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05-2495 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 5`2640 AVENIDA RUBIO 773-283-028-17 -000000- WALL/FENCE COVE RESIDENTIAL 2232 T4ht ����I{,.cv VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 6/21/05 Owner: LYNBERG, JOSH 52640 AVENIDA RUBIO LA QUINTA, CA 92253 --------------------------------- Architect or Engineer: Contractor: Owner --------------- '----- - - - - -- - - - - -- 'nF . L.QPERMIT ------------------------------- LICENSED CONTRACTOR'S DECLARATION . - �. WORKER'S COMPENSATION DECLARATION I hereby.affirm:under penalty.of,perjury,that Iam licensed under provisions of Chapter 9 (commencing with. I hereby affirm under penalty of perjury one of the following declarations: • Section 7000) of Division 3 of the Business and Professionals Code, and my, License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as.provided License Class: _, .. License No::;. •. for by Section 3700 of the Labor Code; for. the performance of the work for.which this. permit is ' issued. .r Date:. Contractor: v � I have'•and will maintain workers' compensation,insuranee,:as required by Section 3700.6f the Labor • - - Code, for the performance ofthe work for which this p' it is issued. My"workers' compensation; . r.OWNER-BUILOEQDECLARATION.,. ' _ .•:, -s ,insurance carrier-andpolicy number are: I hereby';affirmunder penalty of perjury that�I'am exempt from t1ie Contractor's'State license Yaw for the - Carrier'+ _•.Policy Number - following reason (Sec. 7031..5,. Business. and Professions Code: 'Any city, or=county that requires a permit to _ I certify that, in the performance of.the work or which this permit is issued, I shall not employ any • ... ' construct, alter; improve; demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any 'manner so as to become su ect to the"workers' compensation laws of California, permitmfile'a signed=stafement.that he or she is, licensed pursuant to the provisions of the Contractor's State and:agree that, if I should :becomsubl!cflp 'the workers' compensation provisions of Section License Law (Chaptei 9 (commencing with. Section. 7000) of Division 3 of the Business and Professions Code) or 3 00'of the Labor C` , I -with those provisions. ' that he or sheds exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjectsthe applicant'to a civil penalty of notmore than.five hundred dollars. ($500).: Date: Applicant �) I as owner of the property; or my employees with wages as their sole compensation will do;the'work, and _ .ATIO ' 4e structure is not intendedor offered for sale (Sec.. 7044, Business and Professions Code:` The WARNING: FAILURE TO SEC UREWQRKER OMPE OVERAGE IS UNLAWFUL; AND SHALL Contractors' state�.License•Law'does not apply to an owner -of property who builds or improves thereon, SUBJECTANEMPLOYER TO CRIMINAL'F;EN -TIES A ;CIVI .INES UP TO ONE HUNDRED THOUSAND ' _ and wno;goes the.woik himself or herself through his'or f ei own_employees,°:provided that'the a DOLLARS ($100,000).' IN ADDITION TO;,TH OST 0 :COM NSATION'DAMAGES AS PROVIDED FOR IN improvements.a(e not intended or'offered for: sale. If, however, the budding or,inlprovement,is sold within SECTION 3706 OF THE LABOR CODE, INTE ST, AN 'ATT_ EY'STEES. one '.year;of completion,the owner•budder.will have the burden of proving: that he or she did not build or ' improve for the purpose ofsale.l. •. _ APPLICANT ACKNOWLEDGEMENT ' ( 1 I, as owner. of the property,`am.exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the ` 7044; Business and Professions Code: The Contractors' State License Law does not apply -to an.owner of conditions and restrictions set forth on this application., property who builds or improves thereon, and who contracts for the projects with a contractors) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed -un de rbr pursuant to any permit issued as a result of this application, I—) I am exempt under Sec. B.&P.C. for his rea - _ 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 as or omission related to the work being performedunder or following issuance of this permit, ' ^ r VA I W Date.• Owner:.. J /i a 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 cessation of work for 180 days will subject - CONS UCTI LEND AGENCY permit to cancellation. . I hereby affirm under penalty of perjury that there is c nstru tion lends g agency for the performance of the I certify that I have read this application and state that thea ove infor tion is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. city and county ordinances and state laws relating to builds n, and hereby authorize representatives of this county t enter upon the above-mentione r , o inspec a p ses. Lender's Name: . I� Ol ai;.Signafure. ('Applicant•or Agent ....,� �: Lender's Address: , L.QPERMIT LQPERMIT'. Application Number . . . . . 05-00002495 Permit WALL/FENCE PERMIT Additional desc . . Permit Fee . . . . 54.00 Plan Check Fee 00 Issue Date . . . . Valuation . . . . 2232 Expiration Date 12/18/05 ' Qty Unit Charge Per Extension BASE FEE 45.00 1.0a 9.'0000 THOU BLDG 21001-25,000 9.00 ., ti -- ---------------------------------------------------------- _..Special Notes and Comments `6' 80 LF BLOCK WALL'/20 LF '5' -BLOCK '. -WALL., CITY STANDARD. - Fee summary Charged. Paid-, Credited'= Due ---=--------------"=-=-=-------------- ---- --- ---------- -- - Pe'rmit' Permit Fee Tota°I 54`:00 .'00 ..,, 00 :54-:'A0 Of6ai Check .Total .00 .00 .00 :00 GrandTotal' -. 54.00 OD 00 54.00. LQPERMIT'. C(�4 041.��Q�rw Dear Property Owner: 78-495 CALLE TAMPICO LA QUINTA, CALIF 0RNIA';92253 TELEPHONE (709) 777.7012':FAX?(760) 777-7011 O"ER/BUILDER INFORMATION . An application for a building permit has been submitted in your name=,listingyourself as the builder of the property improvements specified. For your protection you shouldbe aware that, as "Owner/Builder" you are the responsible `party of record on such a permit. Building permits are, not' required,toite 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' Jor the proper permit imbis 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 Ework (including materials and other costs) is. $200. 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 asan 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 andunemployment compensation' contributions. There may be financial risks for ydu if.you do not carry out these obligations, and these risks4re 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)„or more specific informationabout. your obligations under State Law, contact the Department'of Benefit Payments and `the Division of Industrial Accidents. If the structure is intended ;for sale,, propertyowners who are not licensed contracts "are!;,allowed to perform their work personally or through,tfieir' own-empl'oyees,-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-buil8er,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 Tampico La Quinta, CA 92253 (760) 777-7012 FAX: (7W) 771-7011 ,5-�661"P,L4, LA CA 91.12,S-3 PROPERTY ADDRESS OS- PERMIT NUMBER(S)