05-0238 (BLCK)Tar,`fC�j
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504
— 7 (760),777-7012
7800 2195 CALLS TAMPICO
I FAX (760) 777-7011
�1 !UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . . LQ75_.z_0 0 000023_8_ / Date
Property Address '53605 AVENIDA RAMIREZ.
'APN: 774-121-018-6 _000000 -
Application description . . . WALL/FENCE
Property Zoning . ... . . . . COVE RESIDENTIAL
Application valuation . . . . 1000
Owner Contractor
1/24/05
COTY CONSTANTINE OWNER
53-605 AVE. RAMIREZ
LA QUINTA CA 92253
----------------------------------------------------- ----------------------
Permit . . . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee .. . . . 25.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 1000,
.Qty . Unit Charge -Per Extension
BASE FEE 15.00
5.00 2.0000 HND BLDG 501-2,000 10.00
----------------------------------------------- ----------------------------
Special Notes and Comments
40 LF. 61 HIGH BLOCK WALL CITY STANDARD
WALL ALONG FRONT AND DRIVEWAY SIDE
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Grand Total -
Charged Paid
---------- -------
25.00. .00
.00 .00
25.00 .00
Credited Due
---------- ----------
.00 25.00
.00 .00
.00 25.00
P.O. BOX 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: O - 38
Applicant:
Applicant's Mailing Address:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1 • ;2 Sl. o5 -
Architect
5 -
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 Protessions 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 permtt 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 s
t1 applicant to a civil penalty of not more than five hundred dollars ($500).): �1e�
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 improvefo
o contracts for the p : The Contractors'
r the purpose of sale
uct . .
U 1, as owner of the property, am exclusively contracting with licensed contractors to constrthe project (Sec. 7044, Business a
State License Law does not apply to an owner of property who builds or improves thereon, and whtrojects with nd Professions
coessions ions Coodede licensed pursuant to
the Contractors' State License Law.).
U 1 am exempt under Sec. , BA P.C. for this reason /
ateof/Cwner �.
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:
Cartier Policy Number
1 certify that, in the performance of the work for which this permit is issued, I shall not employ an
compensation laws of California, and agree that, if I should become subject to the workers' com nssaation r manner so as io become subject to the workers'
forthwith comply with those provisions. g Pe provisions of Section 3700 of the Labor code, l shall
,y I/• os /
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.
I hereby affirm under penaltyof CONSTRUCTION LENDING AGENCY
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
IMPORTANT APPLICANT ACKNOWLEDGEMENT
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 u application.
cion whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any Permit
as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City la CuMte, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. of
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 en upon the a ve-mentioned property for inspection purposes.
Signature (Applicant or Agent): _ C��
_.... ._. _ j ..
asytw:l, ',o
LO
OWNER/BUILDER 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 that as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be 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 for the proper permit in his 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.
`N11e
If you plan to do your own work, with 'the exception of various trades .tha 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 tniierials
and other costs) is $200.00 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 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 may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
r 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). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments 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, 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 -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
. �� ( � �•�-," �•_-_ �-;•, moi'
OWNER'S SIGNATURE/DATE
PROPERTY ADDRESS
PERMIT NUMBER(S)