12-1443 (BLCK)r ,P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: L 12:7-0-0-0-0.144-3-_ r4!
Property Address: 80315 VIA MIRASOL
APN: 7727490-003- - -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 750
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
BERCAW
80315 'VIA MIRASO
l+, LA QUINTA, CA 92
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/18/12
DEC 18 2012 �DJI
Lender's Name:'
Lender's Address:
LQPERMIT
of this county to enter upon the above-mentioned prape b or inspec on rposes.
/Date! { -1& 12 ature (Applicant or Agent). � � _
Contractor:t
Applicant: Architect or Engineer:
RAS MASONRY INC CITY OF LA QUINTA
16780 CRESCENT G EN COU>iNANCEDEF'T.
RIVERSIDE, CA 92503
(760)774-0090
Lica No.: 678140,
----------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury that I am licensedunder provisions of Chapter 9 (commencing with -
.f hereby affirm under penalty of perjury one of the following declarations:
.Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.-
I have and will maintain certificate of consent to self= insure for workers' compensation, as provided
License Class: C29 License No.: 678140
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ry (�
/ate�4 onvactor: j`_ %� _
issued.
�Q•I have and will maintain workers' compensation insurance,., as required by Section 3700 of the Labor
1—'
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 INS CO OF WEST Policy Number WSD502042500
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to_
I certify that, in the performance of the work for 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 manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State -
and agree that, if,l should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall forthwith comply with those provisions.
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).:
ate - 1 pplicant:
(_ 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
WARNING: FAILURE 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). INADDITION 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.l.
APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct theproject (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 andfor
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
performed under or following issuance of this permit.
Date: Owner:
2. Any permit issued as a result of this application becomes null and void if workisnot commenced
"
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
" CONSTRUCTION LENDING AGENCY
permit to cancellation. -
hereby affirm under penalty of perjury that there is a construction lending agency for the performance. of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
,work for which this permit is issued ISec. 3097, Civ. C.).
city and county ordinances and state laws relating to buildin2.9onstruction, and hereby authorize representatives `
Lender's Name:'
Lender's Address:
LQPERMIT
of this county to enter upon the above-mentioned prape b or inspec on rposes.
/Date! { -1& 12 ature (Applicant or Agent). � � _
Application Number 12-00001443
-.
Permit WALL/FENCE PERMIT,
Additional desc .
Permit Fee 21.00 Plan Check
Fee
":00 '
Issue Date . . Valuation
750
Expiration Date.. 6/16/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
3.00 2.0000 HND BLDG 501-2,000
6.00
Special.Notes and Comments
30 L.F. 6' GARDEN WALL - SEVERAL
RETURN WALLS; CITY STANDARD. 2010' CODES. --
-------------------_-----------------------------------
'Other Fees BLDG STDS ADMIN (SB1473)-
-------
-----
1.00
Fee Isummary Charged Paid Credited
Due ,
-- --- ------
Permit Fee Total 21.00 .60
.00
21.00
..Plan Check Total .00 00
.00
.00
Other Fee Total 1.00 .00
.00
1.00
Grand Total 22:00 .00
:00
22.00
city. of La QUlntd
,
Bu11d1ng gt Safety Dit+ision
Permit #
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:'
1
r r Cs' Owners Name:. p
A. P. Number.
Address: <20 _ 1,5- vCd
Legal Description:
City, ST, Zip:.
Contractor.
Telephone:.4
Project Description:
Address:
City, ST, Zip:
Tele hone:
i""/`
- k
t
State Lie. # :
City Lia #;v' D
s
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
�. :� • Construction Type: Occupancy:
State Lie. #:r
" Project type (circle one): ' New Add'n Alter
w»rb
Repair' Demo
Name of Contact Person:
Stories:
.: + Unit;:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
# SubmIttal Req'd
Reed TRACKING PERMfl' FEES
Pfau Sets
Plan Check submitted Item
Amount
Structural Calm
Reviewed, ready for corrections Plan Check Deposit. .
Truss C21cs.
Called Contact Person Plan Check Balance
Tette 24 Calci:
Plans picked up Construction
Flood plain plan
Pians resubmitted ' Mechanical
Grading plan
r' 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 ROUSE:-
'^' Review; ready for correetionsfrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees '
x
LdTotal
Permit Fees