08-0364 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08-00000364
Property Address:
51125 EISENHOWER DR
APN:
773-065-024- -
Application description:
WALL/FENCE
Property Zoning:
VILLAGE COMMERCIAL
Application valuation:'
1025
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I herebyaffirmunder penalty of perjury that,( am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code„and,my License is in full force and effect.
License Class: C29 License No.: 823181
Date: Contractor:
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-for the
permit to file a.signed statement that he or she'is licensed. pursuant to the provisions of the Contractor's State
Lice^^r,e Law (Chepter.9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
the. or she is exempttherefromand the basis for theallegedexemption. Any violation of Section 7031.5. by
any plicant for permit subjects the.applicartt to a civil penalty of not more than five hundred dollars (9500).:
(_ as owner of the property; or my employees with wagesas their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contraciors' 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 arenotintended 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, 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 alcontractor(s) licensed
pursuant to the. Contractors' State. License Law.).
(_) I am exempt under Sec. , B.&P.C. fortes reason
Date: er/114 / Owner:
CONSTR CTION LENDING AGENCY
I.hereby affirm under pen ahy r'jury that there is aconstruction lending agencyfor the performs a of -the
work forwhich this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
® CcATIACT09
VOICE (760) 777-7012
FAX (760)'777-7011
INSPECTIONS (760) 777-7153
Date: 3/24/08
Owner:
MOONEY GEORGER rn TF n
51125 EISENHOWER
LA QUINTA, CA 922
( 1H -MAIL 241000
Contractor:
FEDOR MASONRY INC
P.O.. BOX 1397
LA QUINTA, CA"9.22:47
(76,0)772-3036
Lic. No.: 823181
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 theworkfor 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 anis policy number are:
Carrier :ENDURANCE AMRCN Policy Number WEN100232501.
_ I 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 subject to the workers' compensation laws of California,
and a reethat, if I should become subjectte the workers' compensation provisions of Section
j
370 the Labor Code, forthwith comp) iththase provisions.
Date�I" plicant: - -
WARNING: FAILURE TO SECURE WORKERS' MPENSATION COVERAGE IS UNLAWFU ND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PEN LTIESAND CIVIL FINES UPTO 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 behalfthisapplication is.mad Ia, each person at whose request and for
whose benefit work is performed under or pursuant to anypermit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend,.indemnifyand hold harmless the.City_
of La Ouinta, 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.
I certify that I have read this *application and state that the above information is correct..I agree to comply with all
city and county ordinances and state laws relating to building co ruction, and hereby authorize representatives
of'thiiss c ty t nter upon the above-mentioned property _ spection purposes.
Oat yt/ Signature (Applicant orAgent)'
Application Number 08-00000364.
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 27.00 Plan Check Fee
00
Issue Date . . . . 2/28/08 Valuation
1025
Expiration Date 8/26/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
6.00 2.0000 HND BLDG 501-2,000
12..0'0
-------------------------- t ---------------- I --------- ---------------
Special Notes and Comments
<
41 IN FT X 6 FT HT RET WALL TO CITY
STANDARDS AND APPROVED PLANS.
February 2.8, 2008 10:35:01 AM pjuarez.
Other Fees . . . . . . . . . CHANGE OF CONTRACTOR
4.50
Fee summary Charged Paid Credited
Due
Permit.Fee"Total 27.00 27.00 .00
.00
Plan Check Total. .00 .00 .00
.00
Other Fee Total 4.5;0 .00 .00
4..50
Grand Total 31.50 27.00 .00
4.50
LQPER.MIT
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application NumGer:
08-00000364
Property Address:
51125 EISENHOWER DR
APN:
773-065-0.24- -
Application description:
WALL/FENCE
Property Zoning:
VILLAGE COMMERCIAL
Application valuation:
1025
a 1 #5 ____ # I
Applicant: Architect.or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby -affirm under penalty of perjury that I am licensed -under provisions of Chapter 9 (commencing with
Section 7000) of; Division 3 of, the Business and. Professionals+Code, and my License is in full force' and effect.
LicenseClass: C15 C54 B _ License No.: 756194
^ n
Date: 1 Contractor: 1 A oWTE LL. 4-4(t � G C.W $-T4U(;r 1CeJ
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
construm.aher, 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 apermit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)::
1 _ 1 1, as owner of the property, or myemployees.with wages as their sole compensation, will do the work, and
the,structureisnot.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 orimproves.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 improvemen0s sold within
oneyear 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. whocontracts for the projects with a contractor(s) licensed
pursuant tothe Contractors' State License LawJ.
