05-1841 (BLCK)P. 0' BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00001841
Property Address: 79675 TOM FAZIO LN N
APN: 766-032-020- -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6105
Applicant:
(F,it�v 4 -
BUILDING & SAFETY DEPARTMENT
'BUILDING PERMIT
Architect or -Engineer:
Owner:
HILL ROBERT M
79�620 TOM FAZIO LANE NORTH
HOLTVILLE, CA 92250
Contractor:
CALIFORNIA POOLS & SPAS
WCC: SEABRIGHT INS
WC: BB1050510
CSLB: 656128
01/
10/
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/13/05
---------------------- --------------------------------------------------------------------------
LICENSED ONT TOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am lice sed d provisions of Chapter 9 (commencing with
of
ion 70 isio!�the Busin and Pr I sto al Code, a e and effect.
ir) f2X
VLi�cc.'ns. ZnX�
I hereby affirm under penalty of perjury one oi the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Cla�sso-' �eawfis
ic-ense Z> (Of
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
tg!!�u
issued
6SContracpr:
I have an� will maintain workers' compensation insurance, as required by Section 3700 of the Labor
ou, 0,U
7X
Code, for the performance of the work for which this permit is issued. My workers' compensation
'ER DECLARATION
I hereby
insurance carrier and policy number are:
'Aela`rner� C8 C 27 C29 C53
affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
P I' Y Number4nq&CC_y_o,
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 r which this permit is issued, I shall n6t 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 bec subje I 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 shoWdbecome ject the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
de)11,shall I c, h i
3790 of the Labor C, 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
:. VrC
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
)aW. D5pp,,
OZ 4
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
WARNING: FAILURE TO SECURWKERS'C��4�01\1 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 AND CIVIL FINES 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 OF COMPENSATION, DAMAGES A� 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.). I
I I I,as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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
pursudnt to the Contractors' State License Law.).
I I I am exempt under Sec. _, B.&P.C. for this reason
Date:
Ownen.
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 JSec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
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 d void if rk is not commenced
within 180 days from date of issuance of such permit, or ce tion of wo for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above informat n Aisrre . I agree to comply with all
S uct,
city and county ordinances and state laws relati t bu' Id tryctio and he y authorize representatives
of th�i�o ty to ter upon the above-mentioned propert for rispection urpo
C)�ignature (Applicant or Agent):
Application Number . . . . . 05-00001841
Permit . . . . . . WALL/FENCE PERMIT
Additional desc . .
�Permit Fee 90.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 610S
Expiration Date 11/09/05
Qty Unit Charge Per
Extension
BASE FEE
45.00
5.00 9.0000 THOU -BLDG 2,001-25,000
45.00
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Special Notes and Comments
105 L.F. 41 RETAINING WALL; 75 L.F. 6'
BLOCK WALL, CITY STANDARD; 102 L.F. 6'
BLOCK WALL, ORCO SYSTEM.
Fee summary Charged Paid
----------------- ----------
Credited
Due
----------
Permit Fee Total 90.00
----------
.00
----------
.00
90.00
Plan Check Total .00
.00
.00
.00
Grand Total 90.00
.00
.00
90.00
LQPERNIIT
Bin #
City Of La Quinta
Building &I Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit. Application and Tracking Sheet
Permit #
Project Address: nM F*Zib ZA*VG
6 75—
Owner's Name: 7HE QtkAje-EZ
A. P. Number: N
Address:
Legal Description:
Contractor: Cab'ro ai i a eooLs 4%spas
City, ST, Zip:
... ............. .....
Tele phone: ............ .......... ...
Address: Box - -I Zgo
Project Descr iption:
City, ST, Zip: Coo r—A e— I ta
Telephone: 390— %7, 2, 2�
State Lic. #
City Lic.
P.
Arch., Engr., Designer:
L
Address:
16C frff) IV 105 Wwtc
b 4, 0 t1— /< Wit L L- 0 y
City., ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): Add'n Alter Repair Demo'
Name of Contact Person: MA; /Sj��Y
Sq. Ft.: =#
Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:. /0 00 tq
APPLICANT: DO NOT WRITE BELOW THIS LINE
# I
'Submittal
Req'd
Reeld
TRACKING
PERMIT FEES
Plan'Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed', ready for corrections
Plan- Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 CaIcs.
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
AN HOUSE:-
3rd 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