08-0811 (BLCK)P.O.414 4214M
BOX 1504VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253,.. , ; . BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/07/08
Application Number: [08=00000811 Owner: '
1#�
Property Address: 80320 VIA PESSARO WHITE RESIDENCE
APN: 772-550-002- - - 86-320-VIA PESSARO
i Application description: WALL/FENCE LA QUINTA, CA 92253 O
r Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2240 [ G
Contractor. � r
Applicant:' ✓ Architect or Engineer. A & M CONSTRUCTION AMyM.
O
{ t P.O.. BOX 366
NLA QUINTA, CA 92247 1 OP
D `.
32
Lic. No.'8
': 746198
' LICENSED CONTRACTOR'S DECLARATION - - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:'
Section 70001 of Division 3 of.the Business art ofessionals Code, and my License is in full force and effect.. M - _ I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided
,License Class: B C10 Li�pse No.: 46198 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is -
issued.
CDates'� �U 'Contractor: - ' _ - - 1 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: -
1 hereby affirm under penalty ofperjury that I am exempt from the Contractor's State License Law for they Carrier STATE FUND Policy Number 044-0028-137-07 - - -
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 Ishould be me 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 Code, I h forthwith,pcmply with those provisions.
- that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 7.
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).:. (% Date:�Applicant
(- ) I,-as owner of the property, or my employees with wages as their sole compensation, will do the work, and-
.' thestructure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The - WARNING:'FAILURE TO 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, SUBJECT AN EMPLOYER 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 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 SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one year of completion, the owner-builder will have the burden of proving that he of she did not build or
- improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT
(_•) I, as owner of the property; am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT -Application is hereby made to the Director of Building and Safety for a 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 contractor(s) 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 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 resul[,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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty' of perjury that there is a construction lending agency for the performance of the 1 certify that I have read this application and stale that t above information is correct. 1 agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.1. - - - city and county ordinances and state laws relating to bu ng construction; and hereby authorize representatives
of this county ton upon the above-mentioned prop y for inspectiorl�urposes.
-Lender's Name: -
C/ -Datev Signature (Applicant or Agent):
Lender's Address:
LQPERMIT
Application Number . . . 08-00000811
Permit . . . WALL/FENCE PERMIT
"Additional desc .
Permit Fee 54.00 Plan Check
Fee
00
Issue ..Date Valuation
2240
- Expiration Date 11/03/08
Qty Unit Charge Per
Extension
<> - BASE FEE
45.00•.
1.00' 9.0000 THOU BLDG 2,001-25,000
9.00 •:
- --------------------------------------------------------------
. Special Notes and Comments
m 14LN FT X 61HT / 40LN X 51HT/ 64LN FT X
3'HT• GARDEN WALLS PER CITY STANDARDS AND
APPROVED -PLANS.
,Fee summary - Charged Paid Credited
Due
Permit Fee Total 54.00 00
00
54.00
Plan Check Total .00 .00
.00
00
Grand Total 54.00 .00
.00
54.00
LQPERMIT
Bin #-
City of La Quints g=wvs-e- T�t'�``T
Building at Safety Division 014 g L
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name:
A. P. Number: 1ptz:�w
Address:
Legal Description:
City, ST, Zip:
Contractor:
Address: 3 ��
Telephone:
Project Description:
City, ST, Zip:
Telephone: �lp ` $71 Z
-4
/ !.� $) Lk
State Lic. # :
City Lic. #: Z4>
t — 6 Loqe—
Arch., Engr., Designer:
L(I t 5 L044
Address:
City, ST, Zip:
Telephone: { -
State Lic. #:
Name of Contact Person: #%Ae,- fLL
Construction Type: LvaL wo Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontactor 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