10-0441 (BLCK)1
1 r*�
P.O. BOX 1504 VOICE 760 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/24/10
Application Number: 10-00000441 Owner:
Property Address: 79152 TOM FAZIO LN S BURNS . DAVID
APN: 766-042-004- - - 79152 TOM FAZIO LANE
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 900 O�
tttt I f
- — - - - - _ - Contractor: � I
``�� 11�� 2
Applicant: Architect or Engineer: GUTIERREZ MASONRY/CONR SAIlTIH � � �
31695 AVENIDA DEL PADRE
CATHEDRAL CITY, CA 92234k 1;i�1�iYA
(760) 770-3388 Fll�(A�Jcjo P1;
Lic. No.: 725297
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 Bus' a Professionals Ce, and m License is in full force and effect.
License Class: 128-1229 Li se No.: 5297
Date:!;"Z — 0 Contractor.
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 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
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 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:
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
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 SOUTHERN INS Policy Number WS1003252501
certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any ma&sotoe subject to the workers' compensation laws of California,
and agree that, if bject to the rkers' mpensation provisions of Section
3700 of the Labowith co I ith a provi` onsDate: 7" �� Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLA , AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 ov i or atio is correct agree to comply with all
city and county ordinances and state laws relating to buil n on tr ctio nd here the
r sentatives
of this county to enter upon the above-mentioned propert or in ction rposes.
Date: —Z —I 0 Signature (Applicant or Agent):
Application Number 1.0-00000441
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 23.00 Plan Check Fee..
.0.0
Issue Date . . . . Valuation
900
Expiration Date 11/20/10
Qty Unit Charge 'Per
Extension
BASE FEE
15.00
4.00 2.0000 HND BLDG 501-2,000
8.00
----------------------------------------------------------------------------
Special Notes and Comments
4 FT HT X 40 LN FT RETAINING WALL & 12
FT' X 5 FT HT GARDEN WALL PER ' CITY
STANDARDS & APPROVED PLANS.
----------------------------------------------------------------------------
Other Fees . . . . BLDG STDS ADMIN (SB1473)
1.00
-Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 23.00 .00 .00
23.00
Plan Check Total. .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 24.00 .00 00'
24.00
LQPERMIT
Din #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La
La Quanta, CA 92253 - (760) 777-7012
Permit Application and Tracking Sheet
Permit #
LO
Project Address: 7� I5 Z y
Owner's Name: DAV 1 1) 6 U Q N S
A. P. Number.
Address: ? � ' (S o A 2 I 0 L, A. N �-
Legal Description:
City, ST, Zip: [ A, L)l NT R C A k
Contractor: ATL G x-4.1 M0MZ M4 z7-tj&W
Address: 3 i-(OgS qv e cLe (Pai,"'
Telephone:
Project Description:IL"-tv'Fr
City,ST,Zip:QATtt4C9n►1,.cc CA9223` f
wrAP 4.OAJF- 9LOCK
Telephone:7{ O- Z5o_� J 3
State Lic. # : 72 5 2 R.7 CityLic. #;
Arch., Engr., Designer. a
Pi J Ar-&CC'APe INC-,
/ Z' L, AJ : ' 1 _ Y j46V AR -0 9-N (j4U,
f0f- POOL F0L,/t g "T
Address:
City, ST, Zip: jg"M u 4/4 D U /VCS c4qz2P5
Telephone:7(p0--77.2-3(07-�
State Lic. #:
Name of Contact Person: SAL (a u -t j r&,z- rZ
ConstructionType:mAgeNOcc►pmcy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: p 25 0 Q 3
Estimated Value of Project: °j S 6
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACKING
PERMTr FEES
Plan Seta
Pian Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for correedons
Plan Check Deposit
Truss Cales.
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 correctioasllssue
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 eorrectionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Feu
Total Permit Fees
"PRAWN
CHECK£O
AAT
BC ALE
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•SHEET
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