12-1259 (BLCK)T44P.O. BOX 1504 fly/
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (76 777-70
FAX (7 , -
INSPECTIONS (760 777-7
Date: 10/23/12
Application Number: 12-0 0 0 032 59: Owner:
Property Address: 52555 HUMBOLDT BLVD EAST OF MADIS
APN: 767-200-091-18 -34968 - PO BOX 1482 B
Application description: WALL/FENCE LA QUINTA, CA
Property Zoning: LOW DENSITY RESIDENTIAL (%
Application valuation: 5075 OCT 3 12012
Contractor: C1.- 0 Y
9 FINAN E DEP A
Applicant: Architect or Engineer: DBCA INC
' P.O. BOX 1482
LA QUINTA, CA 92247
(760)393-5271 .
Lic. No.: 915336
---------------
LICENSTI
CONTRACTOR'S DECLARATION WORKER'S COMPENSATION -DECLARATION
I hereby affirm under penalty of perjury that I amsed� er 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 Pssio als 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 : 915336 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ate1 �,ontractor-
O ER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am a pt from the Contractor's State License Law for the Prof tns Code: Any city or county that requires a permit to
following reason (Sec. 7031.5, Business and
construct, alter, improve, demolish, or repair any s cture, 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 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 Law.).
(_ 1 I am exempt under Sec. , BAP.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
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 YJZJB282D7797-12
I certify that, in the performance oJithe work for which this permit is issued, I shall not employ any
person in any manner so as to me 'ect to the workers' compensation laws of California,
and agree that, if I should bec sub ect t e workers' compensation provisions of Section
3700 of the Labor Code, I sha rth ith comp with those provisions.
�GW-a /-
WARNING: FAWURE TO SECURE WORKERS' MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENH S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THEST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR 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 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 above i rmatio ' correct. I agree to comply with all
city and county ordinances and state laws relating to building con ction and by authorize representatives
of th' county to inter upo the above-mentioned property for ins tion rposes.
ate: ature (Applicant or
LQPERMIT
Application Number . . . . . 12-00001259
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 81.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 5075
Expiration Date 4/21/13
Qty Unit Charge Per
Extension
BASE FEE
45.00
4.00 9.0000 THOU BLDG 2,001-25,000
36.00
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Special Notes and Comments
TOTAL OF 203 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 81.00 .00 .00
81.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 82.00 .00 .00
82.00
LQPERMIT
Bin #
Of La Quinta
Building 8L Safety Mision
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application'and Tracking Sheet,%,,.
Permit # �'
\%
Project Address:
Owner's Name:.
A. P. Number.
_ 0?51�
Address: [J
Legal Description:
City, ST, Zip:
Contractor.
Telephone: ..>�3�s,:«x s:•z.;
Project Description:
Address:�j�
City, ST, Zip:-�N�IT 9ZZ�?7
'-` fes/ •/ Fr t�/f f/T' 7
Telephone!� • '1
• �2.
., • �..t
State Lic. # : City Lic. #., A09 -
Arch., Engr., Designer:
Address:
City, ST, Zip: ` VIA 4!
Telephone: r -0 !�
Y" '•„ z,: .>
Construction type: . Occu an p cy.
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person: \16Fe i W0577
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: .6OZ- 765
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
tt
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted '
Mechanical
Grading plan
2s. Review, ready for correctionsfissue
Electrical
Subcontactor list
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.MX
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^` Review, ready for corrections/issue
Developer Impact Fee
Planning Approval.
Called Contact Person
A,I,P,P,
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
....... ........_.......