09-0635 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number. 1:�97_-00
Property Address: 48-239 VISTA DE NOPAL.
APN: 646-110-006- - -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 520
T414t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
HOLLINSHEAD
48239 VISTA DE NOPAL
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/22/09
T' Contractor:
Applicant: Architect or Engineer: BRAUCKMANN INC
50855 WASHCA
IT N.S REET,. #227
LA
(760)48S-9269
1'' l Lic. No.:. 781834
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 followingdeclarations: "
Section 7000) of Division 3 of the Business and Professionals e, a;Zi 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
- Lice�S: B - ice se ( 8'1.834 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
-Dat �� ontractor. _ -_ 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 -BUILDER DECLARATION - insurance carrier and policy number are:
hereby affirm under penalty of perjury that am exempt from the Contractor's State License Law for the. Carrier EX MPT - Policy Number EXEMPT
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the performance of the work for ' permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior toitsissuance, also requires the applicant for the, " person in any manner so as to becomes ct to the er:n 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 becomes ect to th com ierrprovisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3' of the Business and Professions Coder or 00 of. the Labor Code, I shall f i se provisions. - .
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 fivehundred dollars ($500).: .D�URE
t: r -
1 _ 1 1, 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 WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
.. Contractors' State License Law does not apply to an owner of property who builds or improves thereon,. SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 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 1 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 permit subject 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 contractorls) licensed 4 . Each person upon whose behalf this application is made, each person at whose request and for
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 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
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:
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
cit�cou
y rdinances and slate laws rel to bui ing constructio hereby authorize representatives
of enter pon the ova- erred prop y fo a tion purposes.
Da�� re ( p nt
LQPERMIT - - - -- _ — - - -
Application Number 09-00000635
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 17.00 Plan Check Fee
.00
Issue Date . . . Valuation . . .
. 520
Expiration Date 12/19/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 2.0000 HND BLDG 501-2,000
2.00
- -------------------------------------------
Special Notes and Comments
24 L.F: 5' GARDEN WALL AT FRONT YARD &
68 L.F. 2' GARDEN WALL AT REAR.YARD,
CITY STANDARD. 2007 CODES.
--------------------------
Other Fees . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 17.00 .00 --.00 -----17.00
Plan Check Total .00 .00 .00
.00•
Other Fee Total 1.00 :00 .00
1.00
Grand Total 18.00 .00 .00
18.00
LQPERM[T
Bin #
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application. and. Tracking Sheet
Permit #
Project Address: '/ 823 1 Vi S �-4 1V o FIFE
Owner's Name:
A. P. Number:
Address: 'G( Z3� . vrs r4 f /1/0 r- -L
Legal Description:
City, ST, Zip: t) Int. �� tea- .ci ZZ63
Contractor: 9
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Telephone• 26D �'$,� at -Liv �'
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Address: Sflg�s W�Kw iBu. �LZ7
ProjectDescription: r �rt�12rJrr.�( ttA4LG. J� i
City, ST, Zip: V I l t�f'/}f'o
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Telephone: o
State Lie. # : I
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City Lie. C
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Arch., Engr., Designer:
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Address:
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City., ST, Zip:
Telephone:'
State Lie. #:
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Construction Type: Occupancy:
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Project type (circle one): New. Add'n Alter . Repair Demo
Name of Contact Person: �.�,.e, b tWU-U�
Sq. Ft.:#Stories:
# Units:
Telephone # of Contact Person: Fs, 5 ?4 9
d Value of Project: 2--00-0
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
. Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cale s.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctionsrissue
Electrical
Subcontactor List
Called Contact Person.Plumbing
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:- .
3d Reyiew,.ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
4