12-0481 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number' 12 .000o0481--
Property Address: 78430 VIP: SEVILLA
APN: 604-211-004'-25 -23971 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 200
Applicant:
Architect or Engineer:
1 hereby affirm under oknalty of per at I am
Section 7 Div'dlri�iO3 ntth use s and
Licens lass: !/
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ontra tor. /
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BUILDING & SAFETY. DEPARTMENT
BUILDING PERMIT
DE RATION
ns Chapter 9 (commencing with -,
y icense,is in full force and effect.
8 6383
YR—ATION
I hereby affirm under penalty of de4!j5, lNbt I am 'xen&itfi the -Contractor's State License Law for the
following reason (Sec. 7031 .5, Busifes` and Proflicensed
ssions Code Any city or county that requires a -permit to -
construct, alter, improve, demolish, or r air an tructur i'
p y �pnor to its issuance, also requires the applicant for the
permit to file a signed statement that he o she is pursuant to the provisions of the Contractor's State _
License Law (Chapter 9 (commencing with action 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_ permitsubjects the applicant to a civil. penalty of -not more than five hundred dollars ($500).:
(_) .I, as ownerofthe 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, asowner of the property, amexclusively 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 contractor(s) 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: - P
LQPERMIT _
Owner:
STEVE BULLLUM
78430 VIA SEVILLA
LA QUINTA, CA 92253
Contractor:
STEWART POOLS & SPAS
P.O. BOX 961 .
PALM DESERT, CA -92261
(760)217-7777
Lia. No.: 856383
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/02/12
WORKER'S COMPENSATION DECLARATION
I 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 performance of the work for which this permit is
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 EUMPT Policy Number EXEMPT
I certify that, in the performance cf the work for which this permit is issued, I shall not employ any
arson in any er so as to beco a subject to the workers' compensation laws of California,
and agree t , if sh uld e o act to the workers' compensation provisions of Section
700 of t Lab r I s o h mpl with those provisions.
ate: A ' ant
WARNIN FAILU T SEC OR S' COMPE ATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJEC AN EMPLOYER L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000)• INADDITION 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 restrictionsset 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
ermi o tante n. /�/)
I certif/hl hav, read s applicati n n at h t a rt_t` I agree to comply with all
city any rdinan s an state a elate g t I n co tru n, hereby authorize representatives
ofthe t en er pon t e abo - n o rty f ns p on r o
Application Number, . . . . 12700000481
Permit• WALL/FENCE PERMIT
Additional desc .
Permit Fee 15.00 Plan Check Fee
.00
Issue Date Valuation .
. 200
Expiration Date 10/29/12:
Qty Unit Charge. Per
Extension
BASE FEE
• 15.00 -
------------------ ------------------------ - ------------------------
Special Notes and Comments'
8 L.F. 61-GARDEN WALL, CITY STANDARD.
PERMIT DOES NOT INCLUDE GATE.,2010
. CODES.
---------
Other Fees �. BLDG:STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due.
Permit-Fee Total 15.00 .00 .00
15.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 00 .00
1.00
Grand Total 16.00 .00 .00
16..00
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Bin. #
Cit}/ Of %i Q. to -
Buliding 8L Safety Division
P.O. Box 1504, 78-49S Calle. Tampico
6..Quinta, CA 92253 - (760) 777-7012
Building Permit Application' and Tracking Sheet
e
Pemtit #
Project Address: .,
Owner's Name:.
A P. Number.
Address: 1.4 -
Legal
Legal Description:
City, ST, Zip:
Contractor.T d� C /�✓)
Telephone: s
Address: �Q �j p G �.
Project Description:
City, ST, Zip:
Telephone: �Q '7.7ME
a
State Lic. # : City Lie.
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone:
State Lic. #: '
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo '
Name of Contact Person:Sq.
Ft :
#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: �—
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted •
Item
Amount .
Structural cafes.,Reviewed,
ready for corrections
Plan Check Deposit. .
Truss Calcs•
Called Contact Person
Plan Check Balance
Title 24 Cates
Pians picked up ` ' .
Constructloa
Flood plain plan
Plans resubmitted..
Mechanical
Giading plan •
E•° Review, ready for correctionstissue
Electrical
Subcontactor List
.
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
*d Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P. `
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
e