13-0156 (BLCK)s
1
P.O. BOX 1504. ^ VOICE (760) 777-7012
78-495 CALLE TAMPICO / FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT jjj f INSPECTIONS (760) 777-7153
BUILDING PERMIT
1�. Dete: 2/11/13
Application Number: 13-00000156 Owner:
Property Address: 53060 VIA VICENZE LOPER, DENNIS ET.REA��
APN: 777-180-005-180 -29894 -' 1215 K ST. SU 1500\
Application description: WALL/FENCE PALM DESERT,
Property Zoning: LOW DENSITY RESIDENTIAL 4 (760) 564=7816
Application valuation: 4050 1 9013
r FEBLJ
Contractor:.
Ajiplicant: _ - Architect or Engineer: FEDDERLY & A SOCIAi' OF LAQUIPITA
38747 NOPALE AN EDEPT. _
' f F
ALM DESERT, CA 92211
/A /h/� ti •_ �j / �/LY r (760) 773.-5205
'v / ' 1
vl /
_ ++ Lic. No..: 762889 -
t — — — — — — --- — — — — — — — — — — — — — — — — — —.. — — — — — — 7- — — — — — — — — — — — — — — —— — — — — _ — — — — — — — — — .— --,— — — — — — — - — — — — — }.. -
• : LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION _ -
I hereby affirm under penalty.of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby ff• m under penalty dperjury 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. have and will maintain acertificate of consent to self -insure for workers' compensation, as provided' • . r
License Class: B i'� .License No.: 762889.. - fo y Section 3700 of the Labor Code, for the performance of the work for which this permit is
_ ' sued. ' t
DateCongo !` - r -• ,f :. ave 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
OWNER -BUILDER DECLARATION -, - insurance carrier and policy number are: ,
1 - I hereby affirm under penaltyofperjury that I am exempt from the Contractor's State License Law'for the .Carrier EVEREST INS - Policy Number . X760000440081
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to Mf 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 wor 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 - 1. and agree that, if I should�be bject wor ' co p ;onprovisions of SectionLicense Law (Chapter9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or .t• • 3700 of the Labor Code, hw comthat 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 notmore than five hundred dollars (S500).:: Dat -�� Applicant://
(_ 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' COMPENSATIO 0 AGE.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 CIV ES 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 - -
`.
improvementsarenot 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.). f - APPLICANT ACKNOWLEDGEMENT -
r 1 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application ishereby 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 ..I. 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—) I am exempt under Sec. BAP.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 work is not 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., I •
1 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 a e comply withall
-
work for which'this permit is issued (Sec. 3097, Civ. C.)• - city and county ordinances and state laws relating to building constructiog,,aV hereby authoriAApresentatives
of this co my t enter upon the above-mentioned property f ecti pur oses.
Lender's Name: - 'e,,Jy - -
Dat/±V Signature plica or Agent): ~
Lender's Address:
LQPERMIT
Application Number 13-00000156 +` ;
-
=Permit WALL/FENCE PERMIT ". r
Additional desc `
Permit Fee . . 72.00 Plan Check Fee .00
Issue Date •. Valuation 4050
Expiration Date_- ,. 8/10/13" ...
Qty Unit Charge Per '+h Ektension
BASE FEE" a 45.00 ¢
'
- 3.00- `9.0000 THOU BLDG 2,001-25,000 27.00
'
--------------------------------- ----- -- -
- - ----------------- --- -- =
Special Notes aind,,Comments
-;»• 6' HIGH BLOCK WALL 162 LINEAR,FT. LONG
`- BUILT TO ORCO STANDARD. 2010 CODES.
---Other —BLDG
--------------
Fees -- -. STDS ADMIN (SB1473) -- ---1 00-----
�# rDue^
wFee summary Charged Paid a Credited
_
-
'
Permit.Fee Total 72. 00 00` a �. , 00 :•-- . 72.00„tY a
4�
Plan Check,..Total .00 .00 00 00
y - Other,,Fee-Total .''” 1.00_'f' 00 fz` 00 `� `1.-00 _, v}?r �,`,. 4
Grand Total '00
f;ret 73.00 `�•,�a -00 *' 73.00?,' :A.
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LQPERMIT'.
Bin #
City of LQ - Quinta
Building $r Safety. Division
P.O. Box 1504, 78-495 Calle Tampico
La Qginta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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J
13
Project Address: 5a.X-)(o 1 tit i C 4,Z�
Owner's Name: C4-) r)I cS
A. P. Number: —1-7'7 -J<30 -ODt—
Address: 1215 t—, RY� �-�(i�
G�
Legal Description: 'i}�i6�& .2. I q-2'-
' City, ST, Zip: �tkCk- if4ll+C> C4q 615VLf'
Contractor:
Telephone: -
Address: 3 -741
Project Description:
City, ST, Zip: "ry-) �Z?—�
v ` ��WqA I
Tele hone:^
kN; � �}�:i' : n: ice:«:i .. T... !.•,'i:, ]i.
Gtr .:.jr" <C jkxt
e
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State Lic. #:- 7 fo Z.
City Lic. #•: qcj 71
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lic. #:
�^<���.�s>:,.<:;,.:tr:�>y'`>`
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ConstructionType: Occupancy:
Project type (circle one): E2Add'n Alter Repair Demo
Sq. Ft.: tjt 19-0 1 Zs—tones: #Units: '
Name of Contact Person: I `.dk (,>J/�
Telephone # of Contact Person: �tOtJ �'%?J 5 �j
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"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:-
''a 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
Total Permit Fees
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