12-0926 (BLCK)ce000lil�� 4
P:O. BOX 1504 ^�
78-495 CALLE TAMPICO
LA QUINTA', CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 12-00000926 _ Owner:
Property Address: 52849 ROSS AVE SUGARMAN, M&B FAMIL
APN: 767-670-017-21 -33076 - 9440 SANTA MONICA B
Application description: WALL/FENCE BEVERLY HILLS, CA 9
Property Zoning: RL AG/EQ. OVERLAY
Application valuation: 10799
Contractor:
Applicant: Architect or Engineer: DBCA INC
P.O. BOX 1482 '
LA QUINTA, CA 92247
(760)393-5271
`Ipir Lic. No.: 915336
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9.(commencing with
Section 7000) of Division 3 of the Busines n Professionals Code, and my License is in full force and effect.
Lice se Class: B License Ng':
915336
Date: �-S �2- ntracto
V 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 7631.5 by
any *applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
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
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 ownei-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.).
(_ 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: Nth
Lender's Address: '
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
A Date:
Y ST
Ll 407pp11n s q
0 0 r'Uu 1 u 2012
CITY OF LA QU1NTA
FINANCE;)EPT.
8/15/12
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.
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 TRAVELERS Policy Number YJUB282D7797-12
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 shoult�,b oma bject to the workers' compensation revisions of Section
3700 of the Labor C I shall f " ith c ply with s e s'
te:a-16-1 ` licant:
WARNING: FAILURE TO SEC E WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (9100,000). 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 dale 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 ' tion is corract.
.I agree to comply with all
city and county ordinances and state laws relating to buildin nstructi n, and hereby authorize representatives
of this county to enter upon the above-mentioned prope for irtspec i n pur
gnature (Applicant or Agen
LQPERMIT
Application Number . . . . . 12-00000926
PermitWALL/FENCE.PERMIT,.,
Additional desc ".
Permit Fee . . . . 126.00 Plan Check Fee
00
Issue Date . . . Valuation
10799
Expiration Date 2/11/13
Qty Unit Charge Per
Extension
BASE FEE
45.00
9.00 9.0000 THOU BLDG 2,001-25,000
81.00
----------------------------------------------------------------------------
Special Notes and Comments
165 L.F. 7-14" & 190 L.F. �6' GARDEN
WALLS, PROTO II SYSTEM. (9) 7' 2' X 2'
PILASTERS., ORCO SYSTEM. 2010 CODES.
------------------------------------------------------ -----------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
.------
1.00
Fee summary Charged Paid Credited
Due
Permit -Fee Total 126.00 .00 ."00
126.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 127.00 .00 .00
127.00
LQPERMIT
i
Permit #
�C Project Address:
A. P. Number:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
SubcontactoList
J,r
oval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta''
Building & Safety Division - .
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
5S 4ii -F— wner's Name: C:::Z" t �- — 76=1
i
7 -O" '4114 A 7
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Series: #Units:
1� �G11 / _7 %% (J Estimated Value of Projec
APPLICANT: DO NOT WRITE BELOW THIS LINE
'd Recd TRACKING
Plan Check submitted
Reviewed, ready for corrections
Called Contact Person
Plans picked up
Plans resubmitted
roe Review, ready for corrections/issue
Called Contact Person
Plans picked up
Plans resubmitted
Review, ready for corrections/issue
Called Contact Person
Date of permit issue
PERMIT FEES
Item
Plan Check Deposit
Plan Check Balance
Construction
Mechanical
Electrical
Plumbing
S.M.I.
Grading
Developer Impact Fee
A.I.P.P.
Total Permit Fees
Amount
Contractor: � U.
c
Address:
Cit), ST, Zip:
Telephone:
State Lic. #
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Flood plain plan
Grading plan
SubcontactoList
J,r
oval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta''
Building & Safety Division - .
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
5S 4ii -F— wner's Name: C:::Z" t �- — 76=1
i
7 -O" '4114 A 7
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Series: #Units:
1� �G11 / _7 %% (J Estimated Value of Projec
APPLICANT: DO NOT WRITE BELOW THIS LINE
'd Recd TRACKING
Plan Check submitted
Reviewed, ready for corrections
Called Contact Person
Plans picked up
Plans resubmitted
roe Review, ready for corrections/issue
Called Contact Person
Plans picked up
Plans resubmitted
Review, ready for corrections/issue
Called Contact Person
Date of permit issue
PERMIT FEES
Item
Plan Check Deposit
Plan Check Balance
Construction
Mechanical
Electrical
Plumbing
S.M.I.
Grading
Developer Impact Fee
A.I.P.P.
Total Permit Fees
Amount