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11-0445 (BLCK)P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUI'NTA, CALIFORNIA 92253' BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT . Dater 5/02/11 Application Number:-T1 ,00000445:-, Owner: Property Address: c53180 _UTA_ VICENZE JACKMAN,JAMES/BETH APN: 777=180-002= - - 13 BUELL MANSION PARKWAY Application description:. WALL/FENCE ENGLEWOO_D, CO 80113 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 59251 Contractor: O � Applicant: Architect or Engineer: A & M CONSTRUCTION'�� VP.O. BOX 366 V 1 IA �, - 224 . QUINTA,- CA 9 . 7 (760)-564-4832 L*��tOfLAQUINT A Li't% .No.: 746198 , . 3 , �7 7� 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 affirm under penalty of perjury one of the following declarations: -- - , Section 7000) of Division 3 oftheBusiness and rofessionals Code; and Nmy License is in full force and effect. _ 1 have and will maintain' a certificate of consent to-self-insure for workers' compensation, as provided - License Class: B .-CIO _ - License,No.: 746198 - - for by. Section 3700 of the; Labor Code, for the-performance of the work- for which this permit is - �f 11 I - issued. - - ., te: / `� 4' CgrRr/actor: - - - I have and will maintain workers' compensation insurance, asrequiredby 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, - - - 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. - 0002239-2010' ' following` reason (Sec: 7031.5, Business and Professions Code: Any city or county that requires a permit to -. I certify that,.in fhe.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 tobecome 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:1 should ecome.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 3706 of the Labor Code, shall forthwith comply with those provisions. that he or she is exempt therefrom and thebasis 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 (5500).: - D e: �� I,I plicant: A—) I; as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure isnot 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 Wand 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 LABORCODE,-INTER_ EST, 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 .. 1, 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 fora permit subject-to the ' 7044, Business and Professions Code: The Contractors' State License Lawdoesnot 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(sl 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 workisperformed under or pursuant to any permit issued as a result of this application, - - ( 1-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 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 hereby affirm under penalty of perjury that there is a construction lending agency focthe performance of the I certify that I have read this application an d that the above information is correct. I agree to comply.with all work for which this permit is issued (Sec. 309.7, Civ. C.): - - -- city and county ordinances and state laws to buil ding. construction, and hereby authorize representatives of-thh county to enter upon the above-meproperty for inspection purposes. - -' Lender's Name: - - ' ate: ' Sign re (Applicant Lender's Address: ,. LQPERMIT r Application Number 11-00000445 " Permit WALL/FENCE PERMIT Additional desc . - Permit Fee 81.00 Plan-Check-Fee .00 Issue Date, -Valuation 5925 Expiration Date ". 10/29/11 . Qty Unit.Charge Per Extension BASE FEE 45.00 •4.00 9.0000 THOU BLDG.2,001.-25,000 - 36.00 ------------------ --- - Special Notes and Comments -- --- 237,.L.F 6' GARDEN WALL AT VARIOUS LOCATIONS & A TOTAL OF 20 L.F. 30" GARDEN WALLS BOTH CITY STANDARD. 2010 CODES. --------------------------------------------- Other Fees BLDG STDS.ADMIN (SB1473) -- 1.00 Fee summary.* Charged. Paid. Credited Due . - ---. -------- - - - -- ------ Permit Fee Total 81.00 .. 00 00 --- 81.00 Plan Check Total" .00 .00 .00. 00 Other.Fee.Total 1:00 °, .00- 00 1.00 Grand Total - 82:00 .� .00 �.' -: .00 -.:.;_'82.00 Bin # r 0ty of ILd. Quints Building 8T Safety Division - P.O. Box 1504, 78-495 Calle Tampico.-, La Quinta, CA 92253 - (760) 777-7012 Building Permit Application -,and Tracking Sheet Permit # Project Address: 15--3 — gQ 1h— t WA -,7 t� Owner's Name: A. P. Number: .T77— l U —GQ Z Address: dh Legal Description: City, ST, Zip: Contractor: ele hone Telephone- Address: Address:rz 647 Project Description: `B 0U /q( City, ST, Zip: liLIQ C_Y`i-L Telephone: 71W r107 Z/ :a>::::::;:> >:: •t>:, ::»»>::::>: .... L� State Lic. # : CityLic. #; 7i � �• � 3o t I 1 t - t l Arch., Engr., Designer: G �� Address: - City, ST, Zip: Telephone: %>s?>:>:>s:;x:<:N -: ;:::#:>:<; ri::>>:: P :s>:: ..., State Lic. #: Name of Contact Person: Construction Type: _ Occupancy: Project pe (circle one): New ' Add'n Alter Repair Demo Sq. Ft.: ' #Stories:• #Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE ` q Submittal . Req'd Recd TRACKING PERMIT FEES Pian 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 Mechanical 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 correctionsrssue . Developer Impact Fee Planning Approval Called Contact Persom ' `: A.I.P.P.. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees