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09-0293 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00000293 Property Address: 81690 DE SOTO AVE APN: 767-200-091-2 -34968 - Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 5336 Applicant: Architect or Engineer: 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION ' I hereby affirm under penalty of perjury that I anj licensed under provisions of Chapter 9 (commencing with . Section 7000) of Division 3 of the Business angf Professionals Code, and my License is in full force and effect. License Class: 13 C10 License No.: 746198 ate: 3 � Co ctor: Z11 OWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 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 (5500).: (_ 1 1, 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.). (_ 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 ISec. 3097, Civ. C.I. Lender's Name: Lender's Address: LQPERMIT Owner: EAST.OF MADISON LLC PO BOX 1482 LA QUINTA, CA 92247 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/31/09 Contractor: `45.H,(2JV-7 30 u13 A & M CONSTRUCTION P.O. BOX 366 Utz t LA QUINTA, CA 92247 (760)56 `n L i c. No.: .:: 7 4 746 619 8 ,�\\U------ ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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. Y 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 STATE FUND Policy Number 044-0028137-07 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 o become subject to the workers' compensation laws of California, and agree that, if I should come subject to the workers' compensation provisions of Section 3700 of the Labor Code, all forthwith co%ply with those provisions. 11111:-3-3k'9 licant: WARNING: FAIL RE 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. 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 ve information is correct. I agree to comply with all city and county ordinances and state laws relating to build' construction, and hereby authorize representatives of this county to enter upo he above-mentioned prope for inspection purposes. i ignature (Applicant or Agent), Application Number . . . . . 09-00000293 Permit . . . WALL/FENCE PERMIT Additional desc . . Permit Fee . . . . 81.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 5336 Expiration Date 9/27/09 Qty Unit Charge Per Extension BASE FEE 45.00 4.00 9.0000 THOU BLDG 2,001-25,000 36.00 ----------------------------------------- Special Notes and ----------------------------------- Comments 200 L.F. 6- GARDEN WALL & 21 L.F. 4 - GARDEN WALL, BOTH CITY STANDARD. -------=-----------------=-------------------------------------------------- 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 M LQPERMIT ` Bin # City Of La Quinta Recd- TRACKING PERMIT FEES NN Building 8L Safety Division Permit # Plan Check submitted Item Amount P.O. Box 1504, 78-495 Calle Tampico Structural Cates. La Quinta, CA 92253 - (760) 777 -70121 - Truss Cales. Building Permit Application and Tracking Sheet Called Contact Person Plan Check Balance Project Address: �' �{p iM 5 Owner's Name: ��S e � Energy Cales. A. P. Number: Address: -PO Plans picked up Construction Legal Description: City, ST, Zip: LA— rj ZZ L17 Flood plain plan Contractor: o�f O -LA Telephone: Plans resubmitted Mechanical Address: FQ 73 (e Project Descron: `� L('LIL U-3114 Grading plan City, ST, Zip: • �v( DJ %� �� Z Z j ) J JWFJ —12-70 De,- �5©•TO 74-V e- 0 C 'c MET 2" Review, ready for correctionsfissue Electrical Telephone: 56 q4r JZ © T/qq�-� l—Tr Subeontaetor List State Lic. # : 7J&1'78-- CityLic. #: Called Contact Person Plumbing Arch., Engr., Designer: t5A.ryG-f('.1 %A 00 Ft j � �o i Z I F -r 4 L( Fr Grant Deed fj�,,� Address: [ti C �!� (3 �� "� De— 50 -no &ve— Plans picked up S.M.I. City, ST, Zip: H.O.A. Approval Telephone: Construction Type: Occupancy: Plans resubmitted Grading State Lic. It: Project type (circle one): New Add'n Alter Repair Demo IN HOUSE: Name of Contact Person: z -(G- f j� o I �j Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: - Estimated Value of Project: �j DOD APPLICANT: DO NOT WRITE BELOW THIS LINE 9.3 . Submittal Req'd Recd- TRACKING PERMIT FEES NN Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance Energy Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for correctionsfissue Electrical Subeontaetor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. 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