12-0062 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUIlVTA, CALIFORNIA 92253
Application Number: 12-00000062
Property Address: 53408. VIA" DONA
AP"N:. 772-420-999-21 .-298944-
Application description: WALL/FENCE
Property Zoning: ' LOW DENSITY RESIDENTIAL
Application valuation: 5499
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
BRIAN YATES
53408 VIA DONA
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS. (760) 777-7153
Date: 1/23/12
Contractor:
Applicant- Architect or Engineer:. MONARCH HOMES DESERT DIVSA C
49950 JEFFERSON ST, #130-1 4 JAN 2a
2012.
INDIO, CA 92201
I (760)413-8863
lCITYQUINTA
Lic. No.: 457228 F?Pd
?h�'�aR�lIN _
UCENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of per' icensedunder provisions of Chapter 9 (commencing with _ I. hereby affirm under penalty of perjury one of the following declarations: -
Section 7000) of Division 3 of t usiness and ofessionals 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: B license No.: 457228 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date:/ Z3" / ntract S i l0� 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 workerscompensation
OWNER -BUILDER DECLARATION insurance carrier and policy number are: -
I hereby affirm under penalty of perjury that I am exempt from the Contractors State License Law for the - - Carrier STATE ' FUND Policy Number 719006322'
• following reason (Sec. 7031 "5, Business•and Professions Code: Any city o(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 nn 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, uld come subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division of the Business and Professions Code) or 3700 of the or C II forthwith complywiththose provisions..
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).: ate: * Z3'�L PI
ant•
(_) I, 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: FAI RE TO SEC ORKERS' 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 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, 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_), I am exempt under Sec. B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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
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 not commenced
within 180 days from date of issuance p 't, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state t t e abov inf mation is correct. I agree to comply with all
city and county ordinances and tate laws relating to onstr tion, and hereby authorize representatives
/at
county to enter upon a above-mentioned pr pert or inspe ion purposes.
Z�' Z ' nature (Applicant or Agent). %
LQPERMIT
Application Number . . 12-00000062
Permit . . . WALL/FENCE. PERMIT .
Additional desc .
Permit Fee . . . . 81.00 Plan Check Fee
.00 -
Issue Date . . . . Valuation . . ..
5499
Expiration Date 7/21/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
4.00 9.0000 THOU BLDG 2,001-25,000
.36.00
----------7-----------------------------7------------
Special Notes and Comments
160 L.F. 6' GARDEN WALL, 50 L.F. 5'
GARDEN WALL, (2) 24" 6' PILASTERS & (5)
12" 5' PILASTERS, ALL ORCO SYSTEM. 2010
CODES.
-------------------------------------------------------------------
Other Fees . . . . . . BLDG STDS ADMIN (SB1473)
1.00
" Fee summary Charged Paid Credited
Due
-- - -----------------------
Permit Fee Total 81.00 .00 .00
81.00
-. Plan Check Total .00 00 00
00
Other, Fee Total, 1.00 .00 .00
1.00
Grand Total 82.00 .00 ..00
"82.00
LQPERMIT
Bin #
.City of La Quints
Building &'' Safety Division
P.O. Box 1504,78-495. Calle Tampico
La Quinta, CA 92253 -,.(760) 777-701.2• '
Building Permit Application and Tracking Sheet
Permit #
a.
Project Address:S3 ."Y O �a�
Owner's Name: S
A. P. Number:
Address:
Legal Description:
r City;.ST, Zip:
Contractor'. QyliTelept►one
Address: Q$O fFEi1-SO�J .Sr X30
$ ( ti M ° z
Project Description:
City, ST, Zip: T—;J �� D ZZO
Telephone: CJS Co31� - l03� 1
.� �; �:: r;..: ;��. �.
City Lic. #:
a ,(/•J - � G kJ
State Lic. # :
Arch., Engr., Designer:
7 rr-/L r
Address:
- �'2 �• _ S t /� J %�"i,.S
City, ST, Zip:
f -i DRg�o 1 .J
Telephone:'
cz:%<.>:>?rv2
'Construction T YPe: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Pian Check submitted
Item Amount'
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Pian Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctionsrissue
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 correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees