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09-1065 (BLCK)-.. P.O. BOX .1504.., ' t 78-495. CALLE TAMPICO - LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: SCOTT RICHARD 52990 AVENIDA VILL LA QUINTA, CA 9225 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/06/09 , Contractor: / Applicant: Architect or Engineer: PACIFIC HOMES /` ! 42335 WASHINGTON ST E1 PALM DESERT, CA 92211 (760)408-3495 �� `/' /�. Lic. No.: 782324 `�'�`�%'��� 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 7000) of Division 3 of the Busi ss and Professionals Code, d 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 LicenWwa License 782324 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. C ractor: 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 ECLARATION, insurance carrier and policy number are: I hereby affirm underpenaltyof perjury that I am exempt from the Contractor's State License Law for the - Carrier STATE FUND Policy Number' 1576557-2009 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 spluld become subject to a 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 Laboe, I all for with ply with rh,s,on. 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).: Date© /Apgfica/nt:� r of the rty, or my ir do (_ 1 I' as the tructure is not tended or offered for sale (Sec.ployees with wages a 7044,eBus sole so and ProfessionsllCode:eTherk, and WARNIN FAIL E TO O 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 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, DuaiLlcaa ur,d Piureaaluna Cude:'The i.ouuacwis' State ut:ense'Law uues iroL'dpply to all owner Or conaivont arta 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. , BAP.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 result of this application becomes null and void if work is not commenced 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:. - r Lender's Address: LQPERMIT 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 I have read this ap Ii at' and state that the above information is corre . I agree to comply with all city n county ordinances a state lawsrelating to building struction, d her authorize representatives of is ou ty to enter upo the above-mentioned property or ' spe ion r oses ' D gnature (Applicant or Agent): Application Number: 0.9'-00001065 Property Address: 52990 AVENIDA VILLA. APN: 773-334-013-14 -000000- Application description: WALL/FENCE ; - Property Zoning: COVE RESIDENTIAL Application valuation: 1104 Owner: SCOTT RICHARD 52990 AVENIDA VILL LA QUINTA, CA 9225 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/06/09 , Contractor: / Applicant: Architect or Engineer: PACIFIC HOMES /` ! 42335 WASHINGTON ST E1 PALM DESERT, CA 92211 (760)408-3495 �� `/' /�. Lic. No.: 782324 `�'�`�%'��� 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 7000) of Division 3 of the Busi ss and Professionals Code, d 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 LicenWwa License 782324 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. C ractor: 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 ECLARATION, insurance carrier and policy number are: I hereby affirm underpenaltyof perjury that I am exempt from the Contractor's State License Law for the - Carrier STATE FUND Policy Number' 1576557-2009 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 spluld become subject to a 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 Laboe, I all for with ply with rh,s,on. 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).: Date© /Apgfica/nt:� r of the rty, or my ir do (_ 1 I' as the tructure is not tended or offered for sale (Sec.ployees with wages a 7044,eBus sole so and ProfessionsllCode:eTherk, and WARNIN FAIL E TO O 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 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, DuaiLlcaa ur,d Piureaaluna Cude:'The i.ouuacwis' State ut:ense'Law uues iroL'dpply to all owner Or conaivont arta 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. , BAP.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 result of this application becomes null and void if work is not commenced 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:. - r Lender's Address: LQPERMIT 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 I have read this ap Ii at' and state that the above information is corre . I agree to comply with all city n county ordinances a state lawsrelating to building struction, d her authorize representatives of is ou ty to enter upo the above-mentioned property or ' spe ion r oses ' D gnature (Applicant or Agent): •157.. r _ Application'Number . . . . . 09700001065 Permit WALL/FENCE PERMIT .. Additional desc .. Permit Fee -•'. 29.00 Plan Check Fee _ .00 Issue Date Valuation 1104 Expiration Date 4/04/10 Qty Unit 'Charge Per - Extension BASE'.FEE 15.00 ,7.00 2.0000 HND BLDG 501-2,000 14.00 -- ---------------------------------------- Special Notes and Comments. 51 L.F., 5 -FOOT GARDEN WALL, CITY STANDARD, ALONG SOUTH PROPERTY LINE AND DRIVEWAY. + Other Fees . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 29.00 .00 .00 29.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 30.00 .00 .00 30.00 LQPERMIT - - O Alll =� 1 T i(Al.� L �•.'1 t j it .1 I _il � ! u t l� � �' 4i i to 17 M � �J m lc�6-7 CITY OF LA OUNTA BUILDING & SAFE7Y DEPT. AaP OVT&,:-:D FOR CONSTRU , -ION DAT 0 BY Bin # Qty of La Quinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico- ` La Quinta, CA 92253 - (760) 777-7012 Building Permit Application, and Track`ng Sheet Permit # �� �o�s Project Address: 2. f fig ,�,- Owner's Name: A. P. Number: 5 . 2�� .. �) ?j .-� Address: Z.; �V S Legal Description: Ac- L City, ST, Zip: Contractor: Telephone: Address: �-� Project Description: City, ST, Zip: ne• TeleP ho . State Lic. # : City Lic. #; Arch., Engr., Designer: Address: City, ST, Zip: Telephone: ................. a # S t to Lic. <�•... Construction on TY e• ccu Occupancy: P P Y: Project Add n'Alter r Repair Demo type circle one): New Name of Contact Person: 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 Clteck Deposit Truss Cales. Called Contact Person Plan Ckeck Balance Title 24 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 or permit issue School Fees j Total Permit Fees