06-0497 (BLCK)ci�� 4 Qulkm', -
P.O. BOX 1504VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 2/01/06
=' Application Number: `0 -00000497] Owner:
Property Address: 52955 AVENIDA RAMIREZ CORONEL LUCANO S
APN: 773-322-999-1 -33415 - 51324 CALLE TAMAZULA
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL
Application valuation: 4375 k
LfFEBO
Contractor:Applicant: Architect or Engineer: CORONEL CONSTRUCTION06
P.O. BOX 389LA QUINTA, CA 92247(760) 564-4604 g��Lic. No.: 634981 nt
a 1"
Cxt
--------------------------------------------------------------------------------=----------------
{I
LICENSED CONTRACTOR'S D CLA TION
I hereby affirm under penaltyofperjur that I am licensedy6nd6r provisi ns of apter 9 (commencing with
Section 7000) of Division 3 of the Busi ess an Professi nals Code, a my cense is in full force and effect.
License Class: B-1213 ; License No. 6 4981
ate: - -US- ontractor:
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).:
(_ 1 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.).
(_) 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 I am exempt under Sec. , BAP.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
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 174445Z--2006
I certify that, in the p ormance of the work for which this g rmit i issued, I shall not employ any
person in any ma - e `o as to become su ' ct to the wfcoers'mpensation laws of California,
yo
and agree that, if I sho Id bec a subje to the worke pensation provisions of Section
3700 of the Labor od I sh I forthwit comply with s provisions.
te: cant:
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, andthe 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 issuanceUthebove
, or cessation of work for 180 days will.subject
permit to cancellation.
I certify that I have read this application and state thformation i correct. 1 agr to co ply with all
city and county ordinances and state laws relating truction, a hereby autho ze re esentatives
of this county to enter upo a above-mentioned prction pur ses.
%D -\-v ignatur. (Applicant or Agent):
r.�
LQPERMIT
Application Number . . .06-00000497
Permit . . . WALL/FENCE PERMIT
LQPERMIT
Application Number . . .06-00000497
Permit . . . WALL/FENCE PERMIT
Additional desc
"
Permit Fee . . . . 72.00
Plan Check
Fee
00'
Issue Date
Valuation
4375
Expiration Date 7/31/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2.001-25.000
27.00•
----------------- --------------------------------
Notes and Comments
100 L.F. 6' GARDEN WALL, 38 L.F. COMBO
WALL, 2' RETAINING, 6' GARDEN & 37 L.F.
•COMBO WALL 3' RETAINING,.6' GARDEN ALL
ORCO SYSTEM
Fee summary Charged Paid._
-----
Credited
Due
----------------- ----------
Permit Fee Total 72.00
.00
.00
72.00
Plan Check Total .00.
.00
.00
.00
Grand Total 72.00
.00
.00
72.00
FEB -01-2006 WED 0$.23 AM Coronel Construction
r
FAX No.- 160 564 4202 P. 001
City of. La Qu'rnta F
<`<> Building 8L Safety Division
P.O. Box 1504
78-495 Calle Tampico
La Quinta CA 92253
Building Permit APP g Sheet
Application and Trackiri `
,
Project Address: 2o.v�> , Owner's Nam'.
A, P. Number:
Address' o 1
Legal Deseriptian:
City,ST, Zip: S
Telephone: ^i >; »4,:a :x<'
Contractor �'
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Project Description: f
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State Lic• �?`! 8 I r City Lic. #'� \
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Arch.. Ener.. Dtsiguer:
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Address:
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Telephone:
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State Lic. I;:
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Name or Contect Person:
Sq. Ft,:
# Stories:
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Telephone 9 of Contact Person:
Estimated Value of Project:
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