09-0031 (BLCK)P.O. BOX 1504 ^' VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760),777-7011
LA- QUINTA;. CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT. INSPECTIONS (760) 777-7153
BUILDING PERMIT
_---___., Date: 1/13/09
Application Number: 09-0000003E Owner:
Property Address: 52882 VIA DONA SPYKSMA RESIDENCE —7a7
APN: 772-410-99.9-9 -298944- 52-882 VIA DONA j.1
y
Application description: WALL/FENCE LA QUINTA, CA 92253
D:
Property Zoning: LOW DENSITY RESIDENTIAL f i�
Application valuation: 900 ,
� �� 33 2T09
Contractor: CITY 0= o0111GA
Applicant: Architect or Engineer. CAL -TECH DEVELOPMENT CORP ,�t.a-i I K,
'78150'CALLE TAMPICO STE 205h--'-
LA
05Pr---�"'"" """ A�
/ LA QUINTA, CA 92253
/ (760)771-3738
Lic. No.: 683969
LICENSED CONTRAEITOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed u e provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business d,Professio als de, and my License is in full force and effect.
License C I a : B L' nse No.: 683969
_Date:Contractor
WNER-BUILDER DECLARATION
I hereby affirm under penalty ope ury I exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5 sin s nd rofessions Code: Any city or county that requires a permit to
construct, alter, improve, dem sti, o ' any structure, prior to its issuance; also requires the applicant forthe
permit to file a signed statement that he r she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter.9(commencing with Section 7000) of Division 3 o 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 ($500).:
(_) 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 ISec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an ownerofproperty who builds or. improves 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 improvement is sold within
one year of completion, the owner -builder will havethe burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1
1, as owner of theproperty, 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 a contractorls) licensed
pursuant to the Contractors' State License Law.). - - -
(. 1 •I am exempt under Sec. -, B.&P.C. for this reason - - -
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
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 Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are: -
Carrier STATE FUND Policy Number 1768839
I certify that, in the performance of the work for which th' ermit is issued, I shall not employ any
person in any manner sous to become subject to the rkers' compensation laws of California,
and agree that, if I should come s bj t to the w rk s' ompensati.n provisions of Section
#3700 of the LaborCodef'h comp) iseprovisions.Date:#�G
Applicant: -
WARAILURE TO SEC WOR MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER T IMIN P IES AND CIVIL FINES. UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,000). IN DITIO COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE L. BOR CO , I EREST; 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 behalf this application is made, each person at whose 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 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 of such permit, or cessation of work for 180 days will subject
permit to cancellation.- -
.f certify that I have read this application and state that the above information is corr ree to comply with all
city and county ordinances and state laws relating to building nstruction, and h b horize-representatives
of this cou to ter upon the above-mentioned property f ins n urp
Signature (Applicantor Age
- Application Number 09-00000031.
Permit .WALL/FENCE PERMIT
Additional desc .
Permit. Fee23.00.: Plan Check Fee
.00
Issue Date Valuation
9.00.
Expiration Date 7/12/09 �.
Qty Unit Charge. Per
Extension
BASE FEE
15.00', ..._
4.•00 .2.0000 HND BLDG 501-2,000
8.00
------------------------
pecial Notes and Comments
27 LN FT •X 6 . FT HT GARDEN WALL & 9 LN FT
X 67T -HT GARDEN WALL PER CITY STANDARDS
& APPROVED PLANS.
Other Fees . . . . . BLDG STDS ADMIN (SB1473).
1.00
Fee summary Charged Paid-. Credited
Due
Permit Fee Total 23.00. .00, .00
'23.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1:00 .00 .00
1.00
Grand Total 24.00 .00 00
24.00
.. LQPERMIT .. -
Bin #
City of La. Quinta
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:
Owner's Name: _
Address:
A. P. Number:
Legal Description:
Contractor:
City, ST, Zip: AA
Telephone:
Address:
Project Description:
City, ST, Zip:
Telephone: -7-11-7- `,
Q - _
4
�.
`
State Lic. # : City Lir. #: 1
Arch., Engr., Designer: J
Address:
City, ST, Zip:
Telephone:
State Lic. #:
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:zj"% °L
Estimated Value of Project:
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 Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant DeedPlans
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 of permit issue
School Fees
L
Total Permit Fees
ti
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Tay.
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Minta,CA 92253, r ,:°Facsimile 760.771 3374,+`�,
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