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04-6667 (BLCK)x IV B.UILDING'& SAFETY'DEPARTMENT P_ ­�O Box 1504 -(76,0).777-7012 8-49.5 CAILE TAMPICO FAX (70) 7.77-7011 QUJN.TA, CALIFORNIA 92253`INSPECTION REQUESTS (760) 777-7153 BUILDIING.PtAW Ult0A -TY r I OFF T. FINANCE DEPT Application -Number . . . 0A U00666 Date 10/08/0.4 Property Address 787AVEMI-IbA OBREGON' APN: 774-0.45-009,79 •70'00000 - Application* descrip'-ti6n Property Zoning CQVE,.RESIDENTIAL Applic.ation valuation-, 736• Owner Contractor. ----------- -------------- ------ ------------ CHILPA ADRIAN OWNER.,, 53178 AVENIDA-..OBREGON' LA QUINTA CA 92253. - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - --- - - Permit WALL/FENCE PERMIT - - - - - - - - - - - - - - - - - Addit ion"dl-desc. Permi't-.;,Fed . . . 21:0'0 ""-Fila'n'-. Check ,Fe e .00 Issue Date Valuation - 736 Qty Unit Charge, Per Extension BASE' FEE 115.00 3. 00 2.0000 HND BLDG 5, 01 2., 00-0. 6.06 ------------ ---------------------------------------------- Special, Notes. and.Comments, 34 LF:51.BLOCK WALL PER.CITY STANDARD IN' FRONT 1,YARD' ALONG *P7/L. FeesummaryCharged Paid ...--.Credited ----------- -------- Due --- Permit.Fee Total 21:00._. GO ..00 ------ 21.00 .­,. Plan Check Total A'0_'..0.,0 .00 .00 Grand Total 21.00: .00 rk ..00 -2 1-00 A" P.O. Box 1504 • " VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4 4 a INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: 20- K —0 Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 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 Contractors' 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 Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom 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 more than five hundred dollars ($500).): U 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 or 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.). U 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.). U I am exempt under Sec. , BA P.C. for this reason I. - WORKERS' 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 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 should become(subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 1 Date % Q b Y 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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 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 Ouinta, 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. 1 certify that I have read this application and state that the above information is correct. I agree to co.Tply 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 grope for inspection purposes. �b� J Date Signature (Applicant or Agent): �L L OWNER/ BUILDER INFORMATION Dear Property Owner: An application for a building permit ha:s been submitted in your namelisting 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 signed by property owners unle'ss;they are personally performing their own work. If your work is -being perfoimed"by someone other than.youiself, you`may'protect yourself1rom possible liability if that person applies for the proper permit, in his or her.name.- r Contractors are required by law to be licensed and .bondeddby the 'State of'California and to have a business license from the City or County. They are also required by law` to put their licenser umber.on':'all. permits for which they apply. If you plan to do your own work; with the exception of, variuus'.trades that you plan to subcontract, you should be aware of the following information for your benefit and piotedion: If you employ or otherwise engage -any persons other than your immediate family, arid•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 F.,ederal Government:as an,employer and you are subject to several obligations including State "and Federal income ,tax withholding ,federal` social. security taxes, worker's compensation insurance ; disability insurance costs•and unemployment:comperisauon contributions. There may be financial risks for you 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 obligatiois under .F,ederal Law; contact the Internal Revenue Service (and, if you wish, the U.S. Small Bu stness:Adminstratton).-For more specific information aboutyour obligations under Stare Law, contact the Department of Benefit Payments;and,tlie'Division of Indus trial,Accide.nts:, If the structure is intended for, sale, property owners wh -are n-oi licensed contractors,' are. allowed to perform their work personally or through their own' erimployees;:withou a licensed cot tiactor•`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 isoproviding his or her.'own labor and material personally. Building permits are not required to be signed _ by' property owners unless ihey, are performing their own work personally. Information about licensed contractors may be obtaitied ,by:contacting,theContractors' ..State License Board in your community or at 1020 N. Street; Sacramento, California 93814. Please complete and return the, enclosed owner -builder verifi-caiion' form so shat"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, CA 92253 (760) 777-7012 FAX: (760) 777-7011 ~ dI �_ U 4 a,� OWNER'S SIGNATURE/DATE PROPERTY ADDRESS PERMIT NUMBER(s)