10-0725 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t�t 4 4v Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 10-00000725 Owner:
Property Address: 80825 VIA MONTECITO ZUCCHERO J G FAMILY TRUST
APN: 777-410-016- - - 5528 E THE TOLEDO
Application description: WALL/FENCE LONG BEACH, CA 90803
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5000
Contractor:
Architect or Engineer: RAS MASONRY INC
1571 VIA AURORA CIRCLE
CORONA, CA 92881
�[Pr-
(760)77.: 090
678 LiC. No.: 678140
LICENSED CONTRACTOR'S DE ATION
I hereby affirm under penalty of perjury tha m icensed under provisio sof hapter 9 (commencing with
Section 7000) of Division 3 of the Busi s a Professionals Code, a m icense is in full force and effect.
License Class: C29 License N .: 78140
Date: t5ontractor:
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
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 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 (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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 1 1 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: lT1
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/05/10
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.
K 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 DELOS INS CO Policy Number 03DKRM12002497
I certify that, in the performance of the work for which this p it is issued, I shall not employ any
person in any manner so as ecome subject to the wo er 'compensation laws of California,
and agree that, if I should m subject to the work s' ompensation provisions of Section
3700 of the La Cod hall rthwi omply wit ose provisions.
licant:
WAR�:FAILURE TO SECURE W RKERS' COM ENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI L 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 da s will subject
permit to cancellation.
I certify that I have read this application and state that the above' rmation is correct. I afire to mply with all
city.and co my ordinances a state laws relating to building ru ion, an reby author' a presentatives
of this untcto enter up the above-mentioned property sp on pur es.
ate: re (Applicant or Agent):
Application Number
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date.. .
. . . . . 10-00000725
WALL/FENCE PERMIT
72.00 Plan Check Fee . . .00
Valuation . . . . 5000
2/01/11
Qty Unit Charge Per Extension
BASE FEE 45.00
3.00 9.0000 THOU BLDG 2,001-25,000 27.00
---------------------------------------------------------------------7------
Special Notes and Comments
BUILD REMAINING 200 L.F. 6' GARDEN WALL
AND 165 L.F. 2' GARDEN WALL, ORCO
SYSTEM. 2007 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 72.00 .00 .00 72.00
Plan Check Total .00 .00 .00 .00
Other Fee Total 1.00 .00 .00 1.00
Grand Total 73.00 .00 .00 73.00
LQPERMIT '
Bin #
City of La Qumta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
l O
Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:'`
4
Address:
Telephone: .• ~':,.
Project Description:
City, ST, Zip: G
Telephone:
s, n.
State Lic. # rig 40 City Lic. #;
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
k yam.
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Pro ect a circle one New Add'n Alter Repair Demo
j type ) P
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACX3NG
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
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanlcal
Grading plan
2•d Review, ready for corrections/issue
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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
17
Total Permit Fees