06-3352 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
0.6_O0003.3.52
Property Address:
52250 AVENI"DA OBREGON
APN:.
773-255--002-2 -000000-
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
2467
Applicant:.
Architect or.Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
• I.hereby affirm under penaltyof perjury that am licensed under.probisions of Chapter.9 (commencing with
,,.Section 7000) of Division 3 of the Business and 0tofessionals Code,°and my License is in full force and effect.
,.'License Class: ,License No.:
;•
—'7 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,Jmprove, demolish,"or repair any"structure, prior tdits issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed'pu'rsuant 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'exempttherefrom and the basis for.the alleged'exemption ; Any violation of, Section 7031.5 by
• any applicant fora "permit subjects the applicant to a civil penalty of.not morean thfive hundred dollars ($500).:
( )0 1 I, as ownerbf .tl a 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,6cerise Lawdoes notapply to an owner of property who builds'or improves thereon,.
and who dods
�the.work himself or herself'through his or her own.employees; provided that the ,
improvements`are n6t.inie'nddd or offered for sale. If; however„the building or improvement is sold within'
oneyear'of completion, the owner -builder will have the'burden of proving that he or she'did not build or
improve'forthe purpose of sale::
1 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 aw'doesnot apply to an owner of r
property who builds or im"proves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.). -
I_) I am exempt under Sec. , B.&P.C. for this reason -
�Da
rv-ri
C 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 (760) 777-7153
Date: 9/18/06
Owner:
SERVIN DANIEL
52250 Avenida Obregon
LA QUINTA, CA 92253
---------------------------------
Contractor: D e
Owner
SEP18 2006
C1TY..0F LA QUINTA-
ICIGIA►1Hr n ---
-
---
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consenvto self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for whichihis permit is
issued. C
_ I have and will maintain workers' compensation insurance, as required by Section'3700of the Labor
Code; for_the performance of the work •for which this permit is--jssued. M_ y workers compensation
insurance carrier and policy number are: -
.Carrier Policy Number
b 1 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 shouldecome - ct to the workers' compensation provisions of Section
700 of the Labor Cod I shall f rth complywith those provisions.
r
Date, Applicant:.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINALPENALTIESAND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS'($.100,000). IN ADDITiON.TO THE COST OF COMPENSATION,. DAMAGES AS'PROVIDED FOR IN
SECTION 3766 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 a•nd'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 6 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 buildingconstryye ion, and hereby authorize representatives
of this count to a ter upon the above-mentioned ra €c ' rposes.
Late)— 9 /� Signature_IApplicanYo�� Agent): -
Application Number . . . . . 06-00003352
Permit . . . WALL/FENCE
PERMIT
Additional desc . .
Permit Fee . . . . 54.00
Plan•Check
Fee
.00 .
Issue Date . . . .
Valuation
. . .
. 2467
Expiration.Date . . 3/17/07
Qty Unit Charge Per
Extension
BASE
FEE
45.00
1.00 9.0000 THOU BLDG
2,001-25,000
9.00
----------------------------------------------------------------------------
Special Notes and Comments
90 LF 6' & 10 LF 5' BLOCK WALL ALONG
SOUTH P/L PER CITY STANDARD.
Fee summary Charged
-----------------
Paid
Credited
Due
--------------------
Permit Fee Total 54.00
----------
.00
----------
.00
54.00
- Plan Check Total .00
.00
.00
.00
Grand Total 54.00
.00
.00
54.00
LQPERMIT
Bin #
City of la Out=
BuildingSafety .Division
P.O. Box 1504; 78495 Calle Tampico
La•Quinia, CA 92253 - (760).777-7012
Building-Nr ft Application and Tracking Sheet
Permit
Project Address: r'2 (�
J —� c 1�P71 / pi yC O
Owner's Name: '
A. P. Number:
Address: SZ
Legal Description:
:City, ST, Zip:
Contractor:
Telephone:( .,
Address:
jProject Description:,' t
City, ST, Zip: ..
Telephone:
D .
