12-0056 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
C12-00000056 J
Property Address:
80325 VIA PESSARO
APN:
777-180-012- - -
Application description:
WALLJ,FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3500
Applicant:
Tiat 4 4v Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
VILLANUEVA FAMILY TRUST
3807 42ND AVE NE
SEATTLE, WA 98105
VOICE (760) 777-7012 '
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/19/12
t►a� �a a
Contractor: I
:�;J
ENGSTROM CONSTR MANAGEMENT: `!� 2 0 12
•!
77455 EVENING STAR
INDIAN WELLS, CA 92210VIC 1
(760)668-3.961 CITY OFLA PUINTA
I
Lic. No. 835648 rf,1ha%✓tR PT
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C ED CONTRA R'S D CLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury at I lice n r ovi ' of Chapter 9.(commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Bu n ss P s C de, n 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 'lass 13 s N .: 835648 - for by Section 3700 of the Labor Code, forthe performance of the work for which this permit is -
G issued. '
l ntractor. Y-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- UILDER DEC ATION insurance carrier and policy number are: -
I hereby affirm under penalty of perjury that'l am.exemp ontractor's State License Law for the Carrier STATE FUNDPolic Nug
_2381064809
,following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to - I certify that, in the perfor ance f the ich t 's permit is issued, I shallnot employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner o'as o th orkers' 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 s uld come bje o ers' 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 abor de hall f hw' c p those 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).: "bate: pplicant:, -
(_ 1 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 WAR G: AILURE TO SE RE RKER ATION 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 CRIMIN'A 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 or she did not build or
.improve for the purpose of sale.). '" APPLICANT ACKNOWLEDGEMENT
1 _ 1 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 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 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
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.).
Lender's Name:
Lender's Address:
LQPERMIT
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 suopermiefor 180 days will"subject
permit.to cancellation.
I certify that I have read this application and state that theagree to comply with all
city and ount l ordinances and state laws relating to buil thorize representativesof this c untentrupon the above-mentioned prope
ate• - ature (Applicant or Agent),
Application Number . . . . . 12-00000056
Permit ... WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 63.00 Plan Check Fee
.00
Issue Date Valuation . .
3500
Expiration Date-. 7/17/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
2.00• 9.0000 THOU BLDG 2,001-25,000
18.00
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Special Notes and Comments
80LF OF (6) FEET HIGH GARDEN WALLS AT
PROPERTY LINE, EQUIPMENT AND TRASH
-ENCLOSURES AND 60LF OF (3) FOOT HIGH..
RETAINING WALLS AT POOL AREA [CITY
STANDARDS],2010 CALIFORNIA BUILDING
CODES.
January 19, 2012 1:39:01 PM AORTEGA
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_
., ------------------.-------
Other Fees, BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
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Permit.Fee Total 63.00 .00 .00
63.00 ,
Plan Check Total 0.0 :00 _., .00
.00
Other Fee Total .... 1.00 .00 00.
1.00 .
Grand Total 64.00 ~:00 :Q0
.6 4.00
LQPERMIT
'Bin
City of La Quetta
Building &r Safety Division
P.O. Box 1504,78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building- Permit APPlication.and Tracking Sheet
Permit #
Project Address
A
Own_er',i1Name: I LUZ 00eA)11QS
A. P. Number: ni 7
Address:
Legal DescripAon:
City, ST, Zip:
Contractor:
Telephone: 11 Mli;4l�'S
Address:
Project Description:
City, ST, Zip:
Telephone:
..... ...... . ...
j
O.L.
State Lie. #: 23S (oq City Lie.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Construction Type: Occupancy:
Project tfpe (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
L
Estimated Value of Project: &L#W
APPLICANT: DO NOT WRITE BELOW THIS LINE'
N -
Submittal
Reqld
Recd
TRAChaNG PERMIT FEES
Plan Sets
Plan Check submitted Item
Amount'
Structural CaIcs.
Reviewed, ready for corrections Plan Ch . eck Deposit
Truss,Cglcs.
Called Contact Person Plan Check Balance.
71fle 24 Cates.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
20' Review, ready for correctionstissue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed'
Plans picked up S.M.1.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:
Review, ready for cor . rectionue
el
Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees