RPL (14-0180)54075 Avenida Martinez
14-0180
* P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
4
f ' itiGv
I.
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of 'ury that I am lic nsed u ovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of tit ines and rofessio als C e, and my License is in full force and effect.
License Class: B il Lice a No.: 727199
Date: i -J4 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.).
(_ 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:
RW REAL ESTATE
42760 MADEO STR
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/14/14
INDIO, CA 92201
G` 111 .
Contractor.
CORONEL ENTERPRISE a1.
42760 MADIO STREET f RUNTA
INDIO, CA 92201 Gitlr-.6~aD>Ri•
(760) 775-1234 }('
Lic. No.: 727199
-----------------------------------------------
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 STATE FUND Policy Number 090158-2014
_ I certify that, in th rforma ce of the r or w ich his permit is issued, I shall not employ any
person in any nn r so to beco a subjeyotheworkers' compensation laws of California,
and agree that, i I s ould lecome s bject toers' compensation provisions of Section
3700 of the Lab C e, 1 hall fort with tothose provisions.
Date: y 1 - I `( 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 Quints, 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 c(on
n of work 180 days will subject
permit to cancellation.
I certify that I have read this application and state a the abov informs correc . 1 agre to comply with all
city and county ordinances and state laws relating t b ilding c structio hereb autho ' e representatives
of this county to enter upon the above-mentioned pro e y for i pectionses.
Date: ' -I i Signature (Applicant or Agent):
Application Number:
14-00000180
Property Address:
54075 AVENIDA MARTINEZ
APN:
774-221-017-5 '-000000-
Application description:
POOL - RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
14000
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
4
f ' itiGv
I.
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of 'ury that I am lic nsed u ovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of tit ines and rofessio als C e, and my License is in full force and effect.
License Class: B il Lice a No.: 727199
Date: i -J4 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.).
(_ 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:
RW REAL ESTATE
42760 MADEO STR
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/14/14
INDIO, CA 92201
G` 111 .
Contractor.
CORONEL ENTERPRISE a1.
42760 MADIO STREET f RUNTA
INDIO, CA 92201 Gitlr-.6~aD>Ri•
(760) 775-1234 }('
Lic. No.: 727199
-----------------------------------------------
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 STATE FUND Policy Number 090158-2014
_ I certify that, in th rforma ce of the r or w ich his permit is issued, I shall not employ any
person in any nn r so to beco a subjeyotheworkers' compensation laws of California,
and agree that, i I s ould lecome s bject toers' compensation provisions of Section
3700 of the Lab C e, 1 hall fort with tothose provisions.
Date: y 1 - I `( 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 Quints, 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 c(on
n of work 180 days will subject
permit to cancellation.
I certify that I have read this application and state a the abov informs correc . 1 agre to comply with all
city and county ordinances and state laws relating t b ilding c structio hereb autho ' e representatives
of this county to enter upon the above-mentioned pro e y for i pectionses.
Date: ' -I i Signature (Applicant or Agent):
Application Number . . . . . 14-00000180
Permit. . . . POOL 2013
Additional desc .
Permit Fee . . . . 178.75 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 9/10/14
Qty Unit Charge Per Extension
1.00 178.7500 EA MISC POOL/SPA 178.75
----------------------------------------------------------------------------
Special Notes and Comments
POOL AND SPA AT FRONT YARD ONLY [DENISE
POELTLER ENGINEERING] THIS PERMIT DOES
NOT INCLUDE POOL, EQUIPMENT OR PROPANE
TANK ENCLOSURES. ALARMS AND BARRIERS
REQUIRED TO BE INSTALLED AT PRE -PLASTER
INSPECTION. 2013 CALIFORNIA BUILDING
CODE . .
March 13, 2014 4:47:01 PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . BLDG STDS ADMIN (SB1473) 1.00
PLAN CHECK, POOL 97.24
Fee summary Charged Paid Credited Due
Permit Fee Total 178.75 .00 .00 178.75
Plan Check Total .00 .00 .00 .00
Other Fee Total 98.24 .00 .00 98.24
Grand Total 276.99 .00 .00 276.99
LQPERMIT
Project &-ddress:SIA-13-15- ts,
A. P. Number:
Legal DL-:scnption:
Contractor: C r, t\ T%,
Address:,*--ka--I Lo
Ciry.ST. 7_ip__
CQ
Telephone: - Lo_ -7
State Lic 71 c
Arch.. ErtE-,r.- Designer:
Address:
City. ST. Zip:
Telephon e:
Stare Lic. r.
Name of Contact Person:
Telephone --'of Contact Person:
Sub.mirt2l.
:Plaz Se4s...'
S.tr.uctu
Tele. 2.4 0
-77-7777777
City of La Quinta
Building 91 Safety Division
P.O. Box 1504
78-495 Calle Tampico
La Quinti, CA 92253
Building Permit Application and Tracking Sheet
Owner's Name:
Addre*ssAAa--7CA
Ciry,ST, Zip:
City Lic. #:
Project Description:
J
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL: #Stories: # Units:
Estimated Value of Project: N, 0007
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