09-1204 (BLCK)4-
P.O. BOX 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
09-00001204
Property Address:
51205 EISENHOWER DR
APN:
773-065-021-10 -600000=
Application description:
WALL/FENCE
Property.Zoning:
VILLAGE COMMERCIAL
Application valuation:
1299
Applicant: Architect: or Engineer:
BUILDING &. SAFETY DEPARTMENT
BUILDING PERMIT
ucENSm CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed--underprovisions 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: B. C10 C29 se No.: 439904
�6ate:��.2Yd9 ngactor:
// OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the "Contractor's State License Law for the
following reesor"See. 7031.5, Business and Professions Code: Any city or county that requires a permit to
.construct, alter, improve, demolish, or repair any str uturs, prior to its'lssuance,:also requires the applicam for the,
permit to file a.signed statement that he, or she is licensed pursuant to the proyisions of the.Contractoes State
License Law,(Chapter 9 (commencing he,
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 (6600)::
(_ 1 I, as owner of -the property, or rry employees with wages as their sole compensation, will do the,work,:and.
the structure la: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;employess, 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'forthe purposeof sale.).
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 nM apply town 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:).
1-1 I am exempt under Sec. , B.&P.C. for this•reason
Date:
Owner:
CONSTRUCTION'LENDING AGENCY
Thereby affirm under penatty'ofperjury that there is a construction lending agency for the performance of the
work for which this permh.is issued (Sec. 3097, Civ. C.).
Lender's Name: --
Lender's Address:
I.QPERMIT
Owner:
MOONEY GEORGE R
Contractor:
STRZELCZYK, EDWARD J.
83420 SHADOW HILLS WAY
BERMUDA DUNES, CA 92203
(760)34,7-0399
Lic. No.: 439904
VOICE (760) 777-7012
FAX (760) 777-701.1
INSPECTIONS (760) 777-7153
Date: 11/24/09
-------------------
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 Section3700.of the Labor
Code, for the,performance of the work for which.this-parmit is issued. My workers' compensation
Insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
I certify that; in the perfonnance'of the work:for which this permit is,issued, I shall not employ.any
person in any mannerso as to become subject io.the workers' compensation laws of California,
and agree that, If I should become subject to the workers' compensation provisions of Section
3700 of the Lab4WOERS2
all forthwlth.com -I with thosepiovisions.
pat ppliceM•WARNING: FAILURE TO SECURCOMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (8.100,0001• IN ADDITION TO THE•COS'f OFCOMPENSATION„DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE; INTEREST, AND.ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application.ie 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 personat whose request” for
whose benefit work is performed under or pursuant to any permit issued, ass result of this application,
the owner, and the-appticant, each agrees to, and shall defend, indemnify and hold harmless theVty
of La Quints, 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 Isnot 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 resd'Ahis application and state that the aboyelnformation is correct. I agree to comply with all
city and county ordinances and stats4aws relating to building construction, and hereby authorize representatives
of till to enter upo a above-mentioned propsrtyate: �&unty
� (Applicant or Agent: -
Application Number . . . . . 09-00001204
Permit. . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . 31..00 Plan Check Fee
.00
Issue Date Valuation . . .
. 1299
Expiration Date 5/23/10
Qty Unit Charge Per
Extension.
BASE FEE
15.00
8.00 2.0000 HND BLDG 501-2,000
16.00
---------------------------
Special Notes and Comments
TOTAL OF 60.L.F. 5' GARDEN WALL ORCO
SYSTEM - TO CREATE 2 COURTYARD WALLS AT
ADJOINING APARTMENTS.. 2067 CODES.
----------------------•----------------------
-------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
---------
1..00
Fee summary Charged Paid Credited
Due
Permit Fee Total 31.00 .00 .00
31.00
Plan Check Total .00 .00 .0.0
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 32.00 .00 .00
32.00
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Building 8r Safety D1Wsion
P.O. Box 1504, 78-495 Calle Tampico
La Qirinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
(j 1
Project Address:: , j /—,6. S g/
Owner's Name:
Adder:
A. P. Number:
Legal Description:
City, ST, Zip:
Contractor: nO�z,64 Z
Telephone:
Address: g? Z y l.�
Project. Description:
City, ST, Zip: Z �'?
Telephone:
State Lic. # : WffoYCity
Lie. C.M
Arch., Eagr., Designer.
-
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. FL: I #:Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal
Req'd
Ree'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cale.
Reviewed, ready for correctionsPlan
Check Deposit
Truss Gila.
Called Contact Person
Plan Check Balance,
Title 24 Coles.
Pians picked up,
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Meetrial
Subeontoctor,um
Called Contact Person
Plumbing
Grant Deed
Plans picked up
&M.L
H.O.A. Approval
Plans resubmitted
Grading
M HOUSE:-
'^' Review, ready for eorrectlonsNssue
Developer°Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fee