05-4531 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
`05-00004531
77515 AVENIDA MONTEZUMA
773-082-001-24 -00
WALL/FENCE
COVE RESIDENTIAL
3750
Tay/ 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or
LICENSED CONT A'S DECLA 10
I hereby affirm under penalty of perju t t I am li ensed u der provisions Chapte 9 (commencing with
Section 7000) of Division 3 of the Bu 'ne and P essio Is Code, and m Licens is in full force and effect.
License Class: License No.:
ate: lU'-t.'L Contracto .
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
that he or she 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 ($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.).
(_) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
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
Owner:
CORONEL ENTERPRISES
P O BOX 389
LA QUINTA, CA 92253
Contractor:
CORONEL CONSTRUCTION
WCC: STATE FUND
WC: 174445305
CSLB: 634981
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
01/01/06
01/31/06
Date: 10/07/05
-----------------------------------------------
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 B -C13 Policy Number - - - - - - - - - - - - - - -
I certify that, in the p rmance of the work for which tqissuqd,'. sued, I shall not employ any
person in any man er as to become su le o the ensation laws of California,
and agree that, if I ho dbecome subjec to the worktion provisions of Section
3700 of the Labor d I shall orthwit comply witons.atD e: l�-l7_-0� Applica t:WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINEUNDRED 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.
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 n menced
within 180 days from date of issuance of such permit, or cessation of work f 180 days, ill subject
permit to cancellation. -
I certify that I have read this application and state that t above information i ct I agree to co ply with all
city and county ordinances and state laws relating to b it g cons uction, a d hereby authorize re esentatives -
ofcounty to enter upon the above-mentioned pro ga y or insp ction pu oses.
ate: L� t -Li Signature (Applicant or Agent):
Application Number . . . . . 05-00004531
Permit . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 63.00
Plan Check Fee..
.00
Issue Date . . . .
Valuation . . .
. 3750
Expiration Date 4/05/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
2.00 9.0000 THOU BLDG
2,001-25,000
18.00
----------------------------------------------------------------------------
Special Notes and Comments
150 L.F. 6' GARDEN WALL, ORCO SYSTEM.
Fee summary Charged
-------------------------------------
Paid
Credited
--------------------
Due
Permit Fee Total 63.00
.00 .00
63.00
Plan Check Total .00
.00 .00
.00
Grand Total 63.00
.00 .00
63.00
LQPERMIT