Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
06-4304 (BLCK)
P.O. BOX 1504.E 78-495 CALLE"TAMPICO LA QUINTA, CALIFORNIA• 92253 Tityl 4 Xi�Q" Applicant: Architect or Engineer: Ilk ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT . . I hereby affirm under penalty of perjury that I a licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business a re ssionals Code, and my License is in full force and effect. License Cla/s: C8 C27 C29 License No.: 656128 Date. G -Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury tha m exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and rofessions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair nystructure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or sh is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with S tion 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the ba is for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the'applica t to a civil penalty of not more than five hundred dollars ($500).: (_) I, as owner of the property; or my empl yees with wages as their sole compensation, will do the work, and the structure is not intended or offer for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does t apply to an owner of property who builds or improves thereon, and who does the work himself or herse hrough 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, 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.). I—) I am exempt under Sec. , B.&P.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: LQPERAIIT Owner: GURVITZ RESIDENCE 48-420 STILLWATER DR. LA QUINTA, CA 92253 Contractor: CALIFORNIA POOLS & S P.O. BOX 1280 COACHELLA, CA 92236 (760)398-9222 Lic. No.: 656128 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/18/06 PA D DEC 2 0 2006 CITY OF LA QUINTA FINANCE ®� ' 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. 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 polileachagrees m er are: Carrier SEABRIGHT olicy Number BB1060510 _ I certify that, in the performo I the work for which this permit is issued, I shall not employ any person in any manner so ecome subject to the workers' compensation laws of California, and agree that, if I shoul' e bject to the workers' compensation provisions of Section �0 of the Labor Code,I f rth 'th comply with those provisions. atApplicant:WARNING: FAILURE TO SECURE WORCOMPENSATION COVERAGE IS UNLAWFUL, AND SHALL. SUBJECT AN EMPLOYER TO CRIMINALLTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TCOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IEST, AND ATTORNEY'S FEES. PPLICANT ACKNOWLEDGEMENTIMPORTANT Application is hereby made Director of Building and Safety for a permit subject to the, conditions and restrictions set forth on thplication.1 . Each person upon whose beis application is made, each person at whose request and for whose benefit work is perfounder or pursuant to any permit issued as a result of this application, the owner, and the applicanh agrees to, and all defend, indemnify and hold harmless the City, of La Ouinta, its officers, agents and employees f r ny act or omission related to the work being performed under or following issuance of this per i 2. Any permit issued as a result of this application le co as null and void if work is not commenced within 180 days from date of issuance of such ssation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that t ab e i fo mation i correct. I agree to comply with all city and county ordinances and state laws relating to ilding on tion, and ereby authorize representatives of this con to enter upon the above-mentioned pro art(- oses. Date: 1.Signature,(Applicant_ orAgent)" 1 ,t" pplicationTNumber:77-06.0_000_4394 LA Property Address: 48420 STILLWATER DR APN: 6587140-999-154 -29436 Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 125 Tityl 4 Xi�Q" Applicant: Architect or Engineer: Ilk ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT . . I hereby affirm under penalty of perjury that I a licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business a re ssionals Code, and my License is in full force and effect. License Cla/s: C8 C27 C29 License No.: 656128 Date. G -Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury tha m exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and rofessions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair nystructure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or sh is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with S tion 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the ba is for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the'applica t to a civil penalty of not more than five hundred dollars ($500).: (_) I, as owner of the property; or my empl yees with wages as their sole compensation, will do the work, and the structure is not intended or offer for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does t apply to an owner of property who builds or improves thereon, and who does the work himself or herse hrough 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, 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.). I—) I am exempt under Sec. , B.&P.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: LQPERAIIT Owner: GURVITZ RESIDENCE 48-420 STILLWATER DR. LA QUINTA, CA 92253 Contractor: CALIFORNIA POOLS & S P.O. BOX 1280 COACHELLA, CA 92236 (760)398-9222 Lic. No.: 656128 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/18/06 PA D DEC 2 0 2006 CITY OF LA QUINTA FINANCE ®� ' 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. 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 polileachagrees m er are: Carrier SEABRIGHT olicy Number BB1060510 _ I certify that, in the performo I the work for which this permit is issued, I shall not employ any person in any manner so ecome subject to the workers' compensation laws of California, and agree that, if I shoul' e bject to the workers' compensation provisions of Section �0 of the Labor Code,I f rth 'th comply with those provisions. atApplicant:WARNING: FAILURE TO SECURE WORCOMPENSATION COVERAGE IS UNLAWFUL, AND SHALL. SUBJECT AN EMPLOYER TO CRIMINALLTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TCOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IEST, AND ATTORNEY'S FEES. PPLICANT ACKNOWLEDGEMENTIMPORTANT Application is hereby made Director of Building and Safety for a permit subject to the, conditions and restrictions set forth on thplication.1 . Each person upon whose beis application is made, each person at whose request and for whose benefit work is perfounder or pursuant to any permit issued as a result of this application, the owner, and the applicanh agrees to, and all defend, indemnify and hold harmless the City, of La Ouinta, its officers, agents and employees f r ny act or omission related to the work being performed under or following issuance of this per i 2. Any permit issued as a result of this application le co as null and void if work is not commenced within 180 days from date of issuance of such ssation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that t ab e i fo mation i correct. I agree to comply with all city and county ordinances and state laws relating to ilding on tion, and ereby authorize representatives of this con to enter upon the above-mentioned pro art(- oses. Date: 1.Signature,(Applicant_ orAgent)" 1 ,t" s.° Application Number 06-00004304 Permit . . . . . •'WALL/FENCE PERMIT" Additional desc . Permit.=Fee._.. 15.00 Plan Check Feer. .00 Issue Date . . . . Valuation 125 Expiration Date" 6/16/07 Qty, Unit Charge Per Extension BASE FEE 15.00 Special Notes and Comments --------------------------------- 51L.F X 60" CITY STANDARD WALL Fee summary Charged Paid Credited. Due ----- Permit Fee Total 15.00 --------------- .00 ---------- 00• 15.00 Plan Check Total .00 -.00` .00. .00 Grand Total 15.00 .00 .•00 15.00 . LQPERmrr - . P7 .. , Finif Permit Project Address: y8 V 4b A. P. Number: Legal Description: Contractor Address: C) �© Z City, ST, Zip• Telephone: State Lie. # :61c5C>Z Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lie. #: Name of Contact Person: Telephone # of Contact Person: # Submittal* Plan Sets Structural Calcs. Truss Calcs. Energy Cales. Flood plain plan Grading. plan' Subcontactor List Grant Deed H.O:A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees City of. La Quinita Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Owner's Name: Address: q_,_ cy Z o =" City, ST, Zip: Lam. Q \ T Project Description: Lie. 116 Total Permit Fees Constrgction Type: Occupancy: Project type (circle one): Add'n Alter Repair Demo 1� Sq. FL: # Stories: # Units: Estimated Value ofProject:.,,A, ypv APPLICANT: DO NOT WRITE BELOW THIS LINE Recd TRACING • Plan.Check submitted PERMIT FEES Item Amount Reviewed; ready for corrections Plan Check Deposit Called Contact Person Plan Check Balance Plans picked up Construction Plans resubmitted Mechanical Y' Review, ready for corrections/issue Electrical Called Contact Person Plumbing Plans picked up S.M.I. Plans resubmitted Grading Review, ready for correctionslissue Developer Impact Fee Called Contact Person A.I.P.P. Date of permit issue 116 Total Permit Fees