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BLCK (04-3559)77275 Calle Madrid 04-3559 i rC4 BUILDING &.SAFETY DEPARTMENT P.O. Box 1504 (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA .Q.UINTA, CALIFORNIA 92253 INSPECTION ,REQUESTS (760).777-7153- BUILDING 760)777-7153BUILDING PERMIT Application Number . . . 04-00003559 Date 4/16/04 Property Address . . . 77275 CALLE MADRID APN: 774. -232 -012 -1 -000000 - Application description'. WALL/FENCE Property Zoning COVE RESIDENTIAL Application valuation .1825 _ Owner ContractorrAPR 4-- GOLDEN WENDELL OWNER 8*NOT ON FILE UNKNOWN CA 99.9 99 U AUINTA E DEPT. - - - - - - - - - - - - - - - - - - -------- - - - - - - - - - - - - -l- - - - ----------- Perm ---- -- Permxt WALL -,/-PENCE PERMLT :Additional desc Permit Fee 43 00 Plan' ,CHeck.Fee .00 Issue.Date Valuation 1825 Qty Unit.Charge Per Extension BASE FEE 1.5.0 0 14.00 2.0000 HND BLDG 501-2,000 28.00 Special Notes and Comments 73 L..F..6BLOCK WALL CITY STANDARD Fee summary Charged Paid Credited Due Permit. Fee Total, 43:.00 00 .00 43.00 Plan Check Total .00 .00 :00... .00 Grand Total 43.00 .00 .00, 43.00 P.O.5 CALLS TAMPICO / 1504 78-495 C • ' C /i • VOICE (760) 777-7012 FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number. ".3• S^CJ Date: -C7# Applicant: I Architect or Engineer f r1 t r '.. Architect or Engineer's Address: Uc. No.. PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby of m under penalty of perjury that I am licensed under provisions of Chapter 9 (OonmenmV with section 7000) of Division 3 of the Business and Piotessionals Code. and my License is in full force and effect License Class License No. Date • Cor><ractor OWNS -BUILDER DECLARATION 1 hereby alum 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 IeWM a Permit b construct, atter, Improve. demolish, or repair any structum prior b its issuance. also requires the appbcafu for the permit b tie a signed statement that he of she is lioafsed pursuant to the provisions of the Cont acbrs' 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 fire hundred dollars ($500).): U 1. as owner. of the property, or my employees with wages as their sole Compensation. -will do the wok, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contradofs' State License Law does not apply b an owner of property who budds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that the Improvements ore not intended or offered for sale. It. however, the SM within one year of completion, the owrrer-birAder will have the burden d txridag or inproverment a k as owner of the property, am exclusively contracting with licensed contractors construct the project she did not build B improve for the purpose of sale.). State License Law does not appy to an owner of property who builds or proled (Sec. 7044. Business and with Professions Code: The Contractors' the • State license Law.). improves thereon."and who contracts ton the projects with a contractor(s) licensed pursuant to U 1 am exempt under Sec. . B.& P.C/fgrll* reasoraZ WORKERS' COMPENSATION DECLARATION 1 hereby affnn under penalty of perjury one of the Wowing 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 pemrdt 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: Cartier Pbliq Number _ I certify that, in rhe performance of the work for which this permit is issued. l shad not employ any person in any manner so as to become subject b the workers' compensation laws of California, and agree that, if I should become subjed b the workers' compensation provisions of Section 3700 of the Labor Code. l diad brthwitm comply with those provisions. Date Appfxarrt 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 3700 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 Lenders Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application Is hereby made to the Director of Budding and Safety for a.pemut 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 shad. defend, indemnity and hold harmless the City of La Ouinta. its officers. agents and employees for any ad or omission related to the work being performed under or following issuance of this permit 2. Any permit Issued es a result Of this application becomes null and void ff work is not comrnenced 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 carted 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to e er int property inspection purposes. /bate hgnahrce / (Applicant or Agent): 7AI J 3 klU 4 2 V ` 7AI J 3 klU 4 2 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 signed by property owners unless they are personally performing their own work. If your work is being performed 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 variuus trades that you 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 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 including State and 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 Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors 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 to be contractors is to 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 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, CA 92253 (760) 777-7,012 /f1 FARC: (76 7y'1 01 OWNER'S SIGNATURE/DATE 17 - J 15 (_,c PROPERTY ADDRESS v 4- .ass 9 PERMIT NUMBER(s)