY
78-495 Calle Tampico
LaQuinta, CA 92253
RE: Boyle Residence
53-709 (Lot 322) Via Bellagio - The Hideaway
Dear Sirs,
I have personally reviewed the above referenced Framing/ Foundation layout and found the project to be' in
substantial conformance with the approved Construction. Documents subject to the following. items being
completed:
1. Epoxy set for missing anchor bolt (for HTT16) be placed at Grid Line -B, NE shear wall type A (behind
Master tub) and;
2. Provide missing HTT16 hardware at existing bolt at shear wall type A adjacent to door #35 at Garage.
Subject to the items above being completed I have no objection for the City to permit the project to proceed
forward.
Respectfully,
Christopher McFadden
Architect of Record C 17837
72-225 Fred tkHrin, Or., 41' 2045 PFIrn Orr.r-o, GA 32160 i elaribrne: (760) 66-20 14 Fpy (760) 5612-0,r,'62,