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12-0591 (BLCK)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: 5/29/12 Application Number: 112;0:0:0"0:0591 Owner: ` Property Address: • 51-310 AVENIDA VALLEJO ROBERT BOWERS -APN: 773-084-005-20 -0000'00= 51310 AVENIDA VALLEJO Application description: WALL/FENCE _ LA QUINTA,- CA 92253 D /�,;+�, Property Zoning: COVE RESIDENTIAL [�I �• Application valuation: 3315 - f d� • Contractor: lYt�� 292012 Applicant: Architect or, Engineer: HENRY'S MASONRY, - IN_C. - P:O. BOX 5185 C�INDF�gQUI VTq . + LA QUINTA, CA 92248 A�CEO * (760)250-8253 LiC. No.: 704270 - ---------------------------------------- LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION - I hereby affirm under penalty of perjury that 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 3o the Business 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 `Lice a Class: C29 License No.: 704270 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. " Dater tractor: �- I have and will maintain workers', compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work forwhich this permit is issued.- My workers' compensation OWNER-BUILDER DECLARATION - - insurance carrier and policy number are: '. I hereby affirm under penalty of perjury tha 1 am exempt from the Contractor's State License Law for the Carrier LIBERTY MUTUAL. Policy Number WC2Z91458499012 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 the Labor Code s all 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'($ 500).: - ate�X pli y cant: •,' • (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'SECURE WORK _ ' COMPENSATION 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 ENALTIES 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 r. _ 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 fo_ r 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, + (_ 1 I am exempt under Sec: ; B.&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 s 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 1 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 (Sec. 3097, Civ. C.). - city and county ordinances a d state laws relating tAbuildintruction,, and hereby authorize representatives of this county to enter upo the `above-mentioned pction urposes. Lender's Name:e: ignature (Applicant or Agent) Lender's Address: _ LQPERMIT _ Application Number . . . . . 12-00000591 Permit WALL/FENCE PERMIT ' Additional desc Permit Fee . . . . 63.00 Plan Check Fee, ._ .00 Issue Date . . . Valuation 3315 Expiration Date 11/25/12 Qty Unit Charge Per Extension BASE FEE 45.00 2.00 .9.0000 THOU ,BLDG 2,001-25,000 18.00 --------- Special Notes and Comments 130 L.F. 6' GARDEN WALL @ SIDE & REAR P/L.& 20 L.F.•5' GARDEN WALL @ SIDE P/L: ' ORCO SYSTEM. 2010 CODES. ---------------- - -------- -- - ------------- Other Fees BLDG STDS ADMIN (SB1473) 1.00 Fee.summary Charged '" Paid Credited ----------------- Due Permit Fee Total 63.00 '.00 .00 63.00 Plan Check Total, .00 .00• 00 .00 Other Fee Total 1.00 00 .0.0 1.0.0 Grand Total 64.00 .00- .00 64'.00 LQPE"11T Bin. # Qt 'Y. 0 f Lel Quin Bulk ft a Safety Dlvfsion P.O Box 1504,78-495 Calle Tampico P.Qulnta, CA 92253 -:(760) 777-7012 Building Permit Application•and Tracking Sheet Permit #� Project Address:S. l 3/d Ve Gl e Owner's Name:. at . je A. P. Number. Address: . ` Pv Aue I/0-10 Legal Description: City, ST, Zip: Contractor/ Telephone: Address:fir' D 8 C, c, e Project Description: City, ST, Zip: C �� .� / �� % 6 / i�� �i �v Lt!• //,�,, Telephone:?� N, State Lic. #: City Lic #; . A e eek "o I ArclL, Engr., Designer. Address: City., ST. Zip: Telephone: "d State Lic. #: .gam Construction Type:. Occupancy: Project type (cu-cle one): New Add'n Alter Repair . Demo Sq. FL: #Stories: #UniCon= Name of Con= Person: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Req'd Recd TRACK NG PERMIT FEES Pian Sets Plan Check submitted Item Amount Structural Calls. Reviewed, ready for corrections Plan Check Deposit. . Truss Caics. Called Contact Person Plan Check Balance_ Title 24 Cal& Plans picked up Construction Flood plain plan Plans resubmitted.*. Mechanical Grading plan 2id Review, ready for correctionstissue Electrical Subeontactor List Called Contact Person 7. Plumbing Grant Deed Plans picked up ML ILO.A. Approval Plaus resubmitted Grading IN HOUSE-, ''' Review; ready for correctionsfissuc Developer Impact Fee Planning Approval 0. Called Contact Person A.I.P.P. Pub. Wks. Appr . Date of permit Issue School Fees Total Permit Fees