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05-1706 (BLCK)u o TWY BUILDING &C SAFETY DEPARTMENT P.O. Box 1504 c�hfOF 9 78- CALLE TAMPICo (760) 777-7012 FAX (760),-777-70Y.1 h TA, CALIFORNIA 92253 INSPECTION REQUESTS (76.0) 777.-7153 BUILDING PERMIT OF �QUINTA Appel 0 Number . . . 05-00001706 Date 5/04/05 roperty Address . . . . . . 44090 DALEA CIR APN: 604-091-018-18' -22982 - Application description.. WALL/FENCE Property Zoning-, LOW DENSITY RESIDENTIAL Application'valuation . . . . 650 Owner Contractor FIGUEROA JOSE G Owner 44-090.DALEA CIRCLE INDIO., CA '92203 •P.O. Box 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX -(76 0) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760)777-7153 BUILDING &t: SAFETY DEPARTMENT Application Number: 69 20 6, Date: Applicant: Applicant's Mailing Address: Architect or Engineer: . Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class License No. Date Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' State License Law (Chapter 9 (commencing with Section 7t)00) 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).): U 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 Contract ' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or through his or her own mp ye 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 own ,-bui er wi ave 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 cont actin with lic sed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an own r of p p y wh uilds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to - the Contractors' State License Law.). U 1 am exempt undeySec. BA P.C. fo this re I i J1, E COMPENSATION DECLARATION I hereby affirm under penalty of perjury one ofthe foilng ns:I have and will maintain a certificate of coent to If -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 Policy Number _ 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 become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. Date Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of penury 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 IMPORTANT Application is hereby made to the Director of Building and Saf, 1. Each person upon whose behalf this application is made, each& issued as a result of this application, the owner, and the applicaj officers, agents and employees for any act or omission related td 2. Any permit issued as a result of this application becomes null an cessation of work for 180 days will subject permit to cancellation 1 certify that I have read this application and state that the above information construction, a d heby authorize representatives of this co Dat/. / Signature (Applicant or Agent): ►y or ap it subject to the conditions and restrictions set forth on this application. :rs at who request and for whose benefit work is performed under or pursuant to any permit ea agrees and shall, defend, indemnify and hold harmless the City of La Quinta, its the w " being p ormed under or fo issuance of this permit. I void i rk is not aenc�edn 160 days from date of issuance of such permit, or is corre I agree toywidb,. II city and county ordinances and state laws relating to building y tor inspection purposes. --------------------------------------------------------------------------- Application Number . . . . . 05-00001706 ---------------------------------------------------------------------------- Permit . . . . . . WALL/FENCE PERMIT Additional desc Permit Fee . . . . 19.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . 650 Expiration Date 10/31/05 Qty Unit Charge Per Extension BASE FEE 15.00' 2.00 2.0000 HND BLDG 501-2,000 4.00 ---------------------------------------------------------------------------- Special Notes and Comments 30 L.F. 5' BLOCK WALL ALONG SOUTH SIDE OF PROPERTY, CITY STANDARD. Fee summary Charged Paid Credited Due Permit Fee Total 19.00 .00 .00 19.00 Plan Check Total .00 .00 .00 .00 Grand Total 19.00 .00 .00 19.00 Bin # City of La Quinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 0La Project Address: �Iiljqo t Owner's Name: -J, 6 A. P. Number: Address: —11elo ?0 Legal Description: City, ST, Zip: 2 Con actor: tor: ��:e—z j/ow"Y� Telephone: 2M0 9062— Address: Project Description: City, ST, Zip: t50 6W W414-- Telephone: State Lic. # City Lic. #: 7ry Arch., Engr., Designer: 6-ry Address: City, ST, Zip: Telephone: ..... .... .. .... Construction Type: Occupancy: State Lic. #: P oJect type (circle one): New epair Demo r Add'nC Xit!r Name of Contact Person: Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: -.200 706 2- 1�60 I Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Rcqld Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss CaIcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up 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 —7-11 Permit Fees N\Q\ sz, -i6)jl ZI 410 1 b4'LbtF"A- T--