05-0144 (BLCK)53700 Avenida Madero
05-0144
Q BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
OF Sr9ti' 78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number- 05-00000144 Date 1/14/05
Property Address . . . . 53700 V-VENTDA MADERO
APN: 774-1037028-15 -000000- "
Application description WALL/FENCE,
Property Zoning . . . . COVE RESIDENTIAL
Application valuation . . 8950
Owner Contractor
POWER FINANCE CORONEL CONSTRUCTION
P.O. BOX 134 P.O. BOX 389
LA QUINTA, CA 9225.3 LA QUINTA, CA 92,247
(760)564-4604
WCC: STATE FUND
WC: 174445305 01/01/06
CSLB: 634981 01/31/06
CCC: B -C13
JAN 19 0.015,,
CITY OF LA QUINTA
FINANCE DEPT.
c?
P.O. BOX 1504
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Date:'—/. 19-0.5
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:
esUILUINU 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 Licegse is in full force and effect.
icense Class . e 4 nse No._( sat -6
Date —1-,— Contra
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 for a 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. , B.& P.C. for this reason
Date
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 pAy workers' compensation i� ance carrier and policy number are:
artier <. � _� oPolicy Number V-) `t A -k
I certify that, in the performance of the work for which this perm ued, 1 shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if shout ecome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with thouprovisions.
WARNING: FAILURE TO SECURE WQRKERS' 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.).
Lenders Name
Lender's Address XA
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 Quinta, 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 comm 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 ab information is core -agree to mply %y h all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this co nt o enter upon therove-mention d pro arty for inspection purposes.
�—�
Signature (Applicant or Agent):
L- - - - - - - - - - - - - - - - - - - - - - -
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^Application Number105'r0'0000`144--------------------
..
' Permit : . . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee 108.00 Plan Check
Fee >.
.00
Issue Date Valuation
. .
. 8950
Qty Unit Charge* Per
Extension
BASE FEE
45.00
7.00 9.00,00 THOU BLDG 2,001-25,000
63.00
----------------------------------------------------------------------
Special Notes and Comments
254 L.F.'COMBO WALL, 40" RETAINING, 5'
.GARDEN & 104 L.F. 6' GARDEN WALL, BOTH
CITY STANDARD
Fee summary. Charged Paid, Credited
Due
Permit Fee Total 108.00 .00
.00
108.00
Plan Check Total .00 .00
.00
.00
Grand Total 108.00 .00
.00
108.00