09-1120 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
09-00001120
Property Address:
80248 VIA TESORO
APN:
772-250-019-44 -30357 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1325
T44�v 4 4 Q"
Applicant: Architect or Engineer:
4� IPS
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT ,r
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: B ^�� License No.: 777699
ate:,)/ TO 0 .mr.ctor: �/ X11 i
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any 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 ($500)•:
1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor($) 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:
LQPERMIT
Owner: 1
TOLL CA V
C/O KEVIN D
8901'E MOUN
SCOTTSDALE,
Contractor:
TOLL BROS, INC.
50400 JEFFERSON STREET
LA QUINTA, CA 92253
(760) 564 - 993 0
LiC. No.: 777699
61x09
------------------
WORKER'S COMPENSATION DECLARATION
VOICE (760) 777-7012
FAX (760) 777-7011
'TIONS (760) 777-7153
Date: 10/22/09
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.
0. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
7-' Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier ZURICH AMERICAN Policy Number WC3878213-03
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 oft -Labor C deCh forthw h comply with those provisions.
// \
ate:`(L Applicant:
WARNING: FAILURE TO SECURE WORKERS' 0 PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PEN ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. IN ADDITION 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 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 ur 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
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
ofthi ounty to enter up he above-mentioned property for inspectio purposes.
aD te: LAignature (Applicant or Agent):
Application Number . . . . . 09-00001120
Permit WALL/FENCE PERMIT
Additional desc . .
Permit Fee. 33.00 Plan Check Fee
00
Issue Date . . . . Valuation . . .
. 1325
Expiration Date . . 4/20/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
9.00 2.0000 HND BLDG 501-2,000
18.00
----------------------------------------------------------------------------
Special Notes and Comments
43 L.F. 6' GARDEN WALL FOR TRASH
ENCLOSURE & 10 L.F. 6' GARDEN WALL
BETWEEN BUILDINGS, BOTH CITY STANDARD.
2007 CODES
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 33.00 .00 .00
33.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 34.00 .00 .00
34.00
LQPERMIT
Oct. 23. 2009 7:51AMCity Of La Quin� ho. 3616 P. 2
Building a SaPery Dat Wan
Permit # P.O. BOX 1504, 78-49S Calle Tampko
- La Qulnta, CA 9, 253 - (7'60) 777.7012
_11 Building Permit Application and Racking Sheet
Project Addtess: O " Q C .� Owncr's'Neme: dI I lUl �
A. P. Number:
Addraw:
Legal Description: City, St Zip,
Contractor:
Address:
City, ST, zip:
Telcphone0)S�tl
State Lic. # rp
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name, of Contact person;
Telephone # of Contact IN
to 3ubmledl
Plan Sets
Structural CGIa,
Truss Cala,
'NHe 24 Calla.
Piood plain plan
Grading plan
Subcontactor hist
Grant Deed
H.O.A. Approval
IN HOUM.
Planning Approuai
Pub. Wks. Appr
School Fees
�':<Y.'.pi:i$���: �.': )'n'J,b• �3�i�f:N t..: r:..:>�i:�nj
TO/TO 3DVcl ld3G 9G-19 VINIiln t1-1
Total Permit Fees
TTOLLLL09L OS:ST 6006/7,0/60
CopsCvctjon Type:
Occupancy:
Project type (zhrle one): New Add'u Alter Repair Demo
Mac
Ee
Sy. I.
# Stories: 9Units:
T% ` = 0 mom-- Fstimn[ed VedtleofProject:
APPLICANT;
DO NOT WRITE BELOW THIS LINE
'd
Rcs'd
TRAC)(CING
PERMIT FEES
plan Check subtalt0ed
Item Amount
tlovtetred, ready for corrtctlons
Plan ;hcck Deposit
Called Contact Peen
Pha Check BAIRO t.
Plans picked up
Coussuetlon '
Ptans resubtolttad
Mer! anlcat
lievicw, ready for correettawbsuc
Elocsalcxl
Called Contact person
Plumbing
I'lans plckcd up
S•Ma.
Plans resubmitted
Graileg
''" Reytew) ready Ibr come 'dons/lsaue
Dev*.]oper Impact Fee
Called Contact Person
A,E�. p.
Date, of portals issue
TO/TO 3DVcl ld3G 9G-19 VINIiln t1-1
Total Permit Fees
TTOLLLL09L OS:ST 6006/7,0/60
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OF SWALE FROM EXISTING GRADE To PROP ED SW
ADJUST CLEANOUT TO GRADE AND INSTALL TX147 CONCRETE RESOD AS REQUIRED WITH PROJECT SOD PLACEMENT
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