05-2272 (BLCK)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO _ FAX (760).777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING `& "SAFETY DEPARTMENT INSPECTIONS (760) 777-7153.
BUILDING PERMIT .
Date: 6/10/05
Application" Number: 05-0_0-0-0.2272 Owner:
Property Address: 52795 AVENIDA "OBREGON SE AY HAL EDWARD
APN: .773'=31.4-017-4 -000000-
52795 AVENIDA OBREGON
Application description: WALL/FENCE LA. QUINTA, CA 92253
Property2oning: ` COVE RESIDENTIAL--------------------------,-------.-
'Application Valuation: 2066"
.ti
Applicant: Architect or: .eer ''/�/ � Owner- ,
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LICENSED CONTRACTOR'S.DECLARATION - - ,.y WORKER'S COMPENSATION DECLARATION-
• °: - '- '
heretiy affirm under penalty of perjury that ram,licensed _uitder:provisions.of Chapter 9 lcommencing with. - • - Idiereby 4ir— finder'penalty of. perjury oue'of the followmg�tleclaranons -
'Section 7000) ofDivjsion 3 o the Business°and Professionals Code; anA�my License is in ful4.force.and;effect. _ I have and will maintain'a certrficate,;of consen{-to'self-insure foi. _workers compensation;:as provided s
License Class. License No:: - - `for,.by Section 3700 of the Labor=Code, fo'i the performanceof the work.for which this,permit is
.. ..issued ..: - ..
Date: ' Contractor:_ I hale and'will'maintain workers' compensation insurance, as required py Section 3700 of the Labor
"- Code, for'. the
of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION _ insurance carrier and policy number are:
heretiy affirm under'penaltyof perjury that I amt;exempt from the.Confractor'sState-License Law for the _Carrier Policy Number
wi
follong reason (Sec. 7031.5, Business and_Professions Code: Anycitybr;oounty that requires a'permit to - � 11 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 b ome subject to the workers' compensation laws of California,
permrtito flea signed statement that he or she ls.licensed,-pursuant to'thepioyisjonsof-theContractor's State and agree that; if I shouldbeco ub' to the workers', compensation provisions of Section
License�Law'(Chapten9 (commencing with Sectiori_70b6),,of:Division 3 of the Business and Professions Code) or k1Z1.41 f the Labor Code, I's - I i comply with those provisions. .
that he%or she is exempt therefrom and the bans for the alleged exemption.. Any violation of Section 7031.5 by //- `
any applicant for a -permit subjects. the applicant toa civil.penalty:of not more than five hundied dollars ($500).: Date: 1 �(/.vpplican (, 1 I, 53`"ner:of.ihe propehy,.or my.employees with"wages as their sole�compensation,.�will do the :work, and �z the structure is not intended or offered for sal' (Sec. -7044, Business and Professions,Code: The WARNING: FAILURE TO. SECURE W KERS' /MNATION COVERAGE ISUNLAWFUL,.AND SHALLContractors�State,License Law does not apply'to an owner'of property,who builds orimproves thereon, SUBJECT'AN EMPLOYER TO•CRIMINALPd —D CIVIL FINES UP TO ONE HUNDREDTHOUSAND
and wlio does the`work,himself;�o;herself through his or her own employees, provided that the 'DOLLARS($100,000). INADDITION TOTHE C166mPENSATION, DAMAGES AS PROVIDEDFOR'IN
improvements are not intended:or offered for sale. If; however, the building or improvement is sold.withirf SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one.yearof completi6h, the;owner-builder will,have the burden of proving hathe.or she did �not.build or
improve foi. the+purpose of solea. i - APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property; am exclusively contracting with licensed contractors'to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044' BusinessaridProfessions Code: The;Contractors' State License Law does'not apply to an.owner of conditions and restrictions set forth on this application. ' , L"' '
" property who.bwlds or,improves thereon, and who contracts for the projects with a contractor(sl licensed 1. .Each•person upon whose behalf",this application is made, each person.at whose request. and for
pursuant to the Contractors' State License L wwhose benefit work is performed under or pursuant to any permit issued as•a result of this application,
1 _ 1. 1 am. exempt under Sec..' ' ,.B.&P -C. •f re on - the owner, and the applicant, each agrees to, and shall defend; -indemnify and hold harmless the City
- V - of La Quinta its officers agents -and employees for any act or omission related to the work being
CONSTRUCON LENDING AGENCY
1 hereby affirm under penalty of perjury that there is a con ruction 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
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 i for anon is correct.I agree to comply with all
city and county ordinances and state laws relating to building c uai n, and hereby authorize representatives
of this cpupty�topnter upon the above-mentioned property to , ecsi n purposes.
LQrERMrr
Application Number . . . . . 05-00002272
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 54.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 2066
Expiration Date 12/07/05.
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
=
9.00
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Special Notes and Comments
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48 LF 6' BLOCK WALL.& 40 LF 5' BLOCK
WALL TO FORM FRONT COURTYARD -CITY -
STANDARD.
Fee summary Charged Paid
Credited
Due
Permit Fee Total 54.00
00 .00
54.0.0
Plan Check Total 00
.00 .00
Ob'
Grand Total 54:00
.00 '.00
54.00
LQrERMrr
OWNER/BUIL'DER INFORMATION:
,fir i
Dear Property Owner: t` i
An application for a building' permit. has been submitted in, your name listing yourself as the builder of the ,propery
improvements specified.
For your protection you shouldbe aware that as "OwnerBuilder =you are the responsible .party of record on such a
permit. Building permitsarenot,required to be signed by poop"erty ow ne« s; unless`they are'personally performing their
own work. If your work is ,being performed by someone other than yourseyou may protect yourself from possible
liability if that person applies for the proper permit in Itis p , 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.
o
If you plan to do your own work, with the exception of various trades tfiat,,you,i plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage,any persons other than .yout mme& to family, and the ;work (including materials
and other costs) is6•$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 Stateand Federal Government: as:an employer and you are subject
to several obligations include State and Federal income tax; withholding,', federai`social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compgrisation contributions.
There may be financial risks fouyou if you do not carry our these,` obligations, and these risks are especially serious with
respect to worker's compensation insurance. '
For more specific information about your obligations under.Federal,Law contact the Internal Revenue Service (and, if
you wish, the U.S. Small,Business Administration). Forrmore specific information,about'ycur obligations under State
Law, contact the Department of Benefit Payments and the Division' of ln' iAtrial-'Accidents.
If the structure is intended for sale,.,property owners who are snot licensed contracts are allowed to perform their
work personally or through their. own employees, withouta licensed cont actor or. subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to ,be contractors- is to secure an :'Owner/Builder" building
permit, erroneously implying. that the property owner is providing lits 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 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-builder 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
La Quinta, C4 9V53
(760) 777- 1
FAX: (76 70;r j0
/I
6WJWS SIGNATU, ATE
PROPERTY ADDRESS ,
PERMIT NUMBER(S) .;
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