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05-3593 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 05-00003593 Property Address: 53133-AVENIDA CARRANZA APN: 774-045-019-7 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 4000 Applicant: Architect or Engi t� Ta�/ 4 4 Q" BUILDING. & SAFETY DEPARTMENT BUILDING PERMIT O i% D AUG 12 1005 n er: CITY OF LA QUINTA FINANCE DENT. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: License No.: Date: 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 Contrac License Law does not apply to an owner of property who builds or improves thereon, a o contracts for a projects with a contractor(sl licensed pursuant to the Contractors' State Licens Law.l. 1 _ 1 I am exempt under Sec. , B.&P.C. this reason Date: _ CONSTRUCTION LEI E ING AGENCY I hereby affirm under penalty of perjury that th ending 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: LOPEZ OSWALDO 53133 AVENIDA CARRANZA LA QUINTA, CA 92253 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 WORKER'S COMPENSATION DECLARATION Date: 8/11/05 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 nu er are: Carrier certify that, in the performanceko person in any mann so as to and agree that, if I sh Id becoi 3700 of the labor Cod I shall Policy NumbeN the work for w acome subject to iq subject to the cn tms permit is issued, i snag not employ any the workers' compensation laws of California, vorkers' compensation provisions of Section with those provisions. WARNING: FAILURE TO SECURE WORKERS' CO ENSA ON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000). 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 andecorrnectl not commenced within 180 days from date of issuance of such permit, or cessati180 days will subject permit to cancellation. //JJ '/ I certify that I have read this application and state that the above jgfermatio ee to comply with p city and county ordinances and state laws relating to building r structio /and ereby authorize represents ' s of this county to enter upon the above-mentioned property mspectio purpose ate (J �� S' ure (Applicant or Ag - Application Number . . .. ... 05-00003593 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 63.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 4000 Expiration Date 2/07/06 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 160 L.F. 61, GARDEN WALL, CITY STANDARD Fee summary ----------------- Charged ---------- Paid Credited Due Permit Fee Total ---------- 63.00 ---------- .00 ---------- .00 63.00 Plan Check Total .00 .00 .00 .00 Grand Total. 63.00 .00 .00 63.00 LQPERMIT Total.Permit Fees Bin q City of La Quinta Building SE Safety Division P.O. Box 1504, 78-495 Calle Tampico. U Quinta, CA 92253 - (760) 777-7012 - Building Permit Application and Tracking Sheet Permit it �5 1t Project Address: 133 ? A. P. Numbs: Owrer's Narne: T, IA ro ofZ Address: 1 Leeal Description: Cin•. ST. Zip:Ci �tS" X Contractor: F Telephod : x Address: ��`S C/�1(f Project Description: )C Cit}•. ST. Zip: v�-G - r ) - _` r J �t-101 X.TcicphonQ38—LOi - i A State Lic. N: City Lic. Arch.. Engr., Designer: 0e,� - Address: City. ST. Zip: I Telephone: '=��__: ,..- _ Construction Type: Occupancy: State Lic. if : Project type (circle one): New Add'n Alter Repair Demo JC Nae of Contact Person: Name --T Sq. Ft.: # Stories: Units: X Telephone tY of Contact Person: 'ICstimated Value of Proiect: APPLICANT: DO NOT WRITE BELOW THIS LINE 0 Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calls. Reviewed. ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance Energy Cala. Plans picked up Construction Flood plain plan Plans resubmitted. Mechanical Grading plan 2' Review. ready for corrections/issue Electrical SUbcontaetor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. N.O.A. Approval Plans resubmitted Grading IN HOUSE:- s"' Review. ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total.Permit Fees 78-495 CALLE TAMPICO — LA QUINTA, TELEPHONE (760) 777-7012 FAX (760) 777-7011 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 include 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 Administration). 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 contracts 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 Ta La Quinta, 92253 (760) 77 7012 FAX:/X7 ) 777-7011 OWNER'S SIG PROPERTY ADDRESS 05- 35q 3 PERMIT NUMBER(S)