11-0096 (BLCK)Fz, r
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11-00000096 -
Property Address:
5850.5 JEREZ
APN:
764 -650 -001 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
368
T4ht °f 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner -
TD DESERT DEVELOPMENT
81570 CARBONERAS
LA QUINTA, CA 92253
Contractor:
Applicant: Architect or Engineer: BUBBLE SPRINGS
P.O. BOX 1046
RANCHO MIRAGE,
(760)341-2336
1 LiC. No.: 7287
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Q e
JAN 2 u 2011
CA 92270
CITY )r LAi�UiNTA
9 FINAN 1t: OEPT, -
Date: 1/25/11
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under visions 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 fes ' nal and my License 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: C53 D35No.: 728796 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ens
ntractor: - 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
w Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNE UILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am ex t/
rom the Contractor's State License Law for the Carrier EVEREST NATL - Policy Number 76 0 00163 5101
following reason (Sec. 7031.5, Business and Prof 'dns 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 s ructure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California,
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 me subject tat orkers' compensation 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 Cod s II wl with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by �, �LU11
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate pl-cant: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: TO SECURE DRIERS' COMATION 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 PENALTIE NDC
CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her 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 I, as uwner 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 contractorls) 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 .
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
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. II agree to comply with all
city and county ordinances and state laws relating to building cons ion, and/ orize representatives
of this county to enter upolrthe above-mentioned property for ' p tiog0urp
! � ignature (Applicant or Agent):
t
LQPERMIT
Application Number 11-00000096
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 15.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 368
Expiration Date . . 7/24/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
17 L.F. 4110" EQUIPMENT ENCLOSURE, CITY
STANDARD. 2010 CODES.
----------------------------------------------------------------------------
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
16.00
CITY OF LA OUIIATA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE a`f l� BY
Residence
^,,, b. I BUbbie Springs
Equipment
Location
Proposed new
wall 17'x 4'-10" H
Address: P.O. Box 1046
City: Rancho Mirage
State/Zip: Ca, 92270
Phone: 760.341.2336
Cell: 760.275.7676
Email: Bubblesprings@msn.com
License #: 728796
Andalusia
Address: 58505 Jerez Street
City: La Quinta
State/Zip: CA, 92253
Phone:
Lot: Lot #1 POD L
Email:
Bin #
City of La Quinta
Building 8z Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # II ,^,
\, QW
Project Address: _.Sos—
Owner's Name:
A. P. Number:
Address: �t7 �r C0� srSe`'G�'1%S't!�'
Legal Description:
City, ST, Zip: ' / W 716 1��, 5,Wy
d`
Contractor:
':;i�i�,w;x:kyg::zr�«LS::J;>�;>a,:r•> v.
Telephone: "' :;.�.: • r:;.�:...r :
of .•..r.�' Js.J»;. i:::..:
Address:_S Gv�li'
Project Description:
City, ST, Zip:
Telephone:_
State Lic. # City Lic. #;
Arch., Engr., Designer.
Address:
City., ST, Zip:
nJJies'. {4i,i.`.
.N.-
;:...Y.
Telephone: J>1> ,. t.�a? >•: ';.:t'
State Lic. #: ;.,;r sw`;;.•4y s
Name of Contact Person:
Construction Type: Occupancy
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cults.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cults.
Called Contact Person
Plan Check Balance
Title 24 Cults.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
V Review, ready for corrections/issue
Electrical
Subcontactor Last
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''a Review, ready for corrections/'issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees