06-3784 (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
Application Number:
1'06-00003784
Property Address:
`52920 VIA DONA 6
APN:
772-410-999-10. -298944-
Application descriptions
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
. 8000
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
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, d my License is in full force and effect..
License Cla s: C29 ns 0.: 809220
�Da4-/l 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. 703115, 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
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 a permit subjects the applicant to a civil penalty of not more than -five hundred dollars ($500).:
(_ 1 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 '
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 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 have the burden of proving that he or she did not build or
improve for the purpose of 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 not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed -
pursuant to the Contractors' State License Law.).
(_ 1 1 am exempt under Sec. , B.&P.C. for this reason
2i
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'sName:
Lender's Address:
LQPERMIT
Owner:
ANDREW PIERCE CORP
PALM DESERT, CA 92260
Contractor:
ORTEGA MASONRY
P.O. BOX 2.772
INDIO, CA 92201
. (760)342 17.26
Lic. No J- 80.9220
Date: 10%24/06
D e
OCT 214 2006
CITY OF LA QUINTA
FINANCE O��Y
- - - - - - - - - - - - - - - - - - -
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 Secfion 3700 of the Labor
Code, for theperformance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1769129-2005
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 agree that, if I should become su jeejtt.�e w f'ercompensation provisions of Section
37 0 of the Labor , I shall fo "wil with those tovisions.
Date. /Applicant:
�
WARNING. FAILURE TO SECURE WORKERS' COMPENSATIO&VERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO 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 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.
I certify that I have read this application and state that the above informationis correc I agree to comply with all
city and county ordinances and state laws relating to building construction y a t e representatives
of this �tyter upon the above-mentioned p for inspectio
/\Date/% Signature /Applicant or-Agl�ptf: --
Application Number.. 06-00003784
.Permit WALL/FENCE PERMIT
Additional desc
Permit Fee
Plan Check
Fee
.00
Issue Date ..
Valuation
8000
Expiration•Date . 4/22/07
Qty Unit Charge Per
Extension
BASE FEE.
4.5..00:
6.00 9.0000 THOU BLDG 2,,001-25,000•
-
54.00
Special Notes and Comments
320 LF 6' BLOCK WALL PER ORCO SPEC.
Fee summary Charged aid
Credited
Due
Permit Fee Total 99.00
.00
00.,
99-.00
Plan Check Total .00
.00 ..00
.00 �.
Grand Total 99.00
.00
.00
99..00
LQPERMIT
Bin #
4 _ j
City of La Quinta
Building & Safety Division
P.O. Box 15041 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # 3 '17
Project Address: L.f iX_e_ellLo* io
Owner's Name:
A. P. Number:
Address: .
Legal Description: ��G� .may ��`
Contractor: cr
City, ST, Zip: �t h
Telephone:
Address: "� ®� �.. Ly
Project Description:
City, ST, Zip: �—d
Telephone: 3 Y2
State Lic. # : g;�o
City Lic. #:
Arch., Engr., Designer:
Address:
City,. ST, Zip:
Telephone:
State Lia #:
Name of Contact Person:�15f S°�O ®
Construction Type: 6ce_ to,, Occupancy:
Project type (circle one : e Add'n Alter Repair Demo
�$ FL: P .
# Stories:
# Units:
Telephone # of Contact Person: 1 `t oZ
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
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 .Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2wd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
$.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
Total Permit Fees : ......