07-0701 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-00000701
Property Address: 53552 VIA PISA
APN: 772-530-060- -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
"rpplioation 'aaluotion: 6000
Applicant:
Tiht 4 4 Q*m
Architect or Engineer:
ars
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WOODREY
53552 VIA PISA
LA QUINTA, CA 92253
D
Contractor:
RAS MASONRY INC L
1571 VIA AURORA CIRCLE
CORONA, CA 92881
(760)774-0090
Lic. No.: 678140
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/07/07
MAR 0 7 2007
cavo LA ,..—_ I
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LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under pr ' ions 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 ofessionals C e 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
Licen Class: C29 Lic s o.: 678140
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date• ontractor:
�
�[ 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
' OWNER -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 STATE FUND Policy Number 0008738-2007
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance 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 as to 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 should become subject to the we r r 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 Cod all rthwit omply hose provisions.
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).:
scant:
e:r3706
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
00'
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARTO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLL). 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
SECTHE 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.).
(_ 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. , 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.I.
Lender's Name:
Lender's Address:
LQPERMIT
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 1 have read this application and state that the above information is correct. I a ee comply with all
CA and coun y ordinances and state laws relating to buildin ction, a hereby aut or' representatives
of this my to enter upon the above-mentioned propert or i ion p oses.
Date: �* nature (Applicant or Agentl:
Application Number . . . . . 07-00000701
Permit . . . WALL/FENCE
PERMIT
Additional dest . .
Permit Fee . . . . 90.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. .
. 6800
Expiration Date . . 9/03/07
Qty Unit Charge Per
Extension
BASE
FEE
45.00
5.00 9.0000 THOU BLDG
2,001-25,000
45.00
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Special Notes and Comments
268 L.F. 6' P/L GARDEN WALLS & 4
6'
COLUMNS, ORCO SYSTEM
Fee summary Charged
-----------------
Paid
Credited
Due
--------------------•
Permit Fee Total 90.00
----------
.00
----------
.00 -
90.00
Plan Check Total .00
.00
.00
.00
Grand Total 90.00
.00
.00
90.00
LQPERMIT
Bin #
Permit #', O `
Project Address:' 53
A. P. Number:
Legal Description:
Contractor.
Address:
5—zz L11,0
City, ST, Zip: AJ
Telephone:
State Lie. # 6%
Arch., Engr., Designer:
Address: (,,Tq g
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Do
Telephone # of Contact Person:
N Submittal 1
Plan Sets
Structural Cala.
Truss Cala.
Energy Gla.
Flood plain plan
Grading. plan•
Subcontactor Lift .
Grant Deed
ILO.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City Of La Quints
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name: d
Address: 3 r City, ST, Zip:
�j� Description:
5jC� 2$p/
b !fir
O
City Lic. #
U.
Construction Type:
Projxt type (circle one ew
Sq. Ft :. #Stories
Estimated value of Projec
APPLICANT: DO NOT WRITE BELOW THIS UNE
Recd TRACIMG
Plan Check submitted
Reviewed, reidy for corrections
Called Contact Person
Plans Okked up
Pians resubmitted
2'' Review, ready for eorrectionyusne
Called Contact Person
Plans picked up
Plans resubmitted
"RevieW, ready for.corroctions/rssat
Called Contact Person
Date of permit issue
Omupancy:
Add'n Alter Repair Demo
# Units:
PERMIT FEES
Item
Plan Check Deposit
Plan Check Balance
Constritedoa
Mechanical
Electrical
Plumbing
SALL
Grading
Developer Im2act Fee
A.LP.P.
Total Permit tees
Amount .