12-0426 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000426
Property Address: 53539 VIA MALLORCA
APN: 772-420-999-49 -298943-
A 1;-t;- I—A tion' WALL/FENCE
.4 Qum'
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
4 ROBERT F ALLEN
2022 HILLYER PL. NW
WASHINGTON DC 20016
Property Zoning:, LOW DENSITY RESIDENTIAL
Application valuation: 2700
4r
Contractor:
Applicant: Architect or Engineer: MONARCH HOMES DESERT DIVSN
49950 JEFFERSON ST, #130-1
INDIO, CA 92201
�•>f�17�'.>t►` t `r (760).413-8863
Seu
ED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury, hatI a licensed under provisions of Chapter 9 (commencing with '.
Section 7000) of Division 3 of the Bu i rofessionals Code, and my License is in full force and effect.
-
License Class: B ' - License No.: 457228
/ $ate.
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
a - 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).:
(_) 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 improvesthereon,
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.).
(_ 1 11 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 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
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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/18/12
Lic. No.: 457228
-------__`----- -- -- -----
.. -WORKER'S COMPENSATION DECLARATION
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 3700oft1ie;Labor Code, -for the performance of the work for whichthis permit is t
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 719000322 "
_ I certify that, in the performance of the work for which this permit is- issued, I shall not employ any 'r`
-person in any ma a to become subject to the workers' copensation laws of California, .. and agree that, if come subject to the workers' compensation provisions of Section
3700 of the Labor od s II forthwith comply with those provisions.
Date: .I ' iZ Applicant• WiT
WARNING: FAILURE TO SECUR KERS' COMPENSATION COVERAGE 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 r
SECTION 3706 OFTHELABOR CODE, INTEREST, AND ATTORNEY'S FEES. ,
APPLICANT ACKNOWLEDGEMENT +
IMPORTANT Applicationis 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 th t the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to b nstruction, and hereby authorize representatives
of this county to enter upon the above-mentioned prop e r inspection purposes. -
I(Oate: -! �'� Z' Signature (Applicant or Agent):
r Application Number . . . . 12-00000426
PermitWALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 54.00 Plan'Check Fee
.00
Issue Date Valuation
2700
Expiration Date 10/15/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU. BLDG 2.,001-25,000
9.00
Special Notes and Comments
10OLF OF 6' HIGH PROPERTY LINE AND
EQUIPMENT ENCLOSURE WALLS, 8LF OF.3'
HIGH PLANTER WALLS AND (2) 241IX42"
PILASTERS [ORCO SPEC] THIS PERMIT DOES
NOT INCLUDE ELECTRICAL INSTALLATIONS....
2010 CALIFORNIA BUILDING CODES.
April 18, 2012 2:52:40 PM AORTEGA
------------------------------------------- ------
Fees BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due.,
Permit Fee Total`: 54.00 .00 .00
54.00
Plan_Check Total .00 .00 .00
.00
Other Fee Total .,.:. 1.00 .00 .00
1.00
Grand Total 55.00 :00 .00
55.00
Bin #
.
.�...._ Cl.
of -b- E�ulfam
Bul tng 8z Safety Division .; .
P.O.8ox.1504,•78-495 Cage Tampico
La,Quinta, CA 92253 - (760) 777-7012
Building Permit Application• and Tracking Sheet
Permit # .
��• 0`i
Project Address:
OwnWs Name-.
A P. Number
Address: (,44 /✓) aL
Leal D tion:
Contractor. Qj� M S
City. ST. Zip: L Z L S
Telephone: $
Address: SO J t-rA19 . soul S /.3 b
Project Desmription:
City, ST.Tap: �7 ceh D 9 22,0 /
Telephone:
State Lie. #: City Lim, #:
i
e S (.(J �✓ 'W li��
Address:
62 ('W . S
City., ST. Zip:
Telephone:
State Lia #:
Name of Coated Penson:
Construction Type:. Occupancy:
project type (circle one): New Add'n • Aber Repair Demo
Sq. R:
# Stofiew
# Unity:
Telephone* of Comact Perm:
Estimaw Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE ti� OD 06A, !n4
p Submittal Req'd Reed TBAClMgG PBRhIIT FEES
I.Plan
Sets
Pisa Check submitted' " Ibex Amount
Stmetural Cales.
Reviewed, ready for corrections Plan Check Deposit. .
Truss Calks.
Called Contact PersonPlan Check Salanee _
Title 24 Cates.
Pians picked up* Construction
'Flood plain plan
Plans resubmitted.' . Mecharileal
Giadlag plan
X' Review, ready for cortecfionelssue Electrical
Subcontattor List
Called Contact Person Plumbing
Grant Deed.
Plans picked up S M.I.
H.O.A. Approval
Plans resubmitted Grading
IN KOUSB:-
''' Revlew, ready for eorreetionwissue Developer Impact Fee
Planning Approval'
Called Contact Person A.I.P.P.
Pub. Wks. APpr
Date of permit issue
School Fees
`4
Total Permit Fees