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11-0874 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 c& -ht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: CL:11 00000874 ' Owner: Property Address: 53347 -VIA MALliORCA BILL SHIELDS. 1 APN: 777-390-005- - 5004 HOME&ITE DRIVE Application description: WALL/FENCE YAKIMA, WA 98908 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 3200 Contractor: Applicant: Architect or Engineer: MONARCH HOMES DESERT DIVS 49950 JEFFERSON ST, #130- INDIO, CA 92201 (760).413-8863 Lic. No.: 457228 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/15/11 FI�D'� 1 y` -1 tt �' " 2111 ( -13 ,1d ti3,J1A1'i"a -------------------------------------- -- - '`' - ENSED CONTRACTOR'S DECLARATION - _ WORKER'S COMPENSATION DECLARATION _ 1 hereby affirm under penaltethe ury that I licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 70001 of Division 3usiness a Professionals Code, and my License isin 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 J -(T-// issued. /at Contr tor: >(i l% ST _ � � , u - � I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor , r Code, for the performance of the work for which this permit is issued. My workers' compensation" OWNER -BUILDER DECLARATION insurance carrier and, policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 719000322 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in theMaIr-thwith or 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 nect to the workers' compensation laws of California, permit to filen signed statement that he or she is licensed pursuant to the provisions of the Contractor's State ' and agree tha t1 Io 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 Laomply with those provisions. that he or she is exempttherefrom and the basis for the alleged exemption. Any violation ofSection 7031.5 byany applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ' - D e:plicant:d�S (_) 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: FAILRU E TO SECURE WORKERS' 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 (_) 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 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 of La Quinta, its officers, agents and employees for any act or omission related to the work being Date: Owner: CONSTRUCTION LENDING AGENCY - 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 . 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.- t I certify that 1 have read this application and snropertyfo ation is correct. I agree to comply with all city and county ordinances and state laws relon, and hereby authorize representatives of this county to enter upon the above -mention purposes. nature (Applicantor AtJJ S It y " Application Number 11-00000874 Permit . . .. WALL/FENCE-PERMIT Additional desc . Permit Fee . . . . 63.00 Plan Check Fee .00' Issue Date . . . . Valuation 3200 Expiration Date -2/11/12 Qty Unit ChargePer Extension BASE FEE 45-00 2.00 9.0000 THOU BLDG 2,001-25,000 18.00 • Special Notes and Comments 120 L.F. 6' GARDEN WALL,'CITY STANDARD (4) 121IX24" COLUMNS. 2010 CODES. - ------------------------------------------------------.------- Other Fees. . .. . . . BLDG STDS ADMIN (SB1473) 1.00 ,. Fee summary Charged Paid 'Credited Due Permit Fee Total 63.00 .00 :00 63.00 - Plan Check Total .00 .00.00 .04 Other Fee Total 1.00 00 .1 .00 1.00 Grand Total. 64.00 .00 .00- 64.00 ` LQPERMIT Bin Permit # ! I City Ofla Quints . Building 8f Safety Division . , P.O. Box' 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 APPLICANT. n0 NAT WRITF RGI OW TRIC I INF # Submittal uunaing Permit Application and Tracking Sheet Project Address- .S 3 - j % / M LLOR 64 Owner's Name: -7, cc._ /Elft S A. P. Number: . . Z - �ZD - 9 9 g .- ' 3 Address: CIO Legal Description: , 3 '(_ City, ST, Zip: Contractor: A/ p�1,tFs Telephone:.> Address: ,_,_T,iD 0ErF`E-hJ d J ST_ 7i3 u Project Description: City; ST, Zip: � �� p z. L o � p _ L►#tlt w Z U , ll/ t Telephone: �Sr lP 3.y1I .10 3 It State Lic. # : Arch., Engr., Designer: :;;rYriv v:•.:: •:.Vi_W{{, yrt\:f�{{r v::i .... :::'•: J.,ii+.( .. .... .... .. .. City Lic. Y�4I C) Vi�/w' J/ Address: Pian Check Balance City, ST, Zip: Title 24 Calcs. Telephone: State Lic. .,;�._ ;;>;�,w;;,.�:s:.z;;,_:::>�: Construction Type: Occupancy: Prolect type one) New Add'n Alter Repair Demo Name of Contact Person: GO'51 Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: (p3 - (p 3 S, Estimated Value of Project: APPLICANT. n0 NAT WRITF RGI OW TRIC I INF # Submittal Req'd Rec'd TRACKING PERMrF FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cates. 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 correctionstissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for corrcctionsrssuc Developer Impact Fee Planning Approval r Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees'