09-1064 (BLCK)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253BUILDING & SAFETY .DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
_ Date: 10/06/09
Application Number: 09-00001064 Owner:
- Property Address: 81922 SUN CACTUS LN JOHNSON RESIDENCE
APN: 7647330-049- - 81922 SUN CACTUS
Application description: WALL/FENCE LA QUINTA, CA 92
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 411 �� n
V R(�
. Contractor:, -
Applicant: Architect or Engineer: FEDOR MASONRY I JAM$�9+ ,✓q 3x ,� r
P.O. BOX 1397
LA QUINTA, 92247
36
I
Lic. No. 823181'.
---------------------------------------------------------------------------------------------------
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 Business and Professionals Code, and my License is in full force and effect. '
Licensee Class: C29 _ License No.: 823181
Date: Contractor: -
OWNER -BUILDER DECLARATION
I hereby affirm under penally of p jury 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 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
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 fnr sale.. If, however, the building or improvement it; cold within _
one year of completion, the owner -builder will have the burden of proving that he or shedidnot 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.).
(_ 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. CJ..
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 ENDURANCE AMRCN Policy Number' WEN100232503
certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in )manno as [o become subject to the workers' compensation laws of California,
.. and agree Id become su jectto the workers' compensation provisions of Section.
00 of e, I shall fwith complywith those provisions.Date:�0 AppWARNI G. AILURE TORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYERAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 15100,0001 1 TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LADOn CODE, INTERE3T, AND ATTORNEY'S PEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for 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 9 -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.
certify that I have read this application and stAfor
inform ion is correct. I agree tocomply with all
city and county di es and state laws relanstru on, and hereby authorize representatives
of this cou y t enter upon the above-mentionspec ' n pur oses.
Date Signature (Applicant or A
Application Number" . . . . . 09-00001064
Permit . . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee-,. 15.00
Plan Check
Fee
.00
Issue' Date . . .
Valuation
. . .
. 411
Expiration Date 4/04/10
Qty Unit Charge Per
Extension
BASE.
FEE
15.00
Special Notes and.Comments _
BLOCKWALL Q COURTYARD AREA 19' X
5!4"
PER ORCO SPEC.
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
....:; t
_ - �•j-='-r'r/J .. T –_ '�_- � � ~� i t '" t '"l'.N i 1 I ^ :7 {" � ' 1' :.Fx. �
� } - � � _ • _.._-_' _..�..� sr R � � a tr � 1t •• _ _ — i r a Y I�t� .__ __
-
eq
vv
:ld�a -i 3jv$ 2:J1�r� lflfj� _
i
,
1'
i ' •1 '
f )t
1
I
I I
r r
--.... _.._....r. --r - - - -- -• ... - - ..1.
I �
b r :
,
F. 1
I
t
'777—
_._.
+- y
-.
J i
1
• 1
;
-
:
1.61
i -"'•
J -
:
IV
0. 4
` f
_t
.r.
ir
,
• • ' : 1 , • I ' ! /_�/l i L' I ' r t � • • , S Y M 1 • � 1•, r , : � - f �^Jl3��j ,� ' � .. 1- / i - a, ' �, :.• � •. . ..
Bin #
Qty of LaQ uinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Perms
Project Address:. U TU 5 L,,
Owner's Name: Cts 0 N S 0--i
A. P. Number:
Address:
Legal. Description:
Ci ST Zi
Contractor:v+ _ e N
Tele h l_ —
e. Sq9
7 P
Address: t 0Q rz O x 1 3 %
Project Description:
City, ST, Zip:L` U l ✓� 9_2� y
6C JC c I l4 i C:ouvc� �n
hone: 6�
Telephone: 3 � S
� S
y
State Lic. # 3 1 LY' City Lic. #
Arch., Engr., Designer:
C
Address:
4�C
City, ST, Zip:
Telephone:
Construction truct�•
on T YPe: Occupancy:
a cY
a
S t to Lic. #
Project type (circle one):: New Add'n Alter Repair r Dem 0
Name of Contact Person: J Y, L! S C. o p K
Sq. Ft.:7 6
# Stories:
# Units:
_
Telephone # of Contact Person: 7 % U — S 3 S — yS.S
p
Estimated Value of Project: 6 b oO
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
to
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
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 corrections/issue
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
0