10-0494 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92.253
Application Number:
Z 00000494
Property Address:
81411 PEARY PL
APN:
767 -680 -023 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
7518
Applicant
.1 Tiht 4 4 Q"
Architect or Engineer:
WIM
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: B1 LicenseNo.: 673385
Date:lo 1-10 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 1$5001.:
(_ 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 contractors) licensed
nuraiiant to the Contr ra-7,.' Crgtg I iggngg 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:
LARSEN TERRENCE A.
18363 CALLE STELLINA
RANCHO SANTA FE, CA 9209
_.
--Contractor: .
STROTHER CONSTRUCTION CO,L
1 MIRADA CIRCLE
RANCHO MIRAGE, CA 92270
(760)770-5501
Lic. No.: 673385
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
9/10
i i `��� G � f -U �••Uii
WORKER'S COMPENSATION DECLARATION
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 STATE FUND Policy Number 0009332-2009
certify that, in the performance of the work for which this permit is issued, 1 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
�lyn 3700 of the Labor Code,
IIts�halll forthwith comply with those provisions.
Date: 1D ` _' 0 Applicant: 1"W ]")„1�,)
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 re uest and for
wnOse benent WOW IS pefTWM66 Ui5def 6r 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.
Date:L� Signature (Applicant or Agent): ; 1 Jd r
Application Number . . . . . 10-00000494
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 99.00 Plan Check
Fee
.00
Issue Date . . . .. Valuation
. . .
. 7518
Expiration Date . . 12/06/10
Qty Unit Charge Per
Extension
BASE FEE
45.00
6.00 9.0000 THOU BLDG 2,001-25,000
54.00
----------------------------------------------------------------------------
Special Notes and Comments
270 LN FT X 6 FT HT GARDEN BLOCK WALL;
---------._.._ -'48 LN -FT-X' 4 FT HT" -GARDEN "BLOCK -"WALL PER—
ER
CITY
CITY STANDARDS & APPROVED PLANS. ALSO 65
LN FT X 3 FT HT GARDEN WALL.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
-----------------------------------------------
Permit Fee Total 99.00 .00
----------
.00
99.00
Plan Check Total .00 .00
.00
.00
Other Fee Total 1.00 .00
.00
1.00
Grand Total 100.00 .00
.00
100.00
LQPERMIT
Din #
Qty of La'Quinta
Biffldng & Safety MvIdon
P.O. Box 1504, 76-495 Calle Tampko
La Quanta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: I
fUC4_ '.
-Owner's Name: L_
A. P. Number \1
Address:
Legal Description: L6+ 61A,(vza&,-3-av_->7 6.1
Contractor:
'City, ST, Zip:
Telephone:
Project: Description: k 0 Cj< &MIS Z
Address: C-)(- V- Alp
C,j
LC
City, ST, Zip: 0_�CL6 A%/' Ckei't ( 9227 0
2-70 4cle..., o, 60(tU1GJL__
Telephone:70-7"70-STO
,State Lic. # City Lie. C 31 F-7
Arch., Engr., Designer.
K q, 6atj,._a
Address:
City., ST, Zip:
Telephone: Construction Type: Occupancy:
State Lic. #: Add'r. Alter Repair Demo
Project type (circle one): ew
Name of Contact Pawn: Sq. Ft.: T# Stories: _T#Units:
Telephone # of Contact Person:
Estimated Value of Project -1 6)
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Reqld
Rec'd
TRACIMG
PERMIT FEES
Plan Sets
Plan Check submitted
item
Amount
Structural Calm
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Ilde 24 Cales.
Plans picked upcdon
Coustru
Flood plain plan,
Plans resubmitted
Mechanical
Grading plan
H_
V Review, ready for correctionarlssue
Electrical
Subcontactor IAst
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Reylew, ready for corrections/mat
Developer :mpact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
ow