09-0044 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09.-00000044 -
Property Address: 80249 VIA TESORO
APN: 772-250-019-39 -30357 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1325
c&ht 4 4 Q"
Applicant: Architect or Engineer:
1
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Cl/ :
asssB LicenseeNNon.: 777699
Dateir2'Jv! Contractor: ?o // /J�yk," � Js
OWNER -BUILDER DECLA ION
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 _ 11, 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 improvesthereon,
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, 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.).
I—) 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.I.
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
TOLL CA V
C/O KEVIN D DUERMIT
8901 E MOUNTAIN VIEW
SCOTTSDALE, AZ 85258
Contractor:
TOLL BROS, INC.
50400 JEFFERSON STREET
LA QUINTA, CA 92253
(760)564-9930
Lic. No.: 777699
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7154
Date: 1/16/09
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.
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 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 of the Labor Code, I shall forthwith comply with thoVseviDate: G9 Applicant:WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UNDRED THOUSAND
DOLLARS ($100,000). 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 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
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
of this county to enter upon the above-mentioned property for inspection pu oses.
Date4 i/0"Cl f Signature (Applicant or Agent):
' t
Application Number . . . . 09-00000044
Permit . . . . . . WALL/FENCE PFRMTT
AddlLlona1 aesc
Permit Fee . . . . 33.00 Plan Check Fee
.00
Issue Date . . . . Valuation.
1325
Expiration Date 7/15/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
9.00 2.0000 HND BLDG 501-2,000
18.00
----------------------------------------------------------------------------
Special Notes and Comments
53 LN FT X 6 FT HT GARDEN WALL PER CITY
STANDARDS & APPROVED PLANS.
----------------------------------------------------------------------------
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
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73 REQUIRES EVERY PERSON PLANNING TO CONDUCT EXCAVATION
rIFY A REGIONAL NOTIFICATION CENTER AT LEAST TWO DAYS PRIOR TO
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TIFICATION WITHOUT WHICH AW .-PERMIT OR 'DIRECTIVE GIVING
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73 REQUIRES EVERY PERSON PLANNING TO CONDUCT EXCAVATION
rIFY A REGIONAL NOTIFICATION CENTER AT LEAST TWO DAYS PRIOR TO
;AVATION AND, IF PRACTICAL, THE AREA TO BE EXCAVATED SHALL BE
INEATED. A VERIFICATION NUMBER WILL: BE GIVEN UPON SUCH
TIFICATION WITHOUT WHICH AW .-PERMIT OR 'DIRECTIVE GIVING
3MISSION TO EXCAVATE SHALL BE INVALID. VERIFICATION NUMBERS
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CITY of LA 0
F�' F Plan ;pit
050-7(
UNDERGROUND SERVICE ALERT NOTE.
3030 SATURN STREET, SUITE 200
BREA, CA, 92621 PROTECT IfV PLACE ALL EXIST. C � NC, DRIVEWAY APPRI
1-(800) 227-2600 CONC. ;PARKING AREAS,CURBS,FlR HYDRANTS,METER B
DETECTbR pCHE;CK; VAULTS,CLEAN2 TS AND MANHOLES,.
I1D ATQII:'D CVICT l�` . ". IDCO /� r. f%it ITIrC`
N
CITY of LA 0
F�' F Plan ;pit
050-7(
UNDERGROUND SERVICE ALERT NOTE.
3030 SATURN STREET, SUITE 200
BREA, CA, 92621 PROTECT IfV PLACE ALL EXIST. C � NC, DRIVEWAY APPRI
1-(800) 227-2600 CONC. ;PARKING AREAS,CURBS,FlR HYDRANTS,METER B
DETECTbR pCHE;CK; VAULTS,CLEAN2 TS AND MANHOLES,.
I1D ATQII:'D CVICT l�` . ". IDCO /� r. f%it ITIrC`
Jan, 11. 2009 12:42AM
No. 0921 P. 2
Bln
City of La Quinta
Building at Safely Divblon
Perinlc a
P.O. Box 1504, 78-495 Calle Tampico
La Qulhta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: -c2—q2
Owncr''s Name:TT
ie :L/ lC.
A_ P. Number.
Address; iia
Legal Description:
City, S'r, "Lip: 010,
Contractor a� / � �.� Telephonefil%�a,� s2')S.-c to
Address:
Project Description;
City, ST, Zip;
3 p4" Cs �
Telephone:
�7c
Statc Lic, 0:
City Lic. 8:
Arca„ Engr., Designu;
Adders:
City, ST, Lip:
Tolcphorle:
Cunsauetion Type: Occupancy;
State Lie. #:
I�t0iod type (circle nae); New ALd'n Alter Rcpair Demo
Name of ConcofContnc
T� Sq. Pt # 9turiCs M Unlis:
Telophone 4 of son_
0 7s902Fstima[ed Value of Pmjcct: 2Rj
APPLICANT: 00 NOT WRITE BELOW THIS UNE
# Submittal Re -d
Redd TRACKLNG PERMIT FEES
Ylan Sets
Plan Chftk wIbmitted [tem Atttoua[
Structural Calls.
Reviewed, reedy for eorrectious Plan Chock Dcpovlt
Trws Ucs
eJ COn[act p!r 9Ub PIAY ChMIC Balance
�IlCrgy Coley.
#PIWIL-sPicked up
Flood plain plats
s resubmitted Mechanical
Crading plan
Y' Revinv, ready for eorrectiotairmae l3.lectrical
Subeoutaetor i.ist
C><Ilod Contact Perron t'luu►biag
Grant Dccd
Plans picked up
TLO.A. Approval
Plana renubgtllted Grading
1N HOUSE:-
"' Review, ready for eurrectioturisaue bevelofxr impact Fec
Planning Approval
Called Conteh Perron A Lk P-
Pab, Wks. Appr
Date of petwil issue
School Feel:
Total Permit Fees
TR/TGA anH,a IAgn hmR hINTnn hn TIOLLLL09L 00:Lti . 600Z/GT/T0