12-1446 (BLCK)A
TAt!t4
.P.O. BOX1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA; CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING: PERMIT
Date: 12/18/12
Application Number: 12-.0000144 6 Owner:
Property Address: 53031 VIA SAVONA PRIEM RESIDENCE
_ APN: 777-380-002-29 -298943- 53031 VIA SAVONA
Application description: WALL/FENCE LA QUINTA, CA 92253'
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5000
Contractor: D 9
Applicant:Architect•or Engineer: WESTLAKE LANDSCAPE I RIAN
P.O. BOX 5175
LA QUINTA,. CA 9224.8 DEC 182 12
(760)399-1506
Lic. No.: 857801 CITY OFLAQUINTA
FINANCE DEPT-
. - 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 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent'to self -insure for workers' compensation, as provided-
_ License Class: C27 A License No.: 857801 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is,
/fes/] issued.
Date: v `� �e(� Contractqr:/that
fry / _ 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
OWNER -BUILDER DECLARATION - insurance carrier and policy number are:
I hereby. affirm under penalty of perjurm exempt from the Contractor's State License Law for the Carrier GRANITE STATE Policy Number WC0193 96304
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 I 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 (55001.: Daf6: Z_Applicant -
1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is notintendedor offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECUR7WKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' StateLicense Law does not apply to an owner of property who builds qr improves thereon, SUBJECT AN EMPLOYER TO CNALTIES 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). IN ADDIHE 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 EREST, 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 sake.). - - APPLICANT ACKNOWLEDGEMENT
(_) I, 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 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 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,
(_ 1 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 pdrmit.
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
CONSTRUCTIONLENDINGAGENCY - permit to cancellation.
I 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 (Sec- 3097, Civ. C.). - city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this cou ty to enter upon the above-mentioned property f 'spec on purposes.
Lender's Name:
-Date: �C/.Signature (Applicant or Agent): - -
Lender's Address: - -
LQPERMIT • - _ -
Application Number- 12-00001446,_
Permit. WALL/FENCE PERMIT
_Additional desc .
Permit Fee 72.00 Plan Check
Fee
.00
Issue_,Date Valuation
5000'
Expiration Date..-,. 6/16/13
• Qty'..- Unit Charge Per
Extension.
BASE FEE
45.00
3.00 9:.0000 THOU "BLDG 2,001-25,000
27.00
----------------------------- ---------------------------------------
--------------- - -
Sp
Special Notes and Comments
BUILD APPROX. 200 IN FT X 6. FT HT BLOCK
WALL PER CITY STANDARDS AND APPROVED
PLANS.2010 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
r Other Fee .'Total 1.00_ .00
.00
1.00
Grand Total 73.00 .00.-
.00
73>.00
LQPERMIT, -
-
Bin. #
Cray �f iLa Quo :
Bulldog U Safety Division
P.O. Box 1504,'76-495 Calle Tampl o
14.Quinta, CA 92253 - (760) 777-7012
Building Permit'Application• and Tracking Sheet
Permit # , I
Project Address:LCT' 3V N f cz L
Own u's Name:.)
A. P. Number. , t7'� I C( �CcVUYtGt ..
Address:'—? — 63 % Vic, Sic
Legal Description:
CVc)''t
City, ST, Zip:zt/ het ' (fCf l Z 2 s
Contractor.S�/el_
Telephone:.
Address: �U 7 '
Project Description: �jL %Q �c� . 2- 6 C_-)
City, ST, Zip: Lc-, cJLi c:7
Z_% ✓l / vC `C 1-/ f' l
Telephone:
City Lie. #;
L�,,�
ri
State Lic. #: S % 80
Arch., Eugr., Designer
Address:
City., ST, Zip:
Telephone:
State Lic. #: rw�,` ~ ,.'tip `~
,::r Ri ,„/`,....:»ru
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: #Univ:
Name of Contact Person: Le,, LkX_5�—(c
Telephone # of Contact Person: U. 2 SU 2".4 Z
Estimated Value of Project: S . C PIG
- 'APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
' Rec'd
TRACMNG
PERMIT FEES
Plan Sets
Plan Check submitted
itemAmount
Stmcturat Coles.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance.,
Title 24 Calci.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical .
Grading plan
2'" Review, ready for corrections/issue
Electrical
Subeoutattor List,
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval.
Called Contact Person
Pub. Wks. Appr '
Date of permit issue
School Fees
"
Total Permit Fees
A .CITY 'OF -0 -LA QMTA -
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Construction contractor agrees that in accordance with generally accepted construction o R R R - __ (99e) � --1O
practices, construction contractor will be required to assume sole and complete responsibility for p p - c7
job site conditions during the course of construction of the project, Including safety of all persons o p o _ ___---- _'
and property; that this requirement shall bel made to apply continuously and not be limited to 1999) p o o _ �_- _ _ _- OIS `'' + �/� z$
normal wockin hours, and construction contractor further agrees to defend, indemnif an o __ _ __-__ - - N " A V 2Z
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deli n rofesgstonal harmless from an and all liability, real or alleged, in connect on with the ________ -- _____-- --co
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performance of work on this project, excepting liability arising from the sole negligence of design - ---- -------------- `°
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32' I DATE: 2-24-11
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32' I DATE: 2-24-11
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PLANTING PLAN