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05-0815 (BLCK)a V►t,UM�Q''C F. U BUILDING & SAFETY DEPARTMENT O. Box 1504 (760).7717-7012 Q. 7 -495 CALLE TAMPICO w FAX (760) 777-7011 N` oQQq' LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . 05-00000815 Date 4/08/05 Property Address . . . . . . 79720 TOM FAZIO LN S APN: 766-045-002- - - Application description WALL/FENCE Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . 2250 Owner Contractor - - - - - - - - - - - - - - - - - - - - - - - - ------------------------- WADE -- ------- ------WADE FRANK C MODERN BLDRS CONSTR CO INC 79690 S TOM FAZIO LN 1 MONET COURT LA QUINTA CA 92253 RANCHO MIRAGE CA 92270 (760) 578-4967 WCC: EXENOT 01/31/06 WC: EXEMPT 01/31/06 CSLB: 818923 04/30/05 CCC: B -------------------------------- ------------------------------------------- permit . . . . WALL/FENCE PERMIT Additional desc Permit Fee . . . . 54.00 Plan Check Fee .00 Issue Date . . . . Valuation . . 2250 Qty Unit Charge Per Extension BASE FEE. 45.00 .1.00 9.0.000 THOU BLDG 2,001-25,000 9.00 - Special Notes and Comments 901f 8.67' retaining wall .11 -------------------------- - - - - - - - - - - - ,------------------------------------ Other Fees STRONG MOTION'(SMI) - RES .50 Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 54.00 .00 .00 54.00 Plan Check Total .00 .00 .00 .0'0, Other Fee Total .50 .00 .00 .50 Grand Total 54.50 .00 .00 54.50 P.O. BOX 1504 • /� . w VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number:Date: - j a OS Applicant: I Architect or Engineer: Applicant's Mailing Address: 0ph/TlP,4CTUfi� Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS /V/4- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions f Chapter (commencing with Section 7000) of Division 3 of the Business and Professionals /Code, and my Licens i in full force and effect. 1 �� icense Class_ License N '. t Date 4— 11-a00SContractor etk A.0 -V\- 13"LU'C-6 C,,OY%5r Yut�� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).): U I, as owner of the property, or my employees with waves 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 or 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.). U 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.). U I am exempt under Sec. . BA P.C. for this reason Date Owner. WORKERS' 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 ca and policy number are: wrier Policy Num certify that, in the performance of the work for w ich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. to 4j� - Il- "6'-i Applicant WARNING: FAILURE TO SECURE WO KE S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED TH AND DOLLARS ($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. 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 A Lender's Address � ` 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 above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned roperty for inspection purposes. �e�•{-I�'dciu� rQ� Signature (Applicant or Agent). 99 City of La Quinta ^ ~ Building 8' Safety Division -� Permit # v �G P.O. Box 1504, 78-495 Calle Tampico O 0 J La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: - t7�d O Fe,7.tb Owner's Name: A. P. Number: Address: 771- Legal 7Legal Description: City, ST, Zip: Contractor: , v� rr' TeleP phone: i L; O d Address: 1Gv�,L�- �� Project Description: City, ST, Zip: 1��(��6 V�.Yc. 4 CA Ctj-'a o �O y` Telephone: o - b °I o- a- 5 (O 1 L -7 State Lic. # : 11� �ji jj City Lic.: Arch., Engr., Designer: L " �F Address: a — i- I , City., ST, Zip: �tn„ �-t' �✓ C k p0-%() Telephone: hone: V� 3 CO' b Construction struc • hon Type: Occupancy: P Y State Lic. C 3 `� '� Project type (circle one): New Add'n Alter Repair p Demo Name of Contact Person: r t G Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: 7(,b -'3416 90Estimated Value of Project:. 3 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING APERMIT FEES Plan Sets n"«r rL£ — -D Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person1� N% Plan Check Balance Title 24 Calcs. Plans picked up .7t� Construction Flood plain plan Plans resubmitted W, )�f 3 Mechanical Grading plan2"" Review, ready for correction issue) 0065 Electrical Subcontactor List Called Contact Person lj% p5 Plumbing Grant Deed Plans picked up S.M:I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- 3dReview, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue 1y 0 School Fees ' ' t Total Permit Fees ��7, s7-`Lv�7 &�Nz 3 -3a S .Ui 6S4-tt t - A'aLa VA C -S-'o Y0/( M