06-3989 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
. I
Application Number:06-000
03899
_ —
Property Address:
52600 AVENIDA OBREGON
APN:
773-285-005-4 -000000-
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1624
T-vy 4 4 Q"
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: License No.:
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, 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
th he or she it exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
a applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( ) 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 _ 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
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: 11/15/06
Owner:
JAVIER RUVALCABA
52600 AVENIDA OBREGON
LA QUINTA, CA 92253
---------------------------------
Contractor: D
Owner
NOV 151006
-------------------
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 Policy Number
41- 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 shout become subject to the workers' compensation provisions of Section
3700 of the Labor Cod I shall forthwith corn w h tho provisions. .
Date:(Applicant:_ (/
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 1$100,0001 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 underor' 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 h authorize representatives
of county upon the above-mentioned pro- perty or inspection purp es. I
r
Date: 06 Signature -(Applicant -or Agen[I: O/ y lr / / sV n re A
Application Number . . . . . 06-00003989
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit -Fee . . . . 39.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 1624
Expiration Date . . 5/14/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
12.00 2.0000_HND BLDG 501-2,000
24.00
----------------------------------------------------------------------------
Special Notes and Comments
75 LF 5' BLOCK WALL IN FRONT YARD &
INTERIOR SIDEYARD (INSIDE EXISTING 2'
RETAINING WALL). CITY STANDARD.
Fee summary Charged Paid
-------------------------------------
Credited
--------------------
Due
Permit Fee Total 39.00
.00
.00
39.00
Plan Check Total .00
.00
.00
.00
9: Grand Total 39.00
.00
.00
39.00
LQPERMIT
Bin ff
Permit ff
Project Address:
City..;ofla Quinta
Building u Safety Division
P.O. Box 1504 78-05 Calle Tampico
La Qdinta, CA 9225.3 - (760) 777-7011
Building Permit Application and Tracking Sheet
Owner's Name:** 6
A. P. Number.
Address-
57
Qity, ST, Zip:, . I �L a n a q 2
Legal Dekription:
Contractor:
Telephone; (7e 0 re CY L7 72- IS
Address:
Prbject Description:
r
City, ST, Zip:
Telephone:
State Lic. #
City Lic.i .
I.Clion Type, Oceupancy:
Arch., Engr-, Designer:
Address:
City, ST, Zip:
Telephone:
State Lic.
Name of Contact Person:
on
type (circle one) :(EeDw Add'n Alter Repair Demo
Sqt FL: Stories: # Units:
Estimated Valdeqf Project.
Telephone # of Contact Person:
APPLICANT:
*DO NOT W'
PJTE.BELOW THIS LJNF.�
N
Submittal
Plan Sets
Req!a::
Recd
TRA .,
Plan Check submitted
PERMIT FEES
Item Amount
Structural Caics.
Reviewed,,.ready for."rrections
Plan Check Deposit
Truss Calcs.
Called Contact Person'
Pian"Clieck Balance
Energy .Gales.
us picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading.plau,
24 Review, ready for correctio*Wissue
'Electrical
Subcontactor List
Called Contact Person
'Plumbing
Grant Deed
Plans picked tip
H.O.A. Approval
'Plans resubmitted..
Grading
IN HOUSE:-
Rivieyr; ready for co6 fi,
rec ionsrissue
Developer impact Fet�
JPlanning ApprovalC
ailed Contact Person
A.I.P.P.
..Pub. Wks. Appr
Date of permit,issue
School Fees
Tgtal.Permit Fees
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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 `!Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required. to be signe&by property owners unless they are p
mersonally performing their
own work. If your work is, being perfored' by someone; other than•yourself, 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 of the following. information for your benefit.and protection.
If you employ or otherwise eingage any persons other than your immediate family, 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. inciude State Wand. Federal, income, tax withholding, federal social security taxes, worker's
compensation insurance, disability, insurance costs and.unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance. ;
For more specific information about your obligations.under Tederal taw, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration)..For more specific`information about your obligations under State
Law, contact the Departrrient.of'Benefit Payments and the Division of Industrial Accidents.
If the structure is intended foesale, property owners who are not licensed contractors are allowed to perform their
work personally or through their owd employees; without; a'licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors isto secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or.her..own, labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed. contractors maybe `obtained by confacting°the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California- 95814.
Please complete and return; the. enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building pe'rmirwill not be issued until the verification'is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND.SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (7,60) 777-7011 �1
/ e e
O R'S SIGNATURE/DATE
PROPERTY ADDRESS
d6-�q��
PERMIT NUMBER(S)