12-0259 (BLCK)fa
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:1� 00259
Property Address: 52765^HUMBOLDT BLVD
APN: 767-200-091-12 -34968
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 8500
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
EAST OF MADISON
PO BOX 1482
LA QUINTA, CA 92
VOICE. (760) 777-7012
FAX (760) 777-7011
iNSPECTIONS (760) 777-7153
u DMAR z o 202
CITY OF LA
3/20/12
Contractor:
Applicant: Architect or Engineer: DBCA INC
P.O. BOX 1482
LA QUINTA, CA 92247
(760)393-5271
Lic. Noo..:: 915336
-
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• 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 and Professionals Code, and my License is in full force and effect.
Licen •Class: B LicenseNo.: 915336 _
ate: �i ntractor•
1
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 ($5001.:
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
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.).
(_ 1 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 ho contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License 1•
1 _ ) I am exempt under Sec: , B.&P.C. fo7 's r asort
Date:
CONSTRTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a ccatruction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.11
Lender's Name:
Lender's Address:
LQPERMIT
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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:
1--1 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 TRAVELERS PROP Policy Number YEUB282D779711
_ I certify that, in the performan f the work for which this permit is issued, I shall not employ any
person in any manner so a bec a subject to the workers' compensation laws of California,
and agree that, if I should ome ubje o the workers' compensation provisions of Section
3700 of the Labor Code, I �� with co ply with those provisions.
t
).cant:
WARNING: FAILURE TO SECURE WORKE COMPENSTION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL P LTIES ANDACIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. IN ADDITION TO 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 be omes null and void if work is not commenced
within 180 days from date of issuance of such pe or cessation of work for 180 days will subject
permit to cancellation.
I certify that 1 have read this application and state that the abo yy i for do correct. (agree to comply with all
city and county ordinances and state laws relating to building cb ruct n, an reby authorize representatives
of this unty toe ter upon the above-mentioned property for i i purposes.
te: t ' ��-�Si ature (Applicant or
Application Number . . . . . 12-00000259
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 108.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 8500
Expiration Date 9/16/12
Qty Unit Charge Per
Extension
BASE
FEE
45.00
7.00 9.0000 THOU BLDG
2,001-25,000
I
63.00
------------------------------ ---------------
Special Notes and Comments
-------------------------------
340 L.F.6' PERIMETER GARDEN WALL,
ORCO
SYSTEM. 2010 CODES:
------------------------------- -.---------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
-----------------
Paid- .Credited
Due
--------------------
Permit Fee Total 10.8.00
--------------------
.00 .00
108.00
Plan Check Total .00
.00 .00
.00
Other Fee Total 1.00
.00 •.00
1.00
Grand Total , '109.00
.00 -.00
109.00..
LQPERMIT
City Of La Qu(n�a
8u11dfig a Safety Division
P.O. Box 1SO4,78-495 Calle Tampico
La .Quinta, CA 92253 -:(760) 777-7012
Building Permit Application' and Tracking Sheet
Permit #
Project Address: _
Owner's Name: % ,
A P. Number.
Address:'
Legal Description:.
City, ST, Zip: �/I G tog 3
YY(�
Contractor
Telephone:
Address:
Project Description: (O %f �/� l��B/JO/
City, ST, Zap: 2 _ Z$
lig 2 — 16 /4_AeGrTr . _''2 I j
�•!N �7 •�-
Telephone: r �/�` 1G� /��j��/ —
State Lic #: City Lir. # .2 SA
Ate., Eng, Designer ja -a59.
-745 Alv9WWr- G)
Address:
.
City, ST, Zap:
Telephone:
State Lic #: c '
Name of Contact Person: _
Construction Type: Occupancy:
Project type (circle on N Add'n Alter Repair Demo
Sq. FL: #Stories
Unity:
Telephone # of Contact Person �}t7� 20. 7- 4P
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
!E
Submittal
Req'd
Recd
TTtACICIIHG
PERMIT FEES
Plan Sets
Pian Check submitted.
Item Amount
Structural Calls.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Coles.
Called Contact Person
Plan Check Balance
Title 24 Calm
Plans picked up
Construction•
Flood plain plan
Plans resubmitted'
Mecharikal
Grading plan
2`' Review, ready for correctionemue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.KL
H-O.A- Approval
Plans resubmitted
Grading
IN HOUSE--
''a Review, ready for corrections/issue
Developer Impact Fee
Planning Approval.
Called Contact Person
AXP.P.
Pub. Wks. Appy
Date of permit issue
School Fees ,
Total Permit Fees