06-1700 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: CO -00.017.0'0
Property Address: 1310 AVENIDA RAMIREZ
APN: 773-083-004-21 -000000-
Application description: WALL/FENCE
Property Zoning: COVE RESIDENTIAL
Application valuation:. 1250
Applicant: Architect or Engineer: -
BUILDINCd/-8&SAFETY DEPARTMENT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
D G PERMIT
4
Owner:
GARCIA SAMUEL RODOLFO
51310 AVENIDA RAMIREZ
O�O� Q�
LA QUINTA, CA 92253
0
�C o
F�.
---------------------------------
Contractor:
Owner
---------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
t— . 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.
h
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 Professi6ns`Cota:.1Ahy city or county that requires a permit to
Construct, alter, improve, demolish; or repair any structure,. prior to itsissuance, 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 orshe'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`ifollars 155001.:
v (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 theworkhimself 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.).
1 ) .I amexemptunder Sec. , B.S P.C. for this reason
Date: :* � � "' D b Owner: 'c4T
--� STRUCTION 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
Date: 5/02/06
-----------------------------------------------
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 malntaln 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 r '
insurance carrier and policy number are:,
Carrier - Policy Number
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers'. compensation provisions of Section
3700 of the Labor Code, I sha rthwith comply with those provisions.
Date:
WARNING: FAILURE T0, 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 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 correct. I agree to comply with all
city and county ordinances and state laws relating to building construction; and hereby authorize representatives
of this county to enter upon the above-mentioned property f n pur/pooses.
Dater ��—,aCignature (Applicant or Agentl: !�f_/..f�!// h? tC&P A / 14 4i
Application Number . . . . . 06-00001700
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit .Fee . . . . 31.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
1250
Expiration Date . . 10/29/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
8.00 2.0000 HND BLDG 501-2,000
16.00
---------------------------7------------------------------------------------
Special Notes and Comments
501F 6' BLOCK WALL PER CITY STANDARD Q
REAR P/L. NOTE PERMIT FOR SIDEWALL
ISSUED TO 51300.RAMIREZ. CITY STANDARD
Fee summary Charged Paid Credited
-----------------------------------------------
----------
Due
Permit Fee Total. 31.00 .00
.00
.31.00
Plan Check Total .00 .00
.00
.00
Grand Total. 31.00 .00
.00
31.00
LQPERMIT
Bin #
Ci.t�Y of La y Quinta
Building U Safety Division
P:O. Box 1504,78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701.2
Building Permit Application and Tracking Sheet
Permit #
l
Project Address:'
Owner's Name: I' --
c. ti Cl•
A. P. Number:
Address:•
l) C d <<' .� l Z
Legal Description:
City; ST, Zip: G{ 2 Z 3
Contractor: 6
Telephone: 7
Address:
Project Description: l �aL
City, ST, Zip:
Telephone:
City'Lic. #:
State Lic. # :
Arch., Engr., Designer
Address:
City, ST, Zip:
Telephone:.,
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Pro* ect type (circle one):.Neiv Add'n Alter Repair Demo
Sq. Ft.:.
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPUCANT: DO NOT WRITEMELOW THIS UNE
#
Submittal
Req'd
ReedTRACIQNG
•-PERMIT
FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for. corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up _
Construction
Flood plain plan.
Plans resubmitted
Mechanical
Grading. plan
2"° Review, ready for correctionsrssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7r° Review, ready for corrections/imue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date otpermit issue
School Fees
Total Permit Fees
OWNE"VIL-DER 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 thatas' "Owner/Builder" you are the responsible party of record on such a
permit" Buildingpermits.are not iequired.to;be signed.by property owners unless.th'eyare personally performing their
own work..If your' work is=being'performed .by someone other'than;yourseIf, you may protect yourself from possible
liability.if that person applies for the proper permit in his or h'er name:
Contractors -are required bylaw to be` i.tensed 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 ori; 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.W*or more, for the entire project, and such persons are not?licensed as contractors or
subcontractors; then you .may bean 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, 1ed'eral:social security taxes, worker's
compensation insurance, -,disability insurance costs•.and.unemployment compensation contributions.
There may be financiat'risks for you if you do not carryout these obligations, arid' these risks are especially serious with
respect to worker's corripensation insurance.
For more specific informationabout: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'- 'ur obligations under State
Law, contact the Department of�Beriefit Payrrients 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, withouta licensed contraktor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed; persons professing to be contractors. is tosecure an "Owner/Builder" building
permit, erroneously:implying tliat the property' owner is providing his or her':owri labor and material personally.
Building permits are not. required oto 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.verifcation form•so thatwe can confirm that you are aware of
these matters.. The building permit.will not be issued -until the veiificatiori is'returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Jampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760) 777-7011
08 LbGf�
O ER'S SIGNATURE/DATE.
�3 d VC E d. u-rI ISG
A6PERTY ADDRESS
n� Q00
PERMIT NUMMR(S)