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12-1255 (BLCK)-- . h P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 r Application Number: 12-00001255 Property Address: 52595 HUMBOLDT BLVD APN: 767-200-091-16 -34968 - Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 10550 c&t!t 4 4v 4" Architect or Engineer: PIP BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I a icensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business an rof Is Code, and my License is in full force and effect. License Class: B �� Lice a No.: 915336 WNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that Iexempt from the Contractor's State License Law for the following reason (Sec. 7031 .5,.Business and 11essions 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 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 thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.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: le LQPERMIT Owner: EAST OF MADISON LLC PO BOX 1482 LA QUINTA, CA 92247 VOICE (76( 7r77— FAX (76) 77-7 1 INSPECTIONS (760) 777-7153 Date: 10/22/12 Contractor: F DBCA INC n9 P.O. BOX 1482OCT 31 LA QUINTA, CA 92247 (760) 393-5271 I,O�©uiNia LiC. No.: 915336uAkIt-F F_PT — 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, for the performance of the work for which this permit is issued. 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, insurance carrier and policy number are: TRAVELERS S .Policy Number YJUB282D7797-12 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to b c e subject to the workers' compensation laws of California, and agree that, if I should beco a ubj rkers' compensation provisions of Section 337)00 of the Labor Code, I shall o hwi comply w' h those provisions. .can . WARNING: FAILURE TO SECURE WORKERS' JIT PENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAS AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000)• IN ADDITION TO THE 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 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. certify that 1 have read this application and stateAtheaboormation is correct. I agree to comply withall city and county ordinances and state laws relatinu i d hereby authorize representatives of thi county to enter up n the above-mentionedcti n purpos af' ' ignature (Applicant or Agen l r LQPERMIT Application Number . . . . 12-00001255 Permit . . . WALL,/FENCE PERMIT Additional desc . . Permit Fee . . . . 126.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 10550 Expiration Date . . 4/20/13 Qty Unit Charge Per Extension BASE FEE 45.00 9.00 9.0000 THOU BLDG 2,001-25,000 81.00 ---------------------------------------------------------------------------- Special Notes and Comments TOTAL OF 422 L.F. 6' GARDEN WALL AT SEVERAL LOCATIONS AROUND RESIDENCE. CITY STANDARD. 2010 CODES ---------------------------------------------------------------------------- Other Fees . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited --------------------------------------------------------- Due Permit Fee Total 126.00 .00 .00 126.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 127.00 .00 .00 127.00 l r LQPERMIT Bin # Of La Quin ta Building ff Safety Division P.O. Box 1504,78-495 Calle Tampico L-4.Quinta, CA 92253 - -(760) 777-7012 Building Permit Applicationand Tracking Sheet Permit # GG Project Address: 0 Owner's Name:. �T Ar A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: Pj�?Ml IA14. Tele hone M Address: Project Description: City, ST, Zip:- .4-46 Telephone . ........ City Lic. P.- State Lic.'#: Arch., Engr., Designer.: Address: CRY, SL Zip: V Telephone: . ..... • Construction Type: Occupancy: State Lic. #:,ry Project type (circle one): New Add'n. Alter Repair Demo Name of Contact Person: Sq.'Ft.: # Stories: #Units7 Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE Submittal Req'd Rec1d TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural CaIcs. Reviewed, ready for corrections Plan Check Deposit. Truss C21cs. Called Contact Person Plan Check Balance Tide 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan ra Review, ready for correctionslissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3rd Review; ready for corrections/issue Developer Impact Fee Planning Approval. Called Contact Person AJ.P.P. Pub. Wks. Appr - Date of permit Issue School Fees Ft., Permit Fees AND