05-0708 (BLCK)�11a/�Q• r ��
BUILDFNG &SAFETY DEPARTMENT
P•.O: Box (760).777-7012
OF` O 78=495 C'ALLE.'TAMPIco` `- FAX (760) 777-7011
LA QUINTA, CALIFORNIA 922'53. TN-SPECT$ON REQUESTS (760) 777-7153
.. -
BUILDING PERMIT
Application `Number . . . . 05,.,OiQ00�'Oj _8 Date 3/01/05
Property Address 52720 AVENTDA RUB"IO�
APN:: 773=313='0-01=267000000-
Application desc.r'iption -
WALL/FENCE,-Property Zoning : COVE RESIDENTIAL
App -1 cation valuation 3631'
Owner Contractor
DORA LOPEZ. OWNER
52720_AVENIDA.RUB;IO.
LA•QUINTA CA. 92253'
(7.60) .564,:=2095.:".
--------------------------------------------------------------------------------
Perm..t WALL/,FENCE': PERMIT
Additional desc
Permit .Fee 63.0.0 Plan Check Fee .00
Issue Date Valuation . . . 3031
Qty Unit Charge Per'.. t� Extension
BASE FEE << .45.00
2.00 9.0000 THOU BLDG 2,001-25,000 18.00
<S.pecial_ Not.es•,and. Comments
140 LF - 5' . BLOCK :WALL . P 1CITY STANDARD
ALONG FRONT AND EXTERIOR- SIDE !YFRDS'.
Fee summary.. Charged :.Paid Credited ue
--- -----------
---_-
Permit Fee Total • --63.00�.00 ,-----•--,.0-3.--
Plan Check Total 00 00;` Q; h .0
Grand Total 63.00 0.0 ". .00, �O �. 0
O
P.O. Box 1504 •
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: O 7 O $
Applicant:
Applicant's Mailing Address:
Date:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING 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 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 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).):
`J_4- 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. , BA P.C. for this reason
VU 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. My workers' compensation insurance carrier and policy number are:
Carrier Policy Number
_14_ I certify that, in the performance of the work for whit this permit is issued,.[ shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date I O PIpplic� ant,
WARNING: FAILURE TO SECURE WORKERS'COh9ENSATION 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.).
Lender's Name
Lender's Address
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
cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is co
constP. I agree to comply with all city and county ordinances and state laws relating to building
ruction, /nd hereby authorize representatives of this county to en ove-mentioned property for inspection purposes.
Dates 6 Signature_(Applicant or Agent):
OWNER/BVILDER INFORMATION
Dear Property Owner:
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 should be .'aware that as `Owner7Builder ,you are; the responsible: partyy of record on such a
permit.,Building permits are' riot required to be signed by°property' ownersunless they are personally performing their
own work. If your work ts,bemg performed by someone other: than yourself,'you may protect yourself from possible
liability if that person applies for:the proper'permit n•his.or her. name:
Contractors are required,by law to d a
:be licensend",bond' d -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 licensenumber 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 yo ur'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 0U"br 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 maybe financial risks,for you if you do not -carryout these. obligations, and these risks:are especially serious with
respect to worker's compensation: insurance.
For more specific information about, your obligations underFederatLaw, contact the'Internal Revenue Service (and, if
you wish, the U.S. Small ,Business Administration):. For.niore specificinformation'about.your obligations under State
Law, contact the Department of Benefit Payments and the Dtvisioii: 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, io be contractors. is to -secure an "Owner/Builder" building
permit, erroneously implying that the property owner, -is providing his. or het own labor' and material personally.
Building permits are not required to be signed by -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, 61if6rni4'95814.
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 Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760) 777-7011
PROPERTY ADDRESS
®r
PERMIT NUMBER(S)
'APPLICAtION FOR TREE PLANTING'
' '
I (we), the.iundersigned, hereby certify and acknowledge that I (we) have read the application and agree that if trees ore required'under River-
side County Ordinance No. 457, the applicant agrees to install said trees prior to final inspection: It is understood that'rio finial insppection
will be given'until said requirements have been met or exception has been granted by the County. Now, therefore, it is agreed.that the prop-
erty owner shall cause the property lines to be surveyed in the event no survey stakes con be found. Further, it is agreed. that the County. of
Riverside shall assume no responsibility should trees have to be removed due to lot line errors.
�1 N'
Owner s Name Building Permit No.
Mailing Address City Stote'Z4 —Zip
Job Address 'S2 -_7A0 4V45_ c�61 0ommunity - f
Legal Description 2 2 �• G
Assessor's Map, Book Page % _ % J -13/ / 3 — 06 Type Structure !zg=�
Type bf Soil Is water available Road Dept. Plot Plan•No.
Type of existing trees in road right—of—way
`•Trees'preferred by applicant (1) (2) (3)
Date �2 n 2_ Owner's Signature
,t
Planning Commission Case No.
' + ' ROAD DEPARTMENT APPROVAL
Approved species �' Number of trees -
Spacing of trees Distance from lot'lines: Front Side' `
Additional requirements -'
Date`Building and Safety notified Signature
REQUEST FOR EXCEPTION
Reason
(attach additional page if necessary)
Request for hearing: - YES ❑ _
Owner's Signature
4 (Forward application to Planning Dept. if exception requested)
e NO REQUEST FOR HEARING
Planning Dept:' '
Concur ❑ Non -concur ❑ E_xplanotion
Date Signature
Road Dept. +. _
Concur 0 Non -Concur ❑ ' `C
Date Signature
REQUEST FOR HEARING AND COMMITTEE DECISION
Date hearing established Dote hearing notice moiled to owner
Approved ❑ Disapproved ❑•-Date,Owner notified of decision
Date Building & Safety notified, -Signature
Final Date Inspector —
Job Address
Requirements for treelplanting complied with
APPROVAL BY BUILDING INSPECTOR
Building Permit No.
Community
Remarks _
(Detach and forward above information to Road Department Riverside) -
284-230, REV. 1/74 ¢ "
t
617,