12-0768 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4 4'4& Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
12-00009768_'
Property Address:
80753—VfiA—PESSARO
APN:
772-500-068- - -.
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
4625
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION -
hereby affirm under penay
ltof per'ury that I am licensed under provisions of Chapter 9 (commencing with ..
Section 7000) of Division 3 of the s an ofessionals Code, and my License is in full force and effect.
License
Class: B License No.: 457228
/ate-- /: / ont
` ractor'.Ci1/ s% r'
OWNER -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 forthe..
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).:
f _ I 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 buildsor 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 1, 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.). `
(= 1 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
Owner:
RYAN STEELBERG
C/O 49950 JEFFERSON ST #130
INDIO, CA 92201
Contractor',
MONARCH -HOMES DESERT
49950 JEFFERSON ST, #
INDIO, CA 92201
,(760)413=8863
Lic. No.: 457228
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: -
haveand will maintain a certificate of consent to self -insure for workers' compensation, as provided-
' for by Section 3700 of the Labor Lode, 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
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier.STATE FUND Policy Number 719000322
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
`person in any mann r so a [o become subject to the workers' compensation laws of California,
and agree that, if I s come subject to the workers' compensation provisions of Section
"/7, 3700 of the Labo o , I s all forthwith comply with those provisions.
Date:" /� pplicant
WARNING: FAIL RE TO SECURE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000): 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 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 ire a, 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.
1 certify that I have read thi application and s to tha ve information is correct. I agree to comply with all -
city and county ordinance and state laws relate o build' g onstruction, and hereby authorize representatives
ofithis county to enter on the above-mentio d pr y_ fo inspection purposes.
.Date: II ignature (Applicant or. gent):
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/11/12
_Application Number 12-00000768
Permit . . WALL/FENCE, PERMIT
Additional desc .
Permit Fee . . 72.00 Plan Check.Fee
.00•
Issue Date . . Valuation . . .
. 4625
- Expiration Date 1/07/13
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
---------------------------
27.00
--------- ----------------------------------------
--------------- 7 ----------
S
Special Notes and Comments
-------
165 L.F. 6' GARDEN WALL, (5) 24" 6'
PILASTERS, ORCO SYSTEM. 2010 CODES:
----------------------------------- ------------------------ 7 ---------------
Other Fees . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary `Charged 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
tt►n ff
City of La Quinta
Occupancy:
Project type (circle one):
New Add'n Alter Repair Demo
APPLICANT:
DO NOT WF
#
Submittal
Req'd
Rec'd
TRAC
Item Amount
Plan Sets
Plan Check Deposit
Plan Check submitted
Structural Calcs.
Plan -Check Balance
Reviewed, ready for correi
Truss Cales.
Called Contact Person
Mechanical
Title 24 Calcs.
tions/issue
Plans picked up
Flood plain plan
Plumbing
Plans resubmitted
Grading plan
S.M.I.
2"d Review, ready for corre
Subcontactor List
Nonsdssue
Called Contact Person
Developer Impact Fee
Grant Deed
Plans picked up
H.O.A. Approval
Total Permit Fees
Plans resubmitted
IN HOUSE:-
7rd Review, ready for correc
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
'
Construction Type:
Occupancy:
Project type (circle one):
New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Estimated Value of Project:
ITE BELOW THIS LINE
KING
PERMIT FEES
Item Amount
tions
Plan Check Deposit
Plan -Check Balance
Construction
Mechanical
tions/issue
Electrical.
Plumbing
S.M.I.
Grading
Nonsdssue
Developer Impact Fee
A.I.P.P.
Total Permit Fees