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10-0638 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: o:0M-0-06_0_0__638 I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Property Address: 53065 ROSS AVE I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided APN: 767-680-002-8 - - Application description: WALL/FENCE I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Property Zoning: LOW DENSITY RESIDENTIAL - -- - .-Contractor: Application valuation: 550 MAPDEVELOPMENT, _— -- Applicant: - _ _ - - -.— - -- - _-.--_ -- - Arch' tec or E ineer: person in any manner so as to become subject to the workers' compensation laws of California, LAQUINTA 4 4 Qum& BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date Owner: WORK ER'S.COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with RADER STEPHEN"& ANNE I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided 100 N. CRESCENT DR. STE. 300 BEVERLY HILLS, C issued. r'Date:— 67acto 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 - -- - .-Contractor: insurance carrier and policy number are: JUL .15.2010'- 15.2010.MAP MAPDEVELOPMENT, N . _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any 1140 HIGHALND ANU person in any manner so as to become subject to the workers' compensation laws of California, LAQUINTA MANHATTAN BEACH , CA 9 0 ANCE DEPT (310)939-1000 —Date: any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Lic. No.: 813507 (_) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 7/14/10 ---------------------------------------'---------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORK ER'S.COMPENSATION DECLARATION I 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 following declarations: ' Section 7000) of Division 3 of the Business and Professionals Code, and 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 License Class: B License No.: 813507 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is 7��y_L issued. r'Date:— 67acto 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: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EXEMPT 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 which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' 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 and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith com it provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by —Date: any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Appticari -- (_) 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 WARNING: FAILURE TO SECURE 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.). (_) 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, andwho contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( ) 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 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 Date: 7,y';P5ignature (Applicant or t): Application Number . . . 10-00000638 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee 17.00 Plan Check Fee 00 Issue .Date Valuation . . . . 550 Expiration Date 1/10/11 Qty Unit Charge' Per Extension BASE FEE 15.00 1.00 2.0000 HND BLDG 501-2,000 2.00 ---------------------------------------------------------------------------- Special Notes and Comments 22 LN FT X.6 FT HT GARDEN WALL PER CITY --- - --- — -- --- --=-- --- -- ... _ STANDARDS _&..APPROVED 'PLAN : ENCLOSER - FOR— A/C. ---------------------------------------------------------------------------- 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 LQPERAIIT 1 - 1 FIXED PERFORATED 1 METAL SCREEN _ I ❑ (3) HVAC CONDENSERS I 6' HIGH EQUIPMENT yq I ENCLOSURE: 1.°Q 8" CMU SITE WALL W/ PLASTER FINISH 1 v 24" CLEAR 36" CLEAR I _ _ I I 23'-4" FROM F.O. BUILDING I 1 I I 201 S. Santa Fe Ave. 9202 77 Rader Residence t.. Title: Condensor ASK -039 Losa,geles• CA 90012 usA E E — = Enclosure In 213.62WOU n Sheet: A102 tF) 23.62S.7W4 53065 Ross Avenue e<na° La Qulnta, CA 92253 Date: 07.14.10 Scale: Y4 � �� r� Bin # Qty of La Quinta Building 8z Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # / ProjectAddress: $ �G�S �GSS %p v Owner's Namiii, y/ / d✓� L� K �2 v✓ 1� /LN �t �P 'r' A. P. Number: 7 — G(/� Address:�� Legal Description: City, ST, Zip: v `(S gG2 /G Contractor• Telephone:^ Address: �S �- Project Description: City, ST, Zip: /✓� G Side `G vita a % C Cosri t Telephone: l ;:: '.sy,f•+ fY >� City Lic. #; �� rri %� State Lic. # : ' Arch., En DeDesigner.. gr•'si gn � a Address: w City.,`'ST, Zip: LG /6�s✓ �%C Telephone: a / ' Construction Type: Opacy: State Lib. #: C2 <' r $ , ,=q,i 4 . ' �O Project type (circle one): ew Add'n .Alter Repair Dano "4 Name of Contact Person: %, �� env 0c/ Sq. Ft.: �5, S� #Stories: #Units: Telephone,# of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Coles. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Caics. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees e /Gv