( 1 Iam exempt under Sec. , B,&P.C: for thisireason
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:
MOONEY GEORGE R
51125 EISENHOWER
LA QUINTA, CA 92
(
Contractor:
MONTELLANOS CONS
79733 DANDELION
LA QUINTA, CA 92
(760')360-0899
Lic. No.: 75.6194
VOICE (760) 777-70.12
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/28/0.8
WORKER'S COMPENSATION DECLARATION
'I hereby affirm under penalty of perjury one"of.the following declarations:
_ I haverand will.maintain acertificate -of consent to self -insure for workers' compensation, as provided
for by Section -3700 of the Labor Code, for the performance, of thewwork for which this permit_is
issued.
_ Ihave 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 islissued. My workers' compensation
insurance carrjerand policy number are:
Carrier EXEMPT Policy Number EXEMPT
I certify that, in the+performance: of the work for which this permit is issued, I shall not employ any
person,in any manner soas to become "subjeartothe workers' compensation laws. of California,
and agree that,;if I should become subject to the workers' compensation provisions of Section
�t Q 3700 of the Labnode,shall forth- h comply with those provisions.
Date:<Zp� .Applicant: WI
WARNING> FAILURE TO SECURE -WORKERS' COMPENSATION COVERAGEI'IS'UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYERTO'CRIMINAL PENALTIES AND CIVIL FINES UPTO 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 fora permit subject to the
conditions and restrictions set forth onthis application.
1. Each person upon whose behalf this application is made, each person atwhose 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 Ouinta, 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 cessatiomof work for 180 days wilbsubject
permit to cancellation.
I.certify that I have read this application and,state that the above information is correct. I agree to comply with all,
city and county ordinances and state lawsrelating to ilding construction,.and:hereby authorize representatives
of"this county to enter upon the above-mentioned pro y Io jn 'o oses.
Date:` n
��� Signature (Applicant or Agent):
Application Number . . . . . 08-00600364
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 27.00 Plan Check.
Fee
.00
Issue Date . . . . Valuation
. . .
. 1025
Expiration Date . . 8/26/08
Qty Unit Charge Per
Extension
BASE.FEE
15.00
6.00 2.0000 HND BLDG 501-2,000
12.00
-----------------------------------------------------------------------------------
Special Notes and Comments
41 LN FT X 6 FT HT RET WALL TO CITY
STANDARDS' AND APPROVED PLANS.
February 28, 2008 10:35:01 AM pjuarez.
Fee summary Charged Paid Credited
Due
Permit Fee Total 27.00 .00
.00
27.00
Plan Check Total .00 .00
.00
..00
Grand Total 27.00 .00
.00
27.00
LQPEMrr
Bim #
City of La Quinta
Building ex Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta; CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
J
Project Address:' SI'`a S ^ w�-
Owner's Name: Utz (tion,
A. P. Number:
Address:
Legal Description:
Contractor: S M1 u o
Address: R "1 ` ti
City, ST, Zip:
Telephone: (
Project Description:
city, ST,.Zip: �. �c.. izSjv:,
` o r -e yr .: 1
Telephone: -1 lo. 03loc�
f L/ 1=14 1
o ; „ ��' '
State Lic. # City Lic: #:
Arch., Engr., Designer:
Address:
City, ST,.Zip:
Telephone:
State Lic. #: IlR
Name. of Contact Person:
Construction Type: Occupancy:
Project type (circle one):, New Add'n Alter Repair Demo
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person:
�
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIONG •
PERMIT FEES
Plan.Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Pian&oicked up
Construction
Flood plain plan
Plans resubmitted.
Mechanical
Grading plan
tad Review, ready for correctionslissue
Electrical
Subcontactor:List.
Called Contact Person
Plumbing
Grant Deed
Plan&picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
30 Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person,
A.Lpx.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
I
James Fedor Masonry,
P.O. Bet 1397, La Qaima, Ca. 92247
Td (760) 772.1036 Fax (740).112-3313
Lloemoc-29.829181
"Propm8l" .
Ref # 675
March 6, 2000
George Mooney
51125 Eisenhower
La Quints. Ca 92M
Phone: (760) 586-0012.
'Fax: (760) 341-1632
Re: 61125 Eisenhower — La Quirda
Inc
41 LF of Tan Precision BlockII $3,067.00
Demo side of rear wood tenoe (�oR� �''� �'I�.W JIVId N)
TOTAL COST 0 $3.657.00
,/QLD/�<N-i �r � �✓�Gr�,2�,. � 6i� a��r �L
Res fly Submitted,
Bob Gartner
O
O
Customer Approved:
Signature Tide Date
Z/1 A 89WON
EZ£E-ZLL-09L A
O
80033 S3AVf WdZO:Z 80OZ A 1eW