10-0495 (BLCK)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT ONS (760) 777-7153
BUILDING PERMIT
5:;;0000-495'
Application Number: Owner: ! Iv f
Property Address: 80215 VIA MIRASOL ALACER LANCE �L;;� �+•; I'�
APN: 777-090-027-1 - 41-101 MONTEREY 'AVE J ' 'k%
Application description: WALL/FENCE RANCHO MIRAGE, CA 92270 f�`""-n—•� _
67 c';<
Property Zoning: LOW DENSITY RESIDENTIAL (760) 275-9091 .r,S ;,;.z
Application valuation: 1840
Contractor:.
Applicant: Architect or Engineer: SUNROSE CORPORATION
� 40101 MONTEREY AVE STE B1-214
Cv RANCHO MIRAGE, CA 92270
(760)773-6633
L 1 ' N 533670
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, and my License is in full force and effect. '
t' 'License Class: B License No.: 533670
Date: Contractor:
��
., .
,OWNER -BUILDER DECLARATION -
I hereby affirm underpenalty 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).:
(_) 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.).
(_ ) 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:
LQPERI1fIT
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 3700 of the Labor Code, for the performanceof the work for which this permit is o '
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 1948056-2010
I certify that, in the performance of the work for which this permit is issued,) 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 subject to the workers' compensation'provisions of Section
3700 of the Labor Cod Q shall forthwith comply with those provisions. -
Date `Z -/ Cl Apples
WARNING: FAILURE TO SECU ORKERS' 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
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 information is correct. I agree to comply with all ,
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned prop eyt r in (3 ction urposes.
,Date: G - % -(o Signature (Applicant or Agent):
a
Application -Number . . . . . 10-00000495
Permit . . . . . WALL/FENCE PERMIT .
Additional desc .
Permit -Fee. 43.00 Plan Check Fee
00
Issue Date Valuation
1840
Expiration Date 12/06/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
14.00 2.0000 HND BLDG 501-2,000 -
28.00
---------
Special Notes and Comments
-
85.LN FT X 5 FT HT GARDEN WALL PER CITY
STANDARDS -&-APPROVED "PLANS -___-__ ..--:.- --- ----
_ 7-7 .. __ ..
Other Fees BLDG.STDS ADMIN (SB1473).
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total_: 43.00 .00 ._00
43.00
Plan Check Total 00; .00 .00
.00
Other Fee Total , _ 1.00 _0&', 00 `,
,1.m
Grand Total,44.00 00 .00,
44.00'
Bin #
City Of La Quint3
Building & Safety Dh4sion
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
b
Project Address: q Q - S V
Owner's Name: L—q,
A. P. Number.
Address: L{
ti
Legal Description:
City, ST, Zip: 44 Of? L - 7.O
Contractor: ! tQy\ royL cwc V-
Telephone: /
Project Description:
0
Address: �� ' 1v / On_
City, ST, Zip:
S7
Telephone:
Lic. # : U(6 O
nL
(eArcState
City Lie. C on (",(e -
Arch.,
h., Engr., Designer
Address: 0
City., ST, Zip:
Telephone: 6 p ' - 9 ?-z
State Lic. #:
Name of Contact Person:L^'
(M
Construction Type: ( an
o W up cy:
Project type (circle one): Ne Add'n Alter Repair Demo
Sq FL: ��
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: poa
APPLICANT: DO NOT WRITE BELOW THIS LINE
4
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionVissue
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 correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A,LP,P.
Pub. Wks. Appr
Date of permit issue
School Fees
4=F
I-
I Total Permit Fees