10-1045 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINT,1, CALIFORNIA 92253
Application Number:.' 10-00001045
Property Address: -, -
...81550 TIBURON DR
APN:
767-522-007-. - -
Application description:
WALL/FENCE ,
Property Zoning:
LOW DENSITY -RESIDENTIAL
Application valuation:'
1575
Tii�v - 4 etP Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
ROSEN
81-550 TIBURON DRIVE
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153.
Date: 1.0/d7/10
~ Contractor:U Qr' T 0 7 Min
Applicant: Architect or Engineer:.
CAL PACIFIC POOLS
-
P.O. BOX 1804 IrY(i�
PALM SPRINGS, CA 9 263 r►(q��iFLACAUINTA
�CEriePr
(760)345-8483
.1 P
LiC. No.: 552140
' - LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjur hat 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 siss and 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: � B C53 License No.: 552140
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
-.
`
issued.
at . • ontractor: -
� 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
OWNER BUILDER D LARATION
• insurance carrier and policynumber are:
I hereby affirm under penalty of perjury that I am exemp ro Contractor's State License Law for the,
Carrier EVERST INS Policy Number 760001529091
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 become 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 th Lab o , I shall 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 (5500).: ,
tQ;,J Applicant:
(_ 1 1, as owner of the property, or my employees withwages 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' COMPENSAT AGE 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 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 .
(_) 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,
(_) I am exempt under Sec. , 8.&P.C. for this reason
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. -
Date: Owner:
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 .
CONSTRUCTION LENDING AGENCY
permit to cancellation. -
+ I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the •.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued ISec. 3097, Civ. C.). .
'
city and county ordinances and state laws relating tobuildii construction, and hereby authorize representatives -
bove-mentioned inspe�
Lender's Name:
of this county to enter upon the prope p I r n urposes.
'
Sign re (Applicant or Agentl:
Lender's Address:
LQPERMIT
e
Application Number . . . 10700001045
Permit WALL/FENCE PERMIT
Additional desc
- Permit Fee 37.00 Plan. Check
Fee
•.00
' •Issue Date Valuation
*.`
1575
Expiration Date 4-/05/11
`
Qty. Unit Charge' Per'
Extension
1 BASE FEE
15,00
11.00, 'i c 2.0000,..HND ' BLDG .501-2,000
22.00
---=- --------------------`--------------------------------------------------
` Special Notes and Comment's
63'L.F. 6' GARDEN WALL, CITY.STANDARD.&
.103 L.F.•30" WROUGHT IRON FENCING ALONG
REAR P/L.'2007,CODES.
Fee summary ",Charged '.Paid Credited
Due
•' Permit, Fee Total 37.00• .00
.00
37.00
Plan Check Total. '.00: 00
.00
.00
' Grand ,Total 37.00 F .00
.'00'.
37.00
• LQPEIL'NIT
Iain #
Permit # 1 O(�5
l
l�
Project Addres
City of La Quinta
Building a 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:
A. P. Number:
Address:
l
City, ST, Zip �l
Legal Description:
Contractor:
Telephone:
Address:
Project Description:
City, ST, Zip:
Telephon
0
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
Z•
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
P cY=
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Perso ,
Sq. Ft.:
# Stories:
T# Units:
Telephone # of Contact Person.
, .
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd,
Reed
TRACKING
PERMTT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural CAFs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
` 1
Called Contact Person
Plan Check Balance
Energy Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan'
2" Review, ready for correctionstiissue
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
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CITY OF LA QUNTPs
BUILDING & SAFETY DEPT..
APPROVED
FOR CONSTRUCTION
DATE /0 7 BY
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WA -14 -
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