12-1135 (BLCK)�I�IG/1�1�iV .
"P.O. BOX 1504 - ' ' - � VOICE (760) 777-7012.. I -
•
78-495 CALLE TAMPICO FAX (760) 77.7-7011
LA QUINTA, CALIFORNIA 92253 - BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
_ BUILDING P RMIT--y
n
.Date: 9/25/12
Application Number: +CtC12-000011351 i .D. Owner•
Property Address: 53408 VIA PALACIO- r DEr7WEY ��yj+A+ULc ,
APN: 777-220-022-236 -29894 - C PO.B02U1>279�j
Application description: WALL/FENCE PALM 'DESERT C 92255
Property Zoning: - 'LOW DENSITY RESIDENTIAL
Application -valuation: 4216 CSF AF CE DEP T�
Contractor:
Applicant: Architect or Engineer: L M MASONRY
74074 ASTER
PALM DESERT, CA 92260
(760)413-4030 ,
Lic. No.: 966567 ,
----------------------------------------------'------------------------—-------------------------—
ENSED CONTRACTOR'S DECLARATION + "WORKER'S COMPENSATION DECLARATION • ` . •
I.hereby affirm under penalty of perjury t t I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: - ' +
Section 7000) of.Division3 of the Busi ess d Professionals Code, 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 I ss: C29 _ Lic nse No.: 906567 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
00 ,rte issued.
ate: ZJ I ntractor. - ' _ 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' compensations '
NER-BUILDER DECLARATION insurance carrier and policy number are: _ -• '
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the • Carrier E} EMPT Policy Number + EXEMPT "
r following reason (Sec. 703115, Business and Professions Code: Any city or county that requires a permit to - I certify that, in the performan of the work for which this permit is.issued, I shall not employ any, } '
.. construct, alter, improve, demolish, or repair -any structure, prior to its issuance, also requires the applicant for the person in any manner so s t become subject to the workers' compensation laws of California, -
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I sho d b ome subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the "Labor Cc a shall forthwith comply with tho a provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by p
. " any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: e: / P -s z Iicant:
(_) 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 - WARNING: FAILURE TO SECUR WORKERS' C PENSATION COVERAGE IS UNLAWFUL, AND SHALL
_ Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN "
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION3706.OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. _
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.). I - APPLICANT ACKNOWLEDGEMENT
1 — 1 I, as owner, of the property, am exclusively contracting with licensed contractors to construct the project (Sec. c IMPORTANT Application is hereby made to the Director of Building and Safety fora permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. -
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed' 1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). _ _ whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I_), I am exempt under Sec. , B.&P.C. for this reason - •. 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.
Date: Owner: 2. Any permit issued as a -result of this application becomes null and void if work isnotcommenced h
• within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject -
CONSTRUCTION LENDING AGENCY permit to cancellation. -
s I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the ove information is correct. I agree to comply with all -
work for which this permit is issued (Sec. 3097; Civ. C.). city and county ordinances and state laws relating to buil •. g nstruction, and hereby authorize re resentatives
• of this co�ter upo he above-mentioned pro r inspection purposes.
Lender's Name: � - /� �J�•^
gnature-(Applicant or Agent)'
Lender's Address:
LQPERMIT - _
Application Number 12=00001135
Permit- WALL/FENCE PERMIT .
Additional desc
-
Permit Fee . . . 72.00 Plan Check Fee
.00
Issue.Date Valuation
X4216 Z.
Expiration Date .. 3/24/13
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.000.0 THOU BLDG 2,001725,000
27.00
-----------------------------------------------•-
- Special Notes and Comments
-----------
120 -L.F. 6' GARDEN WALL, 16 L.D. 51411
GARDEN WALL, 35 L.F. 4' GARDEN WALL, 15
L.F. 2' WALL, 3.PILASTERS @ 416n,,2
PILASTERS,@ 2' & 1 PILASTER @ 61,.CITY
STANDARD •& ORCO SYSTEM. 2010 CODES.
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
FeesummaryCharged Paid Credited
Due
Permit Fee Total 72.00 .00 .00
72:00
Plan Check Total .00 -.00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total- 73.00. .00 .00
73.00
LQPERMIT
City. of La Quina
Building 8L SafetyDivision
Permit # �
P.O. Box 1504, 78-495 Calle Tampico
14.Quinta, CA 92253 -:(760) 777-7012
Permit
Subm[ttalReq'd
Building -Application and Tracking Sheetut�_fJ
w� .
Project Address:
Owner's Name:. t-1 N L ►'J' S
S V�SVEC'c rr�f
.
A. P. Number.
Address: — 0(9 CA c )
Legal Description:
City, ST, Zip: }- , '412-,
Contactor: L_ ti✓'1
- Tele hon
Address: _ Q -1Ll��jrf � , � DA Project Description: s3 Lx> c- e— L✓ Y� L,� .
Structural Ca[cs
City, ST, zip: P 9_1_r" 04 Sf 2T_ .Cel~, zz6D ) .20 L tA11,4 c- ;
Telephone: `od 'l t' —T �3v
` p `rl:'' :� -,i
` I15 L11V
Lty sTI ItS
State Lic. # :
City Lic. tE:
lti 0 -
LI wf•4c_ 7-,
Called Contact Person
Arch., Engr., Designer.
Plan Check Balance
1 . 1 15 -
-Address: l 5 '' 1
Construction Type:. Occupancy:
Address:
City, ST. Zip:
Telephone:. n
State Lic.#: "
`"''
•��%�y4'a'.. ..
Project type (circle one): New Add'n Alter Repair Demo
Construction
Name of Contaet Person:
'--
Sq. FL: #Stories: # Units:
Food Oala plau_
Telephone # of Contact Person:
—
Estimated Val f P 'ect
—
i
ue o rod
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Subm[ttalReq'd
Recd
TRACKNG
PERMIT FEES'
Plan Sets
Plan Check submitted
Item Amount
Structural Ca[cs
Reviewed, ready for corrections
Pian Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Pians picked up
Construction
'--
Food Oala plau_
—
_Plans:resubmitted..-------
—
-Mechanical
-- -
Grading plan
2'! Review, ready for correctioustissue
Electrical
Subcontactor List -
_
- - -
-- ----_ - - - - - :.
Called Contact Person
-
----- -
Plumbing
Grant Deed
Pians picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review; ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I P.P.
Pub. Wks. Appr
Date of permit issue
Schodl Fees '
Total Permit Fees