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09-0916 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA,• CALIFORNIA 92253. Application Number: 09-0000093:6 Property Address: 52465. AVENIDA VALLEJO APN: 773-262-022-11 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 1516 Applicant: 11::� .4 a 4 BUILDING & SAFETY `DEPARTMENT BUILDING PERMIT Archixyer: ------------------ 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 d Professionals Code, and my License is in full force and effect. Licensee Class: C29 10License No.: 704270 Date: 0—d? Contractor: O ER -BUILDER DECLARATION ...� I hereby affirm under penalty of perjury 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).: (_ ! I, 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, t and who does the work himself or herself, 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.). (_ 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.). (_) I am exempt under Sec. , B.WP.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. C.). Lender's Name: Lender's Address: LQPERMIT Owner: VAGELS, VLADI 52465 AVENIDA LA QUINTA, CA VALLEJO 92253 Contractor: HENRY'S MASONRY, P.O. BOX 5185 INC. LA QUINTA, CA 92248 (760)775-6807 Lic. NO.: 704270 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 77.7-7153 Date: 8/27/09 --—----------—--—---—----——---—-------———------ 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 DELOS INS CO Policy Number 02DKRM12002701 I certify that, in the performance of the work for which 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 sII- thwith co ply with those provisions. . Oate:s_&_12_� Applicant: / WARNING: FAILURE TO SECURE WORKERS' COMP TION ERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL INES UP TO ONE HUNDRED THOUSAND - 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. 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 6wner, 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 c str [ion, and hereby authorize representatives of this county to enter upon the above-mentioned property q i ction p poses. Date Signature (Applicant or Agentl:,✓coS ;Application Number 0,9-00000916 Permit WALL/FENCE PERMIT _.' Additional des_c'.. , Permit: -Fee -•.: 37.0.0 Plan Check Fee .00 Issue .Date Valuation 1516 Expiration Date 2/23/10 Qty.. Unit Charge Per 'Extension ' BASE FEE 15.00 . .11.00. 2.0000 HIND BLDG 501-2,000 22.00 Special Notes and Comments 70t LN FT OF 5 FT HT BLOCK WALL& TWO MASONARY COLUMNS 61 6-11 PER ORCO STANDARDS & APPROVED BY A.J. August 27, 20.09 1:37:37 PM pjuarez. -----------------_-_------------------------------- Other Fees _ . _ _ . BLDG STDS ADMIN (SB1473) 1.00, .Fee summary Charged Paid Credited Due Permit Fee Total 37.00 .00 .00 37.00 Plan Check Total 0.0 00 ..00 00 ` Other Fee Total 1.00 .00 .00 •1•.00 - Grand Total 38.00 .00 .00 38.00 i t4. Vladi Vagel 7!0 250 7431314 p. « 4 1 • g Vladi Va el 1 ' 250 7431314 ••p.3 , i r _ " • � - . � � •, ` y S ` Imo• ��' f, lot in _ �� _ c� _ � T _ J.—.�-. , • Jj• - .�..�_ - .yam. p/_=— � _ � :: ,�j_�-:�- l ' . � - - � s ..._ _� _ . � -,�: � -- _-`.., j •.___. • _�,. -.� . - -- �,T— �- .`—_ � Qom.+ . ` , Ai ti AM 49 .. � _ � . � i' � i a• ca vii ''" .. S i fa.A. �y •L j _ KiAn,�1• • .F. Yom' Smo- f Agar ..i - gam; _ if,+.t;''§ •i , .... :.`"', 71 -y .. .- AV C Afr• g^" -- -_ __ _ .R '� � • � .• %fir- ' --Z _ City of La Quina Building & Safety Division Permit # P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet tProjecFAddi ss: , (/ i `f v� RUL'►'�I � n Owner's Name: � A. P. Number: , Address:52, t16 C Legal Description: City, ST, Zip: "4 Contra ctor:; � A WIN ..<.:y ...::•. S pzs Telephone• Address: Projec D iption: City, ST, Zip: E Telephone: State Lic. # : 0 City Lic. C Arch., Engr., Designer colu Itil LIAR MAS01ift Address: Aq C / l City., ST, Zip: Telephone: Construction Type: Occupancy: State Lic. #: � s"' :<}•:;;�:•<'"`��' Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: -# Sq. FL - Stones: # Units: Telephone # of Contact Person: Estimated Value ofProject: APPLICANT: DO NOT WRITE. BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets . Plan Check submitted 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:- ''" Reyiew,.ready for corrcctionsrmue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Is P.O. BOX 1504 Building // 7&105 CALLE ESTADO a Address flJ "46 LA QUINTA, CALIFORNIA 92253 Ivlauing � Address ���% s"'ote, --ity Zip del. J/�) . � 2 0 Contractor_ City Zip Tel.. State Lic. & Classif. City Lic. # Arch:, Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he 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). J-] 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such 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 did not build or improve for the purpose of sale.) 1 1 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner or property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) i] 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work for which 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name ` Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 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 city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING DIVISION APPLICATION ONLY BUILDING: TYPE CONST.. OCC. GRP. - A.P. Number Legal Description_ Project Description r �j�) b0 1 Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ aimateo valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. t Infrastructure I .iE TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: tll CONSTRUCTION ESTIMATE NO. I ELECTRICAL FEES NO, PLUMBING FEES $ UNITS SLAB GRADE 1ST FL SO. FT. 4t, BONDIN3 HEATING (ROUGH) 2ND FL. SQ. FT. Qr ) YARD SPKLR SYSTEM POR. SO. FT. Q MOBIL'EHOME SVC. BAR SINK GAR. S0, FT, g POWER OUTLET ROOF DRAINS CAR P. SO. FT. OTHER APPJEQUIP. DRAINAGE PIPING WALL S0. FT. 0 TEMP. POLE DRINKING FOUNTAIN SQ. FT. @ GROUT URINAL ESTIMATED CONSTRUCTION VALUATION S FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES =$ WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM i KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11/. c SEWAGE DISPOSAL LATHING SO.FT.GAR @ 3/ac HOUSE SEWER MESH I GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDIN3 HEATING (ROUGH) STORAGE TANK ( FORMS ) SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REIN GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM ' GRADING cu. yd. g plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING {� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION 2 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL y.ti'In.�z.: ni d• .