10-0436 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000436
Property Address: 52620 AVENIDA RUBIO
APN: 773-283-006-18 -000000
Application description: WALL/FENCE
Property Zoning: COVE RESIDENTIAL
Application valuation: 75 r
T -&t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
ANTHONY.ORTEGA
52620 AVENIDA RUBIO
LA QUINTA, CA 92253
Contractor:
Applicant: Architect or Engineer: K M SERVICE INC
41721 NEVIS PL
BERMUDA DUNES, CA 92203
(760)861-2743
rj Lic. No.: 813897
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/20/10
D °Fn
MAY 9 o zoo
CIW OF U1 QUINTA
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'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
las : B License No.: 813897—
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
r
Date:?
�b Contractor:
issued.
on
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
IF
Code, for the performance of the work for which this permit is issued. My 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 S ATE FUND Policy Number 713-0022980
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 Ciptil, I shall forth'th omply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 byG
-
5 ?AO
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
ate: pplicant: A
(_ 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
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.).
( 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
pursuant to the Contractors' State License Law.).
(_ 1 1 am exempt under Sec. , B.&P.C. for this reasorL
ate: 6 wner
CONSTRU TION 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: P4 1 Pt
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 buil 'ng construction, and hereby authorize representatives
of t/hii fun y to enter upon the above-mentioned pro for inspecti urp ses.
Date:? XSature (Applicant or Agent):
Application Number . . . . . 10-00000436
Permit . . WALL/FENCE PERMIT
_ Additional desc .
Permit Fee . . . . 15.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 75
Expiration Date 11/16/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
Special Notes and Comments
714" & 610" SQUARE PILASTERS AT VEHICLE
AND PEDESTRIAN ENTRIES, ORCO SYSTEM.
2007 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
--------------------
Credited
--------------------
Due
-----------------
Permit Fee Total 15.00
.00 .00
15.00
Plan Check Total .00
.00 .00
.00
Other Fee Total 1.00
.00 .00
1.00
Grand Total 16.00
.00 .00
16.00
LQPERMIT
C2> iV `'a`'
�Z•io2o A +tion Q..� CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE O BY /cw.
,t
QAr
..X111• ��l
4 {{ d
Vii• '�^
it
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit APPlication and Tracking Sheet
Permit #
Q�
Project Address: �,.�f,b�10M �R40
Owner's Name:
A. P. Number:
Address: 1512,, WO �
Legal Description:
Address:
City, ST, Zip: Ch gns's
Telephone: :s��a;.• x�;�...
.: x
Ell
Project Description. 1411 J I t X V 1
City, ST, Zip:
Telephone:
State Lie. # :
City Lie. #;
Arch., Engr., Designer.
Address:
'
City, ST, Zip:
Telephone: ,•. Y,.�. ,v.: %..;::rte
State Lie.
?......y
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
D:#
its:
U::I
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 Calcs.
Reviewed, ready for corrections
Pian Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cities.
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
Plan"picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
ha Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
-Pub.-Wks.-Appr
-Date-of permit-igsue.. _ _ -----
--
- — -- ---
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School Fees
Total -Permit Fees