State Lic. # : City.Lic. #:
Arch., Engr., Designer:
—
D s
Address:
City, ST, Zip:
Telephone: K`
State Lic. #:
Name of Contact Person:
h Construction'Type: Occupancy:
i. Project type (circle one): New Add'n Alter Repair Demo
Sq: Ft.: /o?
#Stories:
#Units:
Telephone # of Contact Person:
[Estimated Value of Project:
APPLICANT.: DO. NOT WRITE BELOW THIS LINE
#
Submittal.
Req'd
Recd-
TRA CHING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
'Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for correctionsrssue
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 corrections/issue
'
'Developer Impact Fee .
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
r.
OWNER/BUILDER= INFORMATION
Dear Property Owner:
An application for a _.building permit has been submitted in your name listing.yourself as the builder of the property
improvements specified.
For your protection you should; be aware that as "Owri&Auilder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by,property'owners unless they ar&personally performing their
own work. If your work is being performed by,someone.?other than'yourse'lf, you may protect yourself from possible
liability if that person applies for the proper permit in his..or her'name.
Contractors are required by law to be licensed and .bonded by the State of California and to, have a business license
from the City or County. They -are also required by law'to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of, Various', trades that you plan to subcontract, you should be
aware oP the following information for'your benefit and protection:
If you employ or otherwise engage any, persons other than your immedia[efamily and the .work (including materials
and other costs) is $200.00 or' more, for the entire project, and 'such .persons are 'not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the-State.and Federal Government-as;an employer and you are subject
to several obligations include State;; and Federal income tax `'withh'olding,.fede"ra- i sociaP security taxes, worker's
compensation insurance;, disability insurance costs. and unemployment co'mpe.nsation- contributions.
There may be financial,,risks for you if you do not carryout these obligations, and these risks'aretespecially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contacf the- Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For'inore`specific information about your obligations under State
Law, contact the.Department;of Benefit Payments and the Division of`IndustrialAccide'nts.
If the structure is intended for sale, property owners. who .are not licensed contracts are allowed to perform their
work personally or through their -own employees, without a licensed contractor or,subcontractor, only under limited
conditions.
A frequent practice of unlicensed -persons professing tw be contractors is to' secure an "Owner/Builder" building
permit, erroneously implying:tfiat the property owner is providing hi's or her own labor and material personally.
Building permits are not required to be sigged by prciperty owners unless they are=performing their own work
personally.
Information about licensed contractors may be obtained by, contacting the Contractors' State License Board in your
community or at 1020 N., Street, Sacramento, California 95814.
Please complete and return the enclosed owner-buil'der.verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
r., n,,:. re 01142
PROPERTY ADDRESS
PERMIT NUMBER(S)
Building
Address
Owner
C
Mailing
Address
City
4 14
m
P.O. BOX 1504 APPLICATION ONLY
' t7&105 CALLE ESTADO
-,2.5-(7 V e Rea o N /LA QUINT/A, CALIFORNIA 92253
d(r->
Contractor Q
OFI Ro c
Zip
(9W -i µ •
B
A.
Tel.
3�7-z3/S7 L
City
Zip
Tel.
State Lia
& Classif.
City
Lic. #
Arch., Engr.,
Designer
Address '
Tel.
City Zip . State
LIC. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he 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 (8500).
17 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner or property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such 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 did not build or improve for the purpose of sale.)
I.1 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
17 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT., U, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued: (Sec. 3097, Civil Code.)
Lender's Name-
Lender's
ame Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
1 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 sof this city to enter the above-
mentioned
property for inspection purposes.
Signature of applicant Date
4 Mailing Address
City, State, Zip
FINANCE
UILDING: TYPE CONST. OCC. GRP.-
P. Number 77 3 �11� 51' Z
Le Description
oject Description
Sq. Ft. No. No. Dw.
Size /ZZ "L Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
e ,
/ 2Lir�2.[
Aimated Valuation
PERMIT
�)_< 'AMOUNT,
Plan Chk. Dep.
Plan Chk. Bal.
a'• f 1 F��'`'�
Const.
t
Mech.
7
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances
Front Setback from Center Line
Rear Setback from Rear Prop. Line ' f
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date - Permit
Validated by:
Validation:_