10-0690 (BLCK)53885 Avenida Martinez
10-0690
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4'y,, 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
10-00000690
Property Address:
53885 AVENIDA
MARTINEZ
APN:
774-171-019-7
-000000-
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
3395
Applicant:
Architect or Engineer:
-----------------
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 t e Usines and Pro Sion als a and my License is in full force and effect.
License Class: B Li ns No.: 727199
Date: % -2't -40 Contractor:
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.).
(_) 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
1 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:
3 BOULDERS
42-760 MADIO STREET
INDIO, CA 9220.1
-----,---•-- • ,_.._ Contractor.
CORONEL ENTERPRISES
42760 MADIO STREET
INDIO, CA 92201
(760)775-1234
Lic. No.: 727199
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/29/10
I JUL 29 2010
LA QUINTA
----------------------------- ------------------
WORKER'S COMPENSATION DECLARATION
1 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 UNITED INS Policy Number 238130742009
_ I certify that, in the performance of the work for which ermit is issued, I shall not employ any
person in any er so as to become subject to a wor ers' compensation laws of California,
and agree that, f I s ould ecome su t to the or
ker compensation provisions of Section
3700 of the La r C de, I hall fort ith comp) wit hose provisions.
Date: Z- _"'k 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.
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 commenced
within 180 days from date of issuance of such permit, or tin
n of w r 180 days will subject
permit to cancellation.
I certify that I have read this application and state th t e ab ve informcor ct. I ree to comply with all
city and county ordinances and state laws relating to u ding onstructi he by au orize representatives
of this county to enter upon the above-mentioned pro a fo inspectioses.
Date:? 2`t-10 Signature (Applicant or Agent):
Application Number . . . . 10-00000690
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 6.3.00 Plan Check
Fee
00
Issue Date . . . . Valuation
3395
Expiration Date 1/25/11
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
-90 L.F. 6' GARDEN WALL (HEIGHT TO BE
------------ MONITORED'-IN-FIELD'"BY -INS PECTOR) AT --SIDE -- --
__. ... ... . .. ..._...._.__...---..._.................. .
P/L, 12 L.F. 4' SCREEN WALL, AND 44 L.F.
5' FRONT COURTYARD WALL, ALL CITY
STANDARD. 2007 CODES.
-----------------------------------------------------------------------------
_ Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary _ Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 63.00 .00
:00
63.00
Plan Check Total .00 .00
.00
.00
Other Fee Total 1.00 .00
.00
1.00
Grand Total 64.00 .00
.00
64.00
LQPERMIT
JUL-21-2010 TUE 08:32 AM
CORONEL ENTERPRISES FAX No. 100 115 5353 P•001
JUL-26-2010 MON 08 26 AM CORONEL ENTERPRISES FAX No. 160 11,5 5353 P•002
13i[t ty.f City of La Q u rota
£
Building S Safety Division
p.0. Box 1504
78-495 Calle Tampico
La -Quints, CA 92253
'Building Permit Application and Trac g Sheet
Project Address: aj • ° 2 Owner's Name: r'S
H
A. P. Nwnber: Address:\-('a--XobA, %\ ,
Legal Description: City ST,
Telephone: .7 U -77 S -
Contractor:
Address: \ ,h '
Project Description:
Cit. •_ST, Zip:.-.
"^1 Y'oteJit'< '>°$; o.' :aa,i:;Y e.<
/b:..
Telephone: '7 i;o --775 i a3 `i; > i us«iiay$y:)3
S. _ .
-
Cary Lic. #:
Y
State Lic. r :
\-1 _ 7 1__I
44
Arch.. Engr., Designer:
Address:
City. ST. Zip:
•
Telephone:,>d:iz£lris?r;Y;N.Mgmr?i
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ConstruetioAType: Occupancy
AN
State Lic. R.
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Project type (cirele one); New Add'n A1W Repair Demo
Name of Contact Person: Sq. Ft.: # Stories: # Units:
Telephone --of Contact.Person: Estimated Value of Project:
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