10-1406 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,-CALIFORNIA 92253
Application Number: 10.-00001406
Property Address: 51542 VIA SORRENTO
APN: 772-250-997-146 -31349 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 325
cet-h 4-Q
t4
Ap ga t: Architec o Engineer
LICENSED COhl?RACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penally of perjury tl at am I' sed under provisions of Chapter 9 (commencing with
Section 7 - 0) of ' ision 3 of the Busine rofessionals Code, and my License is in full force and effect.
Licen eCl 3 License No-.: 6S8996
Date: Convactor:
OWNER -BUILDER DECLARATION-
hereby affirm un er penalty of perjury that m exempt from the Contracior's State License Law for the
following reason (Sec. 7031 .5, Business an rofessions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair y structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 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 permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001.:
(_ I• 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
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 lie or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively, 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.).
(_ 1 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:
LQPERNIIT '
Owner:
RONALD TOM,
51542 VIA SORRENTO
LA QUINTA,'. CA 92253
Contractor:
FAMILY POOLS CONSTRUCTION
P 0 BOX 283
LA QUINTA, CA 92247
(760)564-3655
Lic. No.: 658996
VOICE (760) 777-7012,
FAX (760) 777-7011
INSPECTIONS (760) 777-7153.
Date: 12/27/1-0
r .
(j
n:^ yrs fllJ'
l u 2010
01!"1 4! 0 _U41% <1 iA
---------------------------------------_--------
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 3700of the Labor
Code, for the performance of the work for w 'ch this permit is issued. My workers' compensation
insurance carrier and policy number are•
Carrier STATE FUND P ' yNumber 1344032-2010
I certify that, in the p&rnc the work for which this permit is issued, I shall not employ any
person in any manbecome subject to the workers' compensation laws of California,
nd agree that,ifIme subject to the workers' compensation provisions of Section
of the Laborll forthwith comply with those provisions.
Dat Applicant:
WARNIN :'F LURE TO SECURE WORERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP,TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION T HE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, I EREST, AND ATTORNEY'S FEES.
e
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set 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 applicatio ecomes null and void if work is not commenced
within 180 days from date of issuance of su p@rmit, or cessation of work for 180 days will subject
permit to cancellation. 1
I certify that 1 have read this application and state that the bo e i mation is correct. I agree to comply with all
city anountycount ordinances and state laws relating to buildi struction, and hereby authorize representatives
of t eater upon the above-mentioned pr or nspection purposes. _
Dat Signature (Applicant or Agent):
Application Number 10-00001406
Permit . . . . . ELEC-MISCELLANEOUS
Additional desc
'Permit Fee . . . 15.75 Plan Check Fee
3.94
Issue Date . . . Valuation . .
0
Expiration Date 6/25/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7500 PER . ELEC DEVICE/FIXTURE 1ST 20
.75.
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . 15.00 -Plan Check Fee
.00
Issue Date . . Valuation
325
Expiration Date•. 6/25/11
• Qty. Unit Charge Per
Extension
-BASE FEE.
15.00
-------------------------------------------------
Special Notes and Comments
5 FT HT X 15 FT LENGTH BLOCK WALL PER
CITY STANDARDS (2) 1611W X 616" HT
' COLUMNS PER ORCO ENGINERED
SPECIFICATIONS. (2)ELECTRIC CUIRCUITS
FOR LIGHTS. APPROVED PER A.J.
-----
Other Fees . . .BLDG STDS ADMIN (SB1473)
---------------
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 30.75- .00 .00
30.75
Plan Check Total 3.94 -.00 .00
3.94
Other Fee Total 1.00 .00 .00
1.00
Grand Total 35.69 .00 .00
35.69
..LQPERMIT -. -
B`° #
City of La Quinta
Building & Safety Dl don
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 77J,-7012
Building Permit Application and Tracking Sheet
Permit; #
Project Ad _ VZ
9-
Owner's Name: r
A. P. Number.
Address: V/ ;q
Legal Description:
Contractor: /
City, ST, Zip:
Telephone: i
Project Descriptijon�:
Address: v. K
�
City, ST, Zip:
�� GO/� �- • .►
Telephone:
State Lia # :
h
City Lie. #;�
& S
le-eo
Arch., Engr., Designer.
A)
Address:
City., ST, Zip:
Telephone:
;a 4
Construction Type: Occupancy:
State Lic. #:
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 WMTE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIMG
PERMfP FEES
Plan Sets
Pian Cheek submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Pian 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.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for correctionstissae
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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5 1-542 Via Sorrento
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