13-0058 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tiht 4 4`Q"
Application Number: 13-00000058
Property Address: 79138 AVENUE 48
APN: 649-030-069-M -31310 -
Application description: STRUCTURES OTHER THAN. BUILDINGS
Property Zoning: HIGH DENSITY RESIDENTIAL
Application valuation: . 736
Applicant: Architect or Engineer:
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 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: A License No.: 689723
Date: Contractor:
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, 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 Cade: 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS -(-7.60),777-71,53
Owner:
SANTA ROSA DEVELOPMENiy�
/ o 3 2013
46753 ADAMS ST LA QUINTA, CA 92253(760)771-3345 t^lYOrrL ►±
Contractor:
PAULEY CONSTRUCTION INC
2021'W MELINDA LANE
PHOENIX, AZ 85027
(623)581-1200
Lic. No.: 689723
------------------
WORKER'S COMPENSATION DECLARATION
I/02/13
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 LIBERTY INS Policy Number WA763DO04260032
I certify that, in the performance of the work for which this permit is issued, I shall not employ ar y
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 those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' 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 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 purposes.
Signature (Applicant or Agent):
Application Number . . . . . 13-00000058
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 21.00 Plan Check Fee
13.65
Issue Date . . . . Valuation
736
Expiration Date 7/16/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
3.00 2.0000 HND BLDG 501-2,000.
----------------------------------------------------------------------------
6.00
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 34.25 Plan Check Fee
8.56
Issue Date . . . . Valuation
0
Expiration Date 7/16/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
.75
1.00 18.5000 EA ELEC SVC <=600V/<=200A
- m
18.50
---------------------------------------------------
Notes and Comments
BLOCK RET. WALL 46 LIN. FEET X 2-4FT HGT
(ORCO DESIGN) FOR VERIZON CABINET
INSTALLATION. ELECT.PERMIT INCLUDED.
EXIST METER PEDESTAL 70' W. OF HIDDEN
SHADOW RANCH ON LETTERED LOT "M". 2010
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
---------------------------------------------------------
Permit Fee Total 55.25 .00 .00
55.25
Pian Check Total 22.21 .00 .00
22.21
Other Fee Total 1.00 .00 .00
1.00
Grand Total 78.46 .00 .00
78.46
LQPERMIT
ern.#
Permit #
ProjectAddtess: 7,9138 Ave
Cid}/ Of Ld Quintd
Butwkig a safety Division
P.O. Box 1504,78-495 Cafe Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit -Application and Tracking Sheet
48' Owner's Name:. Verizon .
A. P: Number
Address: 295 S Sunrise Wa •
Legal Description:
City, ST, lap: Palm Springs Ga -92262
Contractor. Pauley Construction _ Telephone:
Address: 2 0 21 West
Melinda Lane Project Description:
ciry,ST,zip: Phoenix ,AZ Verizon to replace damaged
Telephone: 760-347-7608 cabinet , new retaining. wall
Stawl,ic.#: 'City Lie.A new abinet. and restore
Anfi.,Engr.,Designer, Bob Matheis landscape see attached insurance
Address: 19 21. w
p ap e•r s .
City, ST, zip: Upland CA
91786
Telephone: Construction Type: , Otxupancyc
State Lic #: Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: John Pomroy Sq. FL:#Stories: #Units:
Telephone I of Contact Person: •. 7 6 0- 3 4 7— 7 6 0 8 Estimated Value of Project:
N Submittal Rcq'd
APPLICANT: DO NOT WRITE BELOW THIS UNE
Reed TRACMG PERIM_ITFEES
Plan Sets
Plan Check submitted % Item Amount
Stmetuial Cales.
Reviewed, ready for corrections Plan Check Deposit
Truss Cater.
Caped Contact Penan Ytaa Check Balance.
'tide 24 Calci.
Plana picked up Constraedon
Flood plain plan
Plans resubmitted.'. Mcthariical
G(ading plan
2`! Review, ready for correcti sfastic f i 1 Electrical
Subeostaetor List
Called Contact Persons Plumbing
Grant Deed
Pians picked up S.KL
HAA. Approval
Plans resubmitted Grading
UV HOUSE.-
Review; ready for eorreetionstissne Devdoper Impact'?ee
Planning Approval
Called Contact Person A.1.P.P'
Pub. Wks. Appr
Date of permit Issue
Sebo61 Fees
Total Permit Fees .LF(Q