13-0554 (BLCK)a P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN: = .
Application description:
Property Zoning:
Application valuation:
Applicant: .
i •
13-00000554
52525 AVENIDA VALLEJO
773-292-012-1 —000000-
WALL/FENCE
COVE RESIDENTIAL
451
Architect or Engineer:
4
BUILDING & SAFETY DEPARTMENT �J
BUILDING PERMIT
----------------------------------------------
LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm.underpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section.7000) of Division 3 of the Business and Profession Code, and my License is in full force and effect.
License Class: B icense No.:. 769229
Dale: Co�ntrraacttlor.
• OWNER -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).:
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 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.).
(_) I, 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.).
( _J 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. C.)•
Lender's Name: r
Lender's Address:
4
LQPERMIT
Owner:
ALBERS WILLIAM '
52525 AVENIDA'VALLEJO
LA QUINTA, CA 92253
(760)774-8787
Contractor:
ALBERS CONSTRUCTION
'P.O. BOX 238 D
LA QUINTA, CA 92253
(760)771-9954
Lic. No.: 769229
VOICE (760) 777-7012
FAX (760) 777-7011 -
INSPECTIONS (760) 777-7153
Date: 4/30/13
MAY 012013 D
CITY OF LA QUINTA —
--_-FINAI�E�Py----- ------
• 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 STATE FUND Policy Number 9028371-2012
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 shall fort r' comply with those provisions.
.Date_ �T Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES 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 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 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 construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property r inspectio p poses
�./// /f -
=Date: 1 Si nature (Applicant or A entl:
Application Number 13700000554
Permit
WALL/FENCE PERMIT
Additional desc
Permit Fee ..
15.00
Plan Check Fee
.00
Issue Date
-
Valuation . . .
." 451
.Expiration Date
10/27/13
Qty Unit'Ch_arge
Per
Extension
BASE FEE
15.00
Special Notes and Comments
WOOD FENCE 53' X'6 FT
HT PER APPROVED
PLANS & AJ. .PER CODE
COMPLAINCE
COURTESY -NOTICE.
-------------------_----------------------------------------
Other Fees
BLDG STDS ADMIN (SB1473)
-.-----------
1.00
Fee summary Charged Paid
Credited
Due
Permit Fee Total
15.00
.00 .00
15.00
PlanCheck Total
.00
.00 .00
.00
Other Fee Total
1.00
.00 .00
1.00 -
Grand Total
..
16.00
..
.00 .00
16.00
LQPERINIT c -
Bin #
City of La Quinta -
ButUng a Safety Division
Permit #
P.O. Box 1504,78-495 Calle Tampico
La "Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: 2S zSAve—
vE .O- Owner's Name:. tl �
A P. Number.
nn \)
Address: S Z S 2-S Ave— 1' t--)
Legal Desaiption:/�
City, ST, Zip_
Contractor I 1i� l r3v�S'71�V LTl Urv� �.C3
Telephone: (e 0 72 — &% e;?
Address: O �� 23
Project Description:
v V. -A ,
City, ST, zip: Lat-k7
CCA- CI 2LS3
vj � �-. S3 L�
Telephone: (0 0 7% Fi 7M
t a
State Lia # : C(
City Lic. #;
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telt phone:
Construction Type:. Occupancy:
State Lia #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. FL: # Stories: A Units:
Telephone 0 of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
M Submittal Req'd geed TRACItIhIC PERMIT FEES"
Plea Sets
Pisa Check submitted Item Amount
Strgdnia! Cala
Revkwed, ready for corrections Pbtn Check Deposit.
Truss Glu.
Called Contact Person Plan Cheek Balance
Mile 20 Gla
Plana picked up Construction
Flood plalu plan
Plans resubmitted Mechanical
Grading plan
Z`! Review, ready for corrcetionsressue Electrical
Sabcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up SM1
11.0.A. Approval
Plans resubmitted Gradhtg
IN HOUSE:-
'''Review; ready for corrcctlonarrssac Developer Impact Fee
Planning Approval.
Called Contact Person A,I,P,P,
Pub. Wks. Appr "
Date of permit issue
School Fees
Total Permit Fees