12-1257 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 0112-00001257
Property Address: 52575 HUMBOLDT BLVD
APN: 767-200-091-17 -34968 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6375
T-iht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
EAST OF MADISON LLC
PO BOX 1482
LA QUINTA, CA 92247
Contractor:
Applicant: Architect or Engineer: DBCA INC
P.O. BOX 1482
LA QUINTA, CA 92247
�( (760)393-5271
l Lic. No:: 915336
I hereby affirm under penalty of perjury that I
Section 7000) of Division 3 of the Business i
Ligense Class: ✓BJJ
Date: °� ' li ontr:cMr.-�
CONTRACTOR'S DECLARATION
ed under provisions of Chapter 9 (commencing with
s Is Code, and my License is in full force and effect.
Li nseNo.: 915336
ICINNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I alnpxempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Plofessions 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)•:
(_) 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 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 Law.).
(_ 1 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:
LQPERMIT
VOICE (76
FAX (7606)1-
INSPECTIONS (760) 777-7153
Date: 10/23/12
WORKER'S COMPENSATIOIi{ DECLA5APW
I hereby affirm under penalty of perjury one of the following declarati
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:
Carrier TRAVELERS Policy Number YJUB282D7797-12
_ 1 certify that, in the performance o_ f the work for which this permit is issued, I shall not employ any
person in any manner so as come ublect to the workers' compensation laws of California,
and agree that, if I should b c e sub' c the workers' compensation provisions of Section
37000 of th Labor Code, 1 I forth ith com y with those provisions.
pplicant:
WARNING: FA RE TO SECURE WORKERS MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PEN IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE OST 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.
I certify that I have read this application and state that the a o infor ati on is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin c stru 1 d hereby authorize representatives
of thisjj;��nature
pon the above-mentioned property f r i pe n purpos
ate: (Applicant or
it - 4
Application Number . . . . . 12-00001257
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 90.00 Plan Check
Fee
.00_
Issue Date . . . . Valuation
. . .
. 6375
Expiration Date 4/21/13
Qty Unit Charge Per
Extension
BASE,FEE
45.00
5.00 9.0000 THOU BLDG 2,001-25,000
45.00
Special Notes and Comments
TOTAL OF 255 L.F. 6' GARDEN WALL AT
SEVERAL LOCATIONS ON PROPERTY, CITY
'
STANDARD. 2010 CODES.
-----------------_-_------------------------------
Other Fees ... . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
---------------------------------------------------------
Due•
Permit Fee Total 90.00 .00 '.00
90.00
Plan Check Total .00 .00
.00
.00
• Other Fee Total 1.00 .00
.00
1.00
Grand Total 91.00 00
.00
91.00
LQPERMIT
Bin #
.
�Ity of La Quinta
Building 8i Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application' and Tracking Sheet
Permit # 1/J
Project Address: 60.- *7 Wyffio�% Owner's Name:.
A. P. Number. Address: �� / %7 %r M
Legal Description:City, ST, Zip: �Z
Contractor: 144, Telephone ",t Si?
Address: `,jam
Project Description:
r
City, ST, Zip: Z --4t` C rI/lN/I!' 9�Z7 ?j fj/ ijfT (j %1
Telephone•
City Lic. #:
State Lie. # : �� 3.3
Arch., Engr., Designer:
n�I,!'�
Address: )I2J11AW eW42W— PDQ .
City, ST, Zip: `l/ �(P`v
Telephone: 'Q !� .� :. ; .-;a>:z° Construction Type:. Occupancy:
State Lie.yam,E project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: \/�i� 1;21591057"Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: .64Vz• 1 " Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Coles.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plaits resubmitted
Mechanical
Grading plan
ltd Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
$" Review, ready for correctionsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
A,I,P,P•
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
AND