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09-1237 (BLCK)P.O. BOX 1504. . 78-495 CALLE TAMPICO LA QUINTA,- CALIFORNIA 92253 . BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: t09-00001237 • Property Address: 52465 AVENIDA VALLEJO APN: 773 -262 -022. -11 -000000 - Application description: WALL/FENCE _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided Property Zoning: COVE RESIDENTIAL for by Section 3700 of the Labor Code, for the performance of the work for which this permit is Application valuation: 476 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 ' Applicant: Architect or Engineer: . A 12 Owner: VAGELS VLADI 52465 AVENIDA V LA QUINTA, CA 9 (760)238-1184 F) Contractor: PANCHO'S CONRET 68895 PEREZ.R CATHEDRAL CITY, VOICE (760)777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/03/09 ' • 'Lic. No.: 791390 , LICENSED CONTRACTOR'S DECLARATION �- WORKER'S COMPENSATION DECLARATION ' hereby affirm under penalty of perjury that I am licensp^nder 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 Business and P of ional� and m cense 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: CS Uc a No.- 91390 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is Date: Contractor / ..�' 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 ' - OWNER -BUILDER DECLARATION ' insurance carrier and policy number are: - I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier NORGUARD INS Policy Number PAWC012609 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 o subject to the workers' co nsation laws of California, person in any manner so as t�br�th 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 be( bject to the workers' comp ation 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, I swith com I those visions. 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 155001.: Da4" Applicant: (_ 1 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 WARNING: FAILURE Ty CURE WORKERS' 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 PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND _ and who does the work himself or herself through his orher 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 ' 1 1 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, - (_ 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 ' - - 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. -. .on .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 informs is correct. I agree to co with all work for which this permit is issued (Sec. 3097, Civ. C.).. _ city and county ordinances and state laws relatingto building constr , and here orize re entatives ' - of this county to enter upon the above-mentioned property for p on- S. Lender's Name: ' � Date�Signature (Applicant o� - _ Lender's Address: LQPERMIT Application Number . . . . . 09-00001237 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee 15.00, Plan Check Fee .00 Issue Date Valuation . . 476 Expiration Date . 6/01/10 Qty Unit Charge 'Per Extension BASE FEE 15.00 Special"Notes and Comments 22 LN FT X 5 FT HT BLOCK WALL CITY STANDARDS AND APPROVED PLANS. -------------- ----------------------------------------- ` Other Fees . . .... BLDG STDS ADMIN (SB1473) 1.00 Fee summary - ----------- - - - -- Charged Paid ---- - - - - ------ - - - Credited - ------- - - - - -'-- Due -- - - - - - - Permit Fee Total 15.00 .00 .00 15.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 16.00 00 .00, 16.100 LQPE"IIT • 4' r •. .� . r. , h � � jjj III //n' i _ y - w ES T LD- kiN'4 s - _ � . • � .: � , � ;; � '-�- � ��6_�-gig-118_ ; - � . r� ol 17 G- ,5�'�� oo N ss Bin # City. of La Quinta Building &T Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: -46 Owner's Name: L/ZA 06 z ZZ1442-1V A. P. Number: Address: 4LCzv-�, k�&52 Legal Description: City' ST, Zip: A aLI Z,-, K-'X. L Contractor: IAA�l Telephone: (7, 00 -?�004if*1 Address: - 0 n(-) Project Description: City, ST, Zip:� Telephon 1/0/11 State-Lic. # 29132ci City tic. #.. Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Construction Type: Occupancy: Project type (circle one New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount* Structural CaIcs. Reviewed, ready for corrections Plan Check Deposit Truss CaIcs. Called Contact Person Plan Check Balance Tide 24 Cales. 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 correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr FDate of permit issue School Fees a— Total Permit Fees