12-0257 (BLCK)4`
P.O. BOX 1504 �^I. VOICE(760) 7 777-7012
(
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/20/12
Application Number: 12c00000257� Owner:
Property Address: 52725 HUMBOLDT BLVD EAST OF MADISON LLC
APN: 767-200-091-14 -34968 - -PO BOX 1482
Application description: WALL/FENCE LA QUINTA, CA 92247
Property Zoning: LOW DENSITY RESIDENTIAL D ;
Application valuation: 4450
Contractor:R
Applicant: Architect or Engineer: DBCA INC t•l 4T
P.O. BOX 1482 CIN OF VA QUINTA
LA QUINTA, CA 92247 FINP�tCECEPT
(760)393-5271
\//1 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: 13 License No.: 915336 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ate: tractor: 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier TRAVELERS PROP olicy Number YEUB282D779711
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance o he work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to comes ct 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 beco subje t to t workers' 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 Code, I shaI ompl with those provisions.
h h h h f h f h II I G' ^"ter•- r -
t at a or s e is exempt t ere rom and t e basis or t e a eged exemption. Any v at 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 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 who 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. f4t is1. rer)3s
Date: .312,1 r
CONST9gCT10N LENDING AGENCY
I hereby affirm under penalty of perjury that there is aj`struction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. )
Lender's Name:
Lender's Address: I
LQPERMIT
WARNING: FAJCURE TO SECURE WORKERS' (i PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENAII' S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000)• IN ADDITION TO THE T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
ODE,
SECTION 3706 OF THE LABOR CINTERS 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 ab inf r ion is correct. I agree to comply with all
city a d county ordinances and state laws relating to building onstr coon, hereby authorize representatives
of is c unty to enter u n the above-mentioned property fo in 'on purpos
Date: Signature (Applicant or nt :
.tee • •
Application Number . . . . . 12-00000257
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee, 72.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 4450
Expiration Date 9/16/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00,• 9.0000.THOU BLDG 2,001-25,000
27.0.0
Special Notes and Comments
178 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 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
LQPERMIT
Bin. #
. .: .
Ga
Of La QUrn�a
Building 8( Safety Division . .
P.O. Box 1504,78-495 Calle T3MPICID
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
ProjectAddress:.
Owner's Name: - % t
A. P. Number
Address:
Legal Description:.
Contractor. /! V
City, ST, Zip:
w .
Telephone:
Address:
Project Description:
City, ST, Zip:
I G
Telephone: a 1
br2'_725 x4e0z4)7— .17 6 U
State Lia # : City Lic. # -.�5
g—
:72^7 !—
Arch., Eng., Design ��
-7E� a.�1�j�G!>T - 3 i �, 4, .
Address:
V.
City, ST, Zap:
Telephoner
State Lia #: : ;
Name of Contact Person: 57—.
Construction Type: Occupancy:
project type (circle on N Add'n Alter Repair Demo
Sq. Fi.:ff
Stories
Units:
Telephone B of Contact Person
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Plan Sets
Req'd
Reed
TRACING
Plan Check submitted
PERMIT FEES
Item Amount
Structural Calls.
Reviewed, ready for corrections
Plan, Check Deposit. .
Truss tales,Called
Contact Person
Plan Check Balance.
Title 21 Coles.
Plans picked up
Construction
Flood plain plan
Plans resubmitted '
Mechanical
Grading plan
2" Review, ready for correctionsf=c
Electrical
Subeontactor 14A
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE.-
3" Review; ready for torr"tionsAssue
Developer Impact Fee
Planning Approval.
Called Contact Person
AJ.P.P.
Pub. Wks. ARpr
Date of permit issue
School Fees
Total Permit Fees