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.
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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• .