11-0657 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11-00000 57'
Property Address: !===�4-3309"PARKWAY ESPLANADE W
APN:
609-380-997-27 -293233-
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
325
Annlinant-
Architect or Engineer:
NA_
4.
u��w
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
---------------------------------------------——--
r.UCENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of. perjury that I am licensed under provisions of'Chapter.9 (commencing withi
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
Lic sefClass: C29 - License No.: • 804168 '
Date: ` Contractor:
V,OWNER-BUILDER C RATION -
1hereby affirmvnderrper alty.of�perjurythat'Lam exempt from' a Cont ctor's State LicenseLawfor the
following reason (Sec. •7031.5, Business and`Profess(ons ii rcounty that requires a permit to -
construct; alter, improve, demolish, or repair:br structure,�prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is, licensed. pursuant.tothe provisions of the Contractor's, State
License Law (Chapter 9`(c6nrmencing with: Section 70001 of Division 3 of the Business and Professions`Code) or
that he or she is,exempt therefrom and the !iasis for -the alleged exemption. "Any Violation of Sectior'7031.5 by
any applicant for apermitsubjects the-applicantto a civil penalty,of'not morethan five hundred dollars ($5001;:
1—). I, as owner of the property, or my.e'mployees with wages as their•sole compensation, will do the work, and
the structure is not intended or offefed•for sale (Sec.'7044, Business and Professions Code: The; .
Contractors', State License Law does not apply.to aoowner of property, who- builds 'or'improves thereon,
` and wliodoes 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 didnot 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 thereoryand 'who.contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.),
1 .1 am exempt under Sec. , BAP.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:
THELEN
43309 PARKWAY ESPLA
LA QUINTA, CA
LA.QUINTA, CA 92253
Contractor:.
AA MASONRY
77530 DELAWARE PL
PALM'.DESERT,.CA:92211
(760)360'7388
Lic.-No._: 804168
A 77-7012
X 76 _7-7011
INSPECTIONS (7 . ' 7-7153
JUN lE 2011
Date: .6116/11
CITY,OF LA QUINTA► -
------------------
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, forthe performance of the work for which,this permit is
issued:
I have and will maintain workers' compensation' insurance, as required by Seciion 3700 of the Labor
• Code, for the performance of the work for whicFi this permit is issued. My workers' compensation
insurance carrier and policy number,'are:
Carrier DELOS INS CO Policy Number WSIO047480' O1,. _ `_
_ I certifyShatfin'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
3700'0 a Labor 'Code, .I shall forthwith comply with' those provisions.; -
Date •Applicant:
WARNIN r (LURE -TO SECURE WORKKENALTI'ES
COMP COVERAGE, IS; LAWFUL AND SHALL
SUBJECTANEMPLOYER T.0 CRIMINAL AND.CIVIL PTO ON HUNDREDTHOUSAND
DOLLARS_ S1100,000). JN ADDITION TO THE COST OF COMPENSATION, ES AS PROVIDED FOR IN
SECTION '3706OF THE LABOR CODE; INTEREST, AND ATTORNEY'S FEES.
APPUCANT ACKNOWLEDGEMENT -
IMPORTANT. Application is hereby made to the Director of Building and Safetyrfor 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 owne.r;'and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Ouinta, 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 ofthis 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 c ' my o enter upon t ove-mentioned property for inspectio urp ses.
XD: ' nature (Applicant or Agent):
Application Number . . .. 11-00000657
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 15.00 Plan Check Fee .00
Issue Date Valuation . . . . 325 -
Expiration Date 12/13/11
Qty Unit Charge Per Extension
BASE FEE 15..00
Special Notes and Comments
13 _L ..F;, 6', GARDEN WALL.. AT.
_ : FRONT, ORCO
` SYSTEM:.'2010 CODES. '
------------------------------------
Other Fees: . . . .BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged Paid Credited Due
Dorm;.* Veo- m..*ol , C ..AA nn c nn .9 r �%1.n
LQPERMIT .
Bin iY
+
•
City' of la Qurnta,
Building 8L Safety.. Division
Permit # �
P.O..Box 1504 p
. ;� 78=495 Calle Tam ico
b
r
la Quinta,-CA'92253 (760) 777-7012
Building Permit;ApOli6tlon-and..Tracking Sheet
Project Address:
Ys
Owner's Name:
A. P. Number. Y
Address:'' ,.
Legal Description:
City, ST, Zip: r.
Contractor:>:
Telephone -+.s::
,::•.::;:v.
.
Address: 77—
ProjectDescription:
City, ST, Zip:
9021[°
S
Telephone: 7 3' {
M.
, � s.• g;
h 4 Joyn
MEN
State Lia # : o
City Lic. #c
Arch., Engr., Designer.
Address:
City, ST; Zip:
Telephone:YP.
' » : �•
Constivction Type::
�. •Occupancy:
N: 4,
State Lic. 5
i :.• :- ; w �.:
=Project type (circle one): New Add'n ' Alter Repair Demo-
emoName
Nameof Contact Person:
Sq Ft.:
#Stories:
#Units:
:Telephone # of Contact Person:
}"
Estimated •Value of Project:
APPLICANT: DONOT WRITE:BELOIN THIS LINE
Submittal
Req'd
R'*
TRACKING
PERMIT FEES
Pin Sets
Plan Check submitted
Item Amount
Structural Cates.Reviewed,
ready for corrections
Plan Check Deposit
Truss Calcs.
`
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked no x
Construction
Flood plain planPlans
resubmitted i
I.Mecitaulcal
Grading plea `
2" Review, ready for correctioasfissue
Electrical
Subcontactor ListGalled'ContaciPerson
Plumbing
Grant Deed
Plans picked -up
S.M.L'"
H.O.A. Approval
Pians resubmitted
Grading
INHOUSE:-
'" Review, ready for correctionstiissuo.
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit Issue.
School Fees
° "
Total Permit Fees
,:
1
3
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