BLCK (04-3663)52215 Avenida Madero
04-3663
QUWC4V
BUILDING & SAFETY DEPARTMENT
P.O. BOX 1504 (760) 777-7012
78-495 CALLS TAMPICO FAX (760). 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number 04_=000Q3663__ f (1 n 2'3/04
Property Address 52215 AVENIDA MADERO
APN: 773-241-017-8 '000000- ]I -
Application description WALL/FENCE APR 2 3 2004
Property Zoning COVE RESIDENTIA
-.Application valuation.. 3000 CITY OF LAQUINTA
FINANCE DEPT
Owner Contractor
DIEMER DOUG OWNER
522:15. AVENIDA MADERO
LA-QUINTA 'CA 92253
(760).668=1024
Permit . . ELEC-MISCELLANEOUS
Additional.desc
Permit Fee 15.00 Plan Check Fee 3.75
Issue Date Valuation 0
Qty Unit Charge Per Extension
BASE FEE - 15.00
Permit WALL/FENCE PERMIT
Additional desc
Permit Fee 54.0.0 Plan Check Fee .00•
Issue Date Valuation 3000
Qty 'Unit Charge Per Extension
BASE FEE '45.00
1.00 9.0000 THOU BLDG -2,001-25,000 9.00
Special Notes and.Comments
45 LF.51.BLOCK WALL.IN FRONT YARD PER
CITY STANDARD. ONE GFI OUTLET CONTROLLED
BY EXISTING SWITCH. 2001 CBC.
Fee summary Charged Paid Credited Due.
Permit Fee Total 69.00 .00 .00 69.00
Plan Check Total 3.75 .00, .00 3.75
Grand.'Total 72.75 00 .00' 72.75
P.O. BOX 1504 4 40
UW(78.495 CALLS T'AM! ICO VOICE (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Date: - .) 3-0
Architect or Engineer.
Architect or Engineer's Address:
Lic. No..
t3UILUING PERMIT DECLARATIONS
I hereby aff nn under penalty of perjury that I amfioensed under LICENSM CONTRACTOR'S DECLARATION
Codnny License b in lei tome and e. and provision d OW OP9 (Cammncing with SW= 7000) d Division 3 of the Business and Pmo6essionaFs effect
Lkense Class License No.
Dab • C ,
I hereby offer under penalty of perjury to I am O INER'BULDER DECLARATION
city or county that reolurires o pertNt b t+om Conb=Wm' Stab License Law for the following mason (Sec. 7031.5. Business and Probssim s Coda: Any
staterrmerrt riot the a she s a p n nit imnp101i . dwaliisfh. or repair any stnrctua, prior b Its issuance. also requires the appicent for ria pwn* b Rte &09
and Profession Code) Oi riot fne or surawt b ris Orovisbro d ria CantracbW State Uoeme Lan, (Chopbr 9 (Comandng with Section 7000) d Division 3 a to Business
appkm t b a dvi he k ohoenpt tmerefrotn and Dais for ria staged srkerrptioh Any visitation d Section 7031.5 by any appimd for a permit subjects
penally a rat minae than Rva fmurndred dobrs (s5oo).):
1, as owner d ria propety. army omployess with wages as their aoie cornponsa5M wi dote work, and the structus Is not i nlanded or offered ler sale (Sec 7044.
Business and Professions Cade; The contraclore State
hiinself hherself or License Law does not apply b owner a an ownproperty who builds or improveson, thereand who does fie work
sold witinr one trough his a fuer own employees, provided that the improvements aro not intended or offmed for sale. a, however. the building or improvement a
U t as owner a as y a completion. the owner -builder willhave the burden amV prothat he or she cid not build or knprove for the purpose a sale.
s property. mn exclusively contracting with I - P 1 P d contractors b construct the project (Sac. 7044. Business and Professions Code: The Contactors'
State License Law doenot
„ jhe-CoMrxbrs' Stab
Lieernselaw. d ply bolds or improves aneieon. and who contracts ler the prgects wfth a ruacbr(s) icensed pursuant b
I atm_ .ez(errpi snorter Sec. P.C. anis
1 hereby afrwm under pernalty of pejuy one of aro WORKERS' COMPENSATION DECLARATION
_ I have and will maintain a certificate of consent to sell -Insure ler workers''
d the work for w hid this po n is issued con pQm a provided for by Settlor 3700 of the Libor Code. for the peramanoe
— I have and will maintain workers' compensation insurance. ss required by Section 3700 of the Labor Code. for the perorrance of the work ler which alis pertNt is
issued- My worker' Compensation insurance tenter and"Carrier P*k number aro:
1 Cerkfy int ti the peromnnoe of the work ler which an pe mit is issued. l shall not employ any person in any roamer to as to become subject brie workers'
Compensation laws of and epee amt, shouAd beoormhe subject b the workers'
comply will lase compensation Provisions of section 3700 a the Labor Code. I shat
WARNING: kAILURE TO SECURE WORKERS' Campe&nON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE 1 ANDRED THOUSAND DOLLARS (8100.000). IN ADOtTiON TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES. .
CONSTRUCTION LENDING AGENCY
1 hereby affirm tmofer penally d perjkry that ries fs a Construction lending agency for the performance d the work ler whirl this pormit is issued (Sec. 3097. Civ. C.).
Lendefs Nam
Lenders Address
IMPORTANT Application is hereby mads b the Director of APPLICANT ACKNOWLEDGEMENT
Butting and Safety for a perm subject b the conditions and restrictions set forth on ails applicalim
1 d usresult ^ Of
the owner, applis ication applicant,
person at ach green requestand for whose benefit work is performed under or b any permit
officers, agents and employees for arty ac! or omhission relaapted to the work b shall, defend. Mhdermify and hold harmless the City d La Gukft. Its
2 Any permit Issued as a result d this application becomes nut and void K work's riPerformed
for e n pnder or following n issuance of d k am> a such per.. mx
Cessation a work for 180 days we subject porn b b canoeRation.
1 omrtiy that i have read ars application and state drat are aboveJa tion is correct I agree b y with at cit and count ordinances and state laws
construction. and hereby authorize ropresermtatives d ars county b enter'Oft" aboveam onbtn d ro erty for inspection spurposes. "b building
13ate L 2,3 o s. or ).
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 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 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,