04-4511 (BLCK)BUILDING-& SAFETY DEPARTMENT
P.O. BOX 1504 (769).777-7012
78-495 CALLE TAMPICO _ FAX (760) 777=7011
LA QUINTA, CALIFORNIA 922.53 INSPECTION REQUESTS (760) 777-7153
BUILDING .PERMIT
Application Number 04-00'004511 Date
•5/21/04
Property Address 52580 AVENIDA RAMIREZ
APN:.. 773.-292-004.=20 -000000-
Application description WALL/FENCE,.:..
Property Zoning COVE RESIDENTIAL
.Application valuation...:. ...:, 3210
Owner Contractor
FAUSTO RUBEN OWNER
..*NOT..ON. FILE..
UNKNOWN.. : :..: CA 99999
Permit'.*..: .. WALL/FENCE PERMIT ;
Additional des ..
Permit. Fee. , .: 63..:0.0 Plan Check Feo ':.
.00
Issue .Date'. Valuat:iori
3210 .
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
6 0 LF .6 '. ' ::BLOCK WALL : ALONG SIDE YARD
.
.PROPERTY.�NE/79 LF 5' BLOCK WALL AT. >
FRONT ..OF. SIDE YARD. & ...FRONTYARD.
COURT .-ALL WALLS PER CITY STANDARD...
Fee summary Charged Paid 'Credited
D:ue
----------------i- ---------- -----.----- --.---.=---.----------
:Permit Fee Total 63.00 .00--,.. ..:00.
.63.00 ...
Plan Check Total: .: .00 .00. ..00.:
OQ
Grand Total 63:00 .00 .00
63.00
P.O. Box 1504
78-495 CALLE TAMPit.o : uwcv
... % . . . 4Q
LA QUINTA, CALIFORNIA 92253 '
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: S-?-r—
Architect or Engineer.
Architect or Engineer's Address:
.Lic.-No.
BUILDING PERMIT DECLARATIONS
1 hereby affirm under penalty of LICENSED CONTRACTOR'S DECLARATION
perjury that 1. am licensed under provisions of Chapter 9 (co
mmancing with Sermon .7000)of Division 3 of the Business and ProfessionalsCode, and my License is in full force and effect.
License Class license No.
Date Contractor
I here affirm under OWNER-BUILDEk DECLARATION
city minty that require ae Pew ale the Contradms' state License Law for the hollowing reason (Sec. 7031.5. Business and Prrofaessions Code:. Any
statement Crat hie or she is @ceased ursuant.to the me demolish, or.repaIr any structure, prior to its issuance: also requires the appTicant for Cie' permit to file a signed
and Professions Cod p provisions of the Contractors' State License Law (Chapter 9 (cammarrcin9 with Section 7000) of Division 3 of the Business
ei oc fbat he or she is�zempt therefrom and the-0asis torlhe
the appficant to a civlvilegedvw"umon any applicant for a permit subjects
penaly of not mon; than five hundred dollars (E500).):
Q4 1. as ovmer of Jhe property. or my emptoYees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044,
T Business and Professions Code: The Contractors' State License Law does not appy to an owner Of Property who builds or improves thereon, and who does the work
• sold within one r I(o f o rough Itis or her own employees. provided that the improvements are not intended or offered for. sale. It. however, the building or irripyvement. is
L.
owner of the rxuripletion, the.awner bu.1der will have Um burden of proving that he or she did not build or improve for Itis purpose of sale.).
V propetes not exclusively contracting with licensed contractors to oonstrud.flia pniject (Sec. 7044, Business and Professions Code: The Contractors'
State License Law deer not apply .) an owner of property who builds or improves thereon. and who. contracts for the projects with a contracta(s) licensed pursuant to
the Contractors' State license Law.).
U I am exempt under Sec. . BA P.C. for this reason.
Date S 2 8 Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one.of the following declarations:
_ I have and wr'11 maintain a certificate of consent to selfAnsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the
of the work for which this permit is issued. ' performance
_ 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
.Carrier issued' My workers' compensation insurance carrier and policy number are:
Policy Number.
1 cert fy 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, ff I should become subject .10 the workers, compensation provisions of Section 3700 of the Labor Code, l shall
forthwith comply with those provisions.
Date 15.17-1i I Applicant V m `L. 10( C
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 (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of CONSTRUCTION LENDING AGENCY
Y 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 a
1, Each person upon whose behalf this application is made, each pplication•
Person at whose request and for whose benefit work is perfommed under or pursuant to any permit
sued as a result of Umirapplication, the owner, and the applicant, each agrees to, and shaft, defend, indemnify and fold harmless the City of La Ouinta, 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 pemmit, or
cessation of work for 180 days will subject permit to cancellation.
1 certify.that I have read this application and state that the above information is torted. 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 for inspection purposes.
Date—)IC O Signature (Applicant or Agent): —L_)t,*t ,