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06-1103 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 06-00001103 Property Address: 51825 AVENIDA VILLA APN: 773-182-016-4 _000000 - Application description: WALL/FENCE Property'Zoninq: COVE, RESMENTTAT Application valuation: 576 Applicant: Architect or Eng . t BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: KOTHLOW RICHARD J *NOT ON FILE . UNKNOWN, CA 99999 VOICE (760) 777-7012 FAX (760) 777-7011 : - INSPECTIONS (760)•777-7153 Date: 3/17/06 Contractor: Owner --------------------------------- LQPERMIT • 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 Business and Professionals Code, and 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 Class: License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is ' " issued. Date: Contractor: _ 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 DECLARATION insurance carrier and policy number are: ' Ihereby affirm under penalty of perjury that I am. exempt from the Contractor's State License Law for the Carrier Policy Number following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to certify that, in the performance of the work for which this permit is issued, I shall not employ any T 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 should b o e subje 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, f al f d comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by. � i any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ////"'' Date: Applicant: - " 1 _ 1 1, 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 WARNING: FAILURE TO SECURE WORK S' COMPENSAT(ON 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 ENALTIES 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 T 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 orshe 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. I 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 ason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City k " - of La Quinta, its officers, agents and employees for any act or omission related to the work being - /ner: performed under or following issuance of this permit. ----Date: i 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 . CONSTRUCTION LEND' G AGENCY _ - permit to cancellation. _ - I hereby affirm under penalty of perjury that there is a construction lend g agency for the performance of the I certify that I have read this application and state that the ab a information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to buildin ons cti , d hereby authorize representatives , ` - of this cou ty to enter upon the above-mentioned pr pert or in t n pure ses. Lender's Name: - - I Date: 'nature (Applicant or Agent): " " Lender's Address: ' _ _1 LQPERMIT 1 Application Number . . . . . 06-00001103' .7 Permit :'.: WALL/FENCE PERMIT Additional desc . Permit Fee.. 17.00 Plan Check Fee .00 Issue Date .. Valuation 57.6 Expiration Date 9/13/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 2..0000 HND BLDG 501-2,000 2.00 - ----o_ Special-Notes and Comments -- - 36 LF. 4' HIGH-BLOCK WALL CITY STANDARD Fee summary Charged Paid Credited Due Permit.Fee Total' 17.00 :.00 .00- 17:00 Plan Check Total .00 .00 00" .00 Grand Total 17.00 .00 .00 17.00 LQPERMIT - \ - Bin # City of La Quints Building U 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:' IS j L L6— Owner's Name: tc ApA . K� jQ A. P. Number: Address: Legal Description: Contractor: City, ST, Zip: ,tn ipJ C� Telephone: 7 -1 ' Address: Project Description: 3 3i�cx w>CZL� City, ST, Zip: Telephone:�— �. Gu 4- ur State Lie. # : City Lie.— Arch., Engr., Designer: Address: City, ST, Zip: Telephone: Construction Type: Pj-cx-�, UaALL Occupancy: State Lie. #: Project type (circle one): New Add Alter Repair Demo Name of Contact Person: Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: .I aD APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING. PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan CheckDeposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Constructicn Flood plain plan Plans resubmitted Mechanical Grading, plan' 2nd 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:- ''d Review, ready for corrections/issue Developer hmpact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees