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12-1409 (BLCK)P.O. BOX, 1504 VOICE 760 777-7012 r 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253` BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 12/05/12 Application Number: ' 120000140-9_ ; Owner: Property Address: 52960 AVENIDA VELASCO JEFF ROY APN: 773-326-012-15 -000000- 52960 AVENIDA VELASCO Application description: WALL/FENCE LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL Application valuation: 1866 D (� Contractor: 'DEC Applicant: Architect or Engineer: AA MASONRY `� 05 1011 77530 DELAWARE PL PALM DESERT, CA 92211 _ EI7°YOF (760)360-.7388 FINANCE DEPT.TA `1f Lic. No.: 804168 ------------------------------------------7------------------------------------------------------ LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION r I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (nnmmencing with I hcrcby offirm under penalty of pejiuiy une of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License.is in full force and effect. _ I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided - Lice a Class: C29 License No.: 804168 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is a issued. ate:� Cy ractor: 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 OWNER-BUILDE CLA TION ` insurance carrier and policy number are: I-hereby affirm under penalty of perjury that 1 am exempt fro a Contract 's State License Law for the Carrier MARKET INS Policy Number MWC003483801 following reason (Sec. 7031.5, Business and Professions Co e:-Any city or unty that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, pri suance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall lipp1hwith,,icomply wit l hose provisions. _ 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).: ate: plicant: l _ 1 I, 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 WARNING: F RE TO SECURE WO ERS'-COMPENSATION .ERA E-IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO-CRIMINAL PENALTIES A L FINES UP ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the - DOLLARS ($100,000). IN ADDITION TO THE COST COMPENSATION, D MAGES AS PROVIDED FOR IN, improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE; INTEREST, AND A -RNE-t:S.E - - - •i 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.). - - APPLICANT ACKNOWLEDGEMENT 1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to,an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_ ). I am exempt under Sec. , B.&P.C. for this reason 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. Date: • Owner: 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 CONSTRUCTION LENDING AGENCY - permit to cancellation. - I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the - I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued'(Sec. 3097, Civ. C.). - city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this ounty to enter upon the above-mentioned property for inspection purp ses. Lender's Name: ' te: Sign re (Applicant or Agent): Lender's Address: r LQPERMIT n Application Number . . . . . 12-00001409 Permit . . WALL/FENCE PERMIT Additional desc - Permit Fee--. 43.00 Plan Check Fee 00, Issue Date Valuation . . . . 1866 Expiration Date 6/03/13 Qty Unit Charge Per ..Extension BASE FEE •15.00 ,14.00 2.0000 HND BLD•G'501-2,000 28.00 ------------------------------------------------------------------------------ Special Notes and Comments 40 L.F. COMBO WALL @ SIDE YARD -2' RETAINING, 5—GARDEN, INSIDE EXISTING WALL, & 40 L.F. L.F. 5' GARDEN WALL TO CREATE FRONT COURTYARD. ORCO SYSTEM. 2 010 . CODES -----------------_------------------------------------ ' Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee.Total 43.00 _ .00 .00 43.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 44.00 00 .00 44.00 LQPERMIT S a 0 veias c.© Qo cn.�-a SID L, zow�,bc;natco�n 61®c,k wc,11 610J tl � r cows. �ii dt a .fpij. , .: { t t �i 1 L' t C ITY SOF LA QUINTA ' . ' , /�r. �' , t� r r� I DING & SAFETY DEPT. 1 APPROVE® t i, C ' ` p ' ✓ ' JJ ! FOR CONSTRUCTION IV?...... x fi!d .z �Ia.tic w� l/ .7� %!o cf DtG9 ATE `I J` Y Ge 044 Blockworks Inc. i - -- - --- - ; �l dba AA Masonry t !% ' , ' /' #. . 804168 - -- � < < � tic 77530.. Delaware Place Palin Deserts CA 92211 i c L t d ✓ L ./ L 1_ i Bin.# City of La Quinta Building a Safety DW6r; P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92253 -:(760) 777 7012 Building Permit Application' and Tracking Sheet Permit # } : Project Address: a — Owner's Name:. 7 n 4? - A. P. Number. Address: . �.Y60e,Ga Legal Description: City, ST, Zip: Contractor. Telephone;£si1�U"^ ` Address: —R Project Description: G Q,w ' City, $T, Zip: ".pl �Q�� pGoc/ I t,i Ls % Telephan % 3 �oO' 3< -�, Zvi"::a -,i City Lic. #; ¢YD State Lic. 4: g i Arch., Engr., Designer. Address: City., ST, Zip: Telephone: `� P . v r � State Lic. #: • .. - � `� ' :�. Name of Contact Person: Construction Type: Occupancy: ' Project type (circle one): New Add'ti Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Rcq'd Recd TRACKNG PERMIT FEES Plan Sets Pian Check submittedItem Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit. . Truss Cates. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2if Review, ready for correctionsfissue Electrical Subeontactor List Called Contact Person _ Plumbing Grant Deed Pians picked up S.M.I. ILO.A. Approval Plans resubmitted Grading IN HOUSE-- ''" Review, ready for correctionslissue Developer Impact Fee Planning Approval Called Contact Person A.T.P.Y. Pub. Wks. Appr Date of permit issue Schodl Fees LPr-it Fees