09-1285 (BLCK)tK'
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T-iht-4 44"
Application Number: c 09-00001285
Property Address: 80740- VIA PORTOFINO
APN: 777-150-006- - -
Application description: WALL/FENCE
-Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2360
Applicant: le Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETYDEPARTMENT
BUILDING PERMIT .
I hereby affirm under penalty of perjury that I am licensed under provisionsof Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Profey6ionals Code, and my License is in full force and effect.
License CIa B / Lice No.: 717813
atet ontracto :
OWN E -BUILDER DECLARATION
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 for the
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 155001::
(_ 1 1, as ownerof 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 builds or 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 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.l.
I—) I am exempt under Sec. , B.&P.C. for this reason
Data:
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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/22/09
Owner:
PRIEM JOHN4'
80740 VIA PORTIFINO
LA QUINTA, CA 92253 y
(714)000-8961 j DEC' 022
2.09
Contractor: �'rTy'
AERY CONSTRUCTION - •'�d.�?;
52641 AVENIDA BERMUDAS
LA QUINTA, CA 92253
(760)200-7910
Lic. No.: 717813
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: -
• I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, 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
T 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 1890225-07
certify that, in the performance of the work for which this permit is.issued, I shall not employ any
person in any manner so as to become subJ'�t to the workers' compensation flaws of California,
and agree that, if I should become subjec to thelr\etrs'
compensation provisions of Section
37 0 of the labor Code,l•sHellforfhw'. cg lhose provisions.
JW11.
pplicant: -
G: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP, TO ONE HUNDRED THOUSAND
DOLLARS 15100,0001. 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, indemnity 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 hot commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
certify that 1 have read this application and state that the above informayfon is correct. I agree to comply with all
City and con 'ordinances and state laws relating to building c nstrL26n, and her y authorize representatives
of this tb a �� r�upon the ove-mentioned p! pelt or inspec ' n p pose
(/Sign re (Applicant or A • 0
i
Application Number . . . . . 09-00001285
-
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 54.00 Plan Check
Fee
00
Issue Date . . . . Valuation
. . .
. 2360
Expiration Date 6/20/10
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
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Special Notes and Comments
109 LF X 5 FT HT GARDEN WALL PER CITY
STANDARDS & APPROVED PLANS. ALSO (7)
PILASTERS & 68 LN FT X 18 HT BLOCK WALL
COURTESY INSPECTION.
----------------------------------------------------------
Other Fees . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
---------- ---
Due
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Permit Fee Total 54.00 .00_
.00
54.00
Plan Check Total .00 .00
.00
.00 -
Other Fee Total 1.00 .00
.00
1.00
Grand Total 55.00 .00
.00
55.00
s
LQPERMIT
Bin#
City Of La Quinta
Building 8z Safety Division
P.O: Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
I00
Project Address: �_� via d v F s
Owner's Name:
A. P. Number:
Address:/,4&7-11—"-61t')4
Legal Description:
City, ST, Zip:
Contractor:„
Telephon ''":"««'<`:"''?x
Address: . �(�(� /k1ap1 I �%
Project Description:
City, ST, Zip: C . c .—
-G
Telephone:76 La ,
State Lic. # : j City Lic. 4;
Arch., Engr., Designer-
esignerAddress:
ell&
t3
1
Address:
City., ST, Zip:
Telephone:..�.:
0-. >
Construction Type: Occupancy:
State Lic.
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:Sq.
Ft.:
#Stories:
#Units:
Telephone # of Contact Person: 760 GU 7 9/J
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Pian Sets
Plan Check submitted
Item
Amount
Structural Caics.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2A 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:
3' Reyiew; ready for correctionsfissue
Developer Impact Fee '
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
...%a .
i �•C, o �.. 1016,5 E