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06-4008 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 ' Application Number: 06-...00004008 Property Address: 52887 VIA SAVONA APN: 772 -410 -999 -23 -298943 -- Application description: WALL/FENCE Property Zoning:, LOW DENSITY RESIDENTIAL, Application valuation: 2043 Applicant: Architect or Engineer: 4 BUILDING & SAFETY -DEPARTMENT BUILDING PERMIT Owner: M/M CROUCH 48150 PASO TIEMPO LA QUINTA, CA 92253 Contractor: ORTEGA MASONRY P.O. BOX 2772 INDIO,-CA 92201 (760)342-1726 Lic. No.: 809220 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/17/06 NOV 17 2006 OF LA LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION . 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 7 001 of Division 3'of the Business and ofess' Cod 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 C ss: 29 cert 809220 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is . � � � issued. ` _Date: • -Contractor: _ 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-BUILDEFWLARATION insurance carrier_ and policy number are: - hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 1769129-2005 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ 1 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 be me s ec 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 an agree that, if I should beco subi t he er compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 37 0 of the Labor Cod I sh forth ith m ose provisions. ,t! 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 ($5001: Dater V�pplic t: (_ 1 I, as owner of the property, or my employees with wages as their sole compensation; will do the work, and _ l the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNI : FAILURE TO SE RE RKERS' COMPENSATI COVERAGE IS UNLAWFUL, AND SHALL y' Contractors' State License Law does not apply to an owner of property who builds or.improves thereon, SUBJEC AN EMPLOYER TO INALFENALTIES 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 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 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.). - 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 for a permitsubject 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 ,t� 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. , 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 su or W 80 days will subject CONSTRUCTION LENDING AGENCY .. .. 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 hat the above' orme to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and co ty or inances and state laws relating to niki' n r Kize representatives • of this cou ty to nter upon the above -menti a erty f p as. - Lender's Name: / Date: �I aJ�_5_ignature (Applicant or ent): Lender's Address:' °� -' - LQPERMIT . Application Number 06-00004008 Permit WALL/FENCE•PERMIT Additional desc . ' Permit Fee 54.00 Plan _Check Fee .00 Issue Date Valuation2043 ». Expiration Date .' 5/16/07 Qty Unit'Charge Per Extension BASE FEE 45.00 - 1.00 9.0000 THOU BLDG -2,001-25,.000 9.00 ' ------- • -•-- -- .---------- -- - - --- Special Notes,and Comments ---- -- -, -----_--- - - - - - , -, 67 -LF 6'8" BLOCK WALL & 5 CLOUMNSQ 514" AND 12 LF 5' BLOCK WALL. ALL PER ORCO DETAIL Fee summary Charged" Paid Credited -. Due Permit Fee Total" 5.4:00 .00 . .00 54.00 Plan Check Total `.00 .00 .00 .00 " Grand Total 54.00 .00, .00: 54.00 ' -..•LQPERMIT r . - -. • . � .. _ _ f - _ , ' - .. - .. Bin f . •City of La Quinta Building a Safety Division Permit # P.O. Box 1504, 78-495 Calle Tampico 1� La Quinta,�GA 92253 - (760)'777-7012 Building Permit Application and Tracking Sheet Project Address: S z— • O g7 Owner's Name: C S• J A. P. Number ? �� Op I Z Address: ' SQ t7 2 Legal Description: City, ST, Zip: V (_.,4t"� - — ' Contractor: Telephone: �(o _ Maui= .. Address: Project Description: — G (4 cq City, ST, Zip: J / ClI 7i�li �j�0 r 6 4-14 (�L))0A �r . Telephone: d ! Z �t p State Lic. # :. D Z� City Lic. #: Arch., Engr., Designer: C. , Address: :0 City,.-ST, Zip- I pb. ' . Telephone: 3o'3--771 — Construction Type: Occupancy: ' State Lic. #: Project J type (circle one): New Add'n Alter • Repa¢ Demo Name of Contact Person:%' f�%-(.l�#Stories: # Units: Telephone # of Contact Person: (Z 1 Falpd Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE' M Submittal Req'd gWd TRACKING .. PERMIT FEES Plan Sets Plan (beck submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan-Check Deposit Truss Calcs Called Contact Person Plan Check Balance. Energy .Cala. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading.plan 2" Review, ready for correctiow issue Electrical Subcontactor Idst Called Contact Person plumbing ' Grant Deed Plans picked up $.NL I [LOA. A. Approval Plans resubmitted .Grading IN HOUSE:- „ "Review, ready for corrections/issue ' Devdoper Impact Fee.. ; Planning ApprovalCalled Contact Person .Pub. Wks. Appr Date of permit issue School Fees Total.Pcrmit Fees.. ..