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09-1001 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00001001 Property Address: 53955 AVENIDA VELASCO APN: 774-164-023-11 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 2252 T4t!t 4 4 Qumz BUILDING & SAFETY DEPARTMENT BUILDING PERMIT . Owner: . LEWIS CARL E 53955 AVENIDA VELASCO LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/16/09 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: LQPERMIT of La Quin a, 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 abo in mation is correct. I agree to comply with all city d county ordinances and state laws relating to Wiled co ruction, and hereby authorize representatives o . c unty to enter upon the above-mentioned prop e f spectio purposes. Da /� S' ature (Applicant or Agent - Contractor: Applicant: Architect or Engineer: HENRY' S MASONRY, INC. D d P.O. BOX 5185 Q LA QUINTA, CA 92248 (760) 775-6807 SEP 51009 Lic. No.: 704270 tA ---------------------.---------------------------- CE DEPt ------------------------ - - - - -- -_--- LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business apo 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 License Class: C29 License No.: 704270 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is [ Date: �C C ractor, - issued. 1 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 OVNEA/BUIUVDECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier DELOS INS CO Policy Number 02DKRM12002701 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county 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, prior to its issuance, 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 Vcpffie 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 t Labor Code all forthwith comply with those 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. Applicant: (_ 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: FAILURE TO SECURE WORKERS' OMP SA COVERAGE 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 IVFINES UP TO 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 O COMPENSATION, DAMAGES 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 ATTORNEY'S FEES. - 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 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 contractor(s) 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, (_ 1 I am exempt under Sec. , BAP.C'. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City 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: LQPERMIT of La Quin a, 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 abo in mation is correct. I agree to comply with all city d county ordinances and state laws relating to Wiled co ruction, and hereby authorize representatives o . c unty to enter upon the above-mentioned prop e f spectio purposes. Da /� S' ature (Applicant or Agent - LQPERMIT Application Number . . . . . 09-00001001 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . 54.00 Plan Check Fee .00 Issue Date Valuation . . . . 2252 Expiration Date 3/15/10 Qty Unit Charge Per Extension BASE FEE 45.00 1.00 9.0000 THOU BLDG 2,001-25,000 9.00 --------------------------------------------------------------- Notes and Comments 104 L.F. 5' GARDEN WALL FROM FINISH GRADE @ FRONT YARD & PART OF SIDE YARDS. 2007 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 Bin # Qty of La Quinta Building &r Safety Division { P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 1C (� Project Address:/4o f L) (a Owner's Name: C e Lo lL A. P. Number: Address: /eve el tis c- o Legal Description: City, ST, Zip: Contractor: S � 0W 7 Te P 'Telephone: t Address: �.� 6 S� 6 t��p Project City, ST, Zip: /D,escription: TeleP ho ne 77 G SUwje State Lic. # : ),6(y Q City Lie. #: Arch., Engr., Desig r: S r T �� Address: City, ST, Zip: Telephone:ne: State Lic. #: t to Name of Contact Person: Con truction TY P e: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories:# Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2". Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. . H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees .Total Permit Fees .