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12-0258 (BLCK)P.O. BOX 1504 insurance carrier and policy number are: 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: f12-0000025 Property Address: 52745 HUMBOLDT BLVD APN: 767-200-091-13 -34968 - Application description: WALL/FENCE Property Zoning: LOW DENSITY - RESIDENTIAL Application valuation: 4875 4'4 Qulk& BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: EAST OF MADISON LLC PO BOX 1482 LA QUINTA, CA 92247 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777=7153 Date: 3/20/12 tMAR 2 0 20172F, Contractor: Applicant: Architect or Engineer: DBCA INC LCITY OF LA QUINTA P.O. sox 1482 FINR.VCE nEP7 LA QUINTA, CA 92247 (760)393-5271 Lic. No.: 915336 ------------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION ' I hereby affirm under penalty of perjury that I am licensed under 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 Professionals Code, 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: B License No.: 915336 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is w� issued. ta: tractor: I7f I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor 7� Code, for the performance of the work for which this permit is issued. My workers' compensation 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 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.). (_) 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, t��giiii,,,,nd who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State Licens�lCaw.I I—) I am exempt under Sec. , B.&P.0 r thislre�jy n� Date: : 3 t LI I 1 CONRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is 4tonstruction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ .1. Lender's Name: Lender's Address: LQPERMIT 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 permi , r cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above i rmati n is orrect. I agree to comply with all city and county ordinances and state laws relating to building con ction and he by authorize representatives of this-,�ej��ypt�nt'�o�enter upon the above-mentioned property for ins poses. �✓ P ((77.�Si ure (Applicant or Ag insurance carrier and policy number are: Carrier TRAVELERS PROP Policy Number YEUB282D779711 I certify that, in the performance of the work for which this permit is issued, I shall not employ any any manner so as to ome subject to the workers' compensation laws of California, that, if I should bec a subje- the workers' compensation provisions of Section he Lab r Code, I sh e• 10 rscant: =CODE,INTER orthw' co ly with those provisions. WARNING: FAISECURE WORKERS' MPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN ETO CRIMINAL PEN ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($10N ADDITION TO TH OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 ABOR CODE, INTER T, 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 permi , r cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above i rmati n is orrect. I agree to comply with all city and county ordinances and state laws relating to building con ction and he by authorize representatives of this-,�ej��ypt�nt'�o�enter upon the above-mentioned property for ins poses. �✓ P ((77.�Si ure (Applicant or Ag ill Application Number . . 12-00000258 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 72.00 Plan Check Fee .00 Issue Date Valuation 4875• Expiration Date 9/16/12 Qty Unit Charge Per Extension BASE FEE 45.00 . 3.00 9.0000 THOU BLDG_2,001-25,000 27.00 ------------------------------------- Special Notes and Comments 195 L.F.6'.PERIMETER GARDEN WALL, ORCO SYSTEM. 2010 CODES. I ------------------------------------------------------ Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged ----------=---------------- Paid, Credited -------------------- Due Permit Fee Total ---------- 72.00 .00 .00 72.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand'Total 73.00 .00 .00 73.00 01 LQPERMIT 9 City of La Qulnta Bulkring & Safety Dit+Irion . . P.O. Box 1504,78-495 Calle TMPICo, La 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: p� Contractor: �("� . Telephone: f6 Address: Project Description: City, ST, Zip: 2 - 2Jt :l Z X4_A0G_17%'Z '4 Telephone: 17 6 i f 6 tl RI 1AW60407 �� State Lia # : City Lia #• s?' Arch., P.agr., Designer. /� -.96 -145 PvA1&Wr - L GLC Address: V. City. ST. Zip: N Telephone: .. State Lia #: , . _ r� Name of Contact Penson: s%' Construction Type: Occupancy: Project type (circle on - N Add'n Alter Repair Demo Sq. Ft : # Stories: # Unit$: Telephone # of Contact Person TJ6 alue of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Plan Sets Req'd 'Reed TRACIUNG Plan Check submitted PERMIT FEES Item Amount Struclum Cales. Reviewed, ready for corrections Plan Check Deposit. . Trus Cates. Called Contact Person Plan Check Balance Title 24 Calm. Plans picked up Construction Flood plain plan Plans resubmit"., Mechatilcal Giading plan Z`' Review, ready' for corrections/issue Electrical Subeontactor List Called Contact Person Plumbing Grant Deed Plans picked up S bLl. H.O.A. Approval Plans resubmitted Grading IN HOUSE#, ''` Review, ready for correctionvissae Developer Impact Fee Planning Approval. Called Contact Person AXP.P. Pub. Wks. Appr Date of permit issue School Fees r Total Permit Fees