13-0391 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000391
Property Address: 79775 WESTWARD HO DR
APN: 649-061-002-2 -2190' -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 844
Applicant:
T4ht 4�
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Architect or Engineer:
gh-
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 Busin s nd Professionals Code, and my License is in full force and effect.
License Class: C29 License No.: 704270
Date: Contractor: ^
NER-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 ($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 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.).
(_) 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
Date: 4/02/13
Owner: IJ
SID MAHOCK d %]
79775 WESTWARD HO (� 1
LA QUINTA, CA 92253
APR 02-2g13
C17Y
Contractor: FIIV NC QUTAIM
HENRY'S MASONRY, INC. Eoepr
P.O. BOX 5185
LA QUINTA, CA 92248
(760)904-4143
Lic. No.: 704270
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
'V Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier LIBERTY MUTUAL Policy Number WC2Z91458499013
_ 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 shoul b o subject to the workers' compensation provisions of Section
3700 of the Labor Cod hall forthwith comply with those provisions.
Date:4_ Applicant:
WARNING: FAILURE TO SECURE ORKER COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001• 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 persori 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property r'nspection purposes.
Dat -01 /) Signature (Applicant or Agent):
Application Number . . . . . 13-00000391
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 23.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 844'
Expiration Date . . 9/29/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
4.00 2.0000 HND BLDG 501-2,000
8.00
----------------------------------------------------------------------------
Special Notes and Comments
16LF. OF 5' AND 23LF OF 4' GARDEN WALL AT
WEST PROPERTY LINE [ORCO SPECIFICATIONS]
PRECISION CONCRETE BLOCK SHALL BE
COVERED WITH STUCCO, PAINT, OR TEXTURED
COATING WHERE VISIBLE FROM OUTSIDE THE
PROPERTY. 2010 CALIFORNIA BUILDING
CODES.
April 2; 2013 9:50:30 AM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
-----------------
Due
------------------------------
Permit Fee Total 23.00 .00
----------
.00
23.00
Plan Check Total .00 .00
.00
.00
Other Fee Total 1.00 .00
.00
1.00
Grand Total 24.00 .00
.00
24.00
LQPERMIT
Bin.#
City of b Qillflta
Bullding 8z Safety Division
P.O. Box 1504,78-495 Calle Tampico
fa.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: y �,S &-ACS
(,.j4 jed . x (j. Owner's Name:. S 1 In M yy4 ®C
A. P. Number.
Address: / W eJ
Legal Description:
City, ST, Zip: L) t w
Contractor. 1-le" M 4 S; ® W)tTelephone:
Address: 10 l 0 0 VISttom .
jY 04 �jd-e Project Description:
City, ST, Zip: J� L) !t Ljk-
t 9 fe, 0 U A rlikf-
5"'14
Telephone: "0—
State Lie. #: 0 a)
City Lie. #;
Arch, Engr., Designer.
Address:
City., ST. Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair
Sq. Ft.: # StoriesUnits:
Demo
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
M
Submittal
Req'd
Recd
TRACIMG
PERMLTFEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
74-
Plan Check Deposit. .
Truss Cales.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
V Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S hLL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review; ready for eorreetionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
j A.I.P.P.
Pub. Wks. Appr
Date of permit Issue
7.
School Fees
Total Permit Fees
6 k p-, ax y -
Arl2-- .t- -
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
BY
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