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05-1345 (BLCK)2 s' -5 BY ' UILDING & SAFETY DEPARTMENT ox 1:504 (760).777-7012 `SOF 78' '.CALLE TAMPICo FAX (760) 777-7011 LA INTA,'CAUFoitN1A'52253 INSPECTION REQUESTS (760) 777-7153 .APR 1 1�>y2005 : � BUILDINGPERMIT CITY OF (A`.QUINTA FIPIA"O DEPT: Application Number '`05 0.0001.3,45 ys Date 4/11/05 Property.Addres,s 54330 AVENIDA-RAMIREZ APN:. 774=244.",D,05`2 0 -000000- Application de'script ion-;'.,`.:' 4WALL/FENCE: Property Zoning COV E'RESIDEN TIAL , 'Application valuation . 1.083 Owner Contractor ASHLEY GOLDNER 'OWNER 54330 :AVENIDA. RAMLREZ LA QUINTA,�' t CA 922.53.. . - - - - - • - - - - - - - - - - . - -,. -. -k - - ' - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Permit .... WALL/.FENCE' PERMIT Additional desc. Permit Fe'e 271, 00 Plaft' Check 'Fee .00 Issue-DateValuation 1083 Expiration Date 1'0/11/0:5 Qty Unit Charge.' Per ,' < Extension BASE , F'EE; 15.00 6.00 2.0000 HND1. BLDG .5,01-.2;000 12.00 Special. Notes•.and Comments 50 LF. 5', SLUMPSTONEWALL PER CITY STANDARD ALONG. A PORTION,_' OF. FRONT & SIDE PROPERTY - LINE-. Fee summary Charged., Paid ------Credited ..:, Due ------ - -- --- --= -- 7---- '------- -- -- Permit F,ee Total 27.:0,0' 0`0 .00 27.00 Plan Check ;To'tal' .`0,0 00 =00 00 Grand Total 27:0„0 .00 00 27.00 P.O. Box 1504 /; , w 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: Date: `� -//-0j Applicant: Architect or Engineer: r; nG1,1/6- .11 Applicant's Mailing Address: 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).): (� 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. , B.& P.C. for his reason r Date r J Owner 7 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 IC 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 shall forthwith comply with those provisjerfy. 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. CONSTRUCTION I hereby affirm under penalty of perjury that there is a construction lending agency orVthe peAGENCY performance of he 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 or apermit G subject to he 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 applica�on, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold 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 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 for inspection purposes. .Date �7 ! Signature (Applicant or Agent):. OWNE"U..LD.ER INFORMATION Dear Property Owner: An application fora building permit has been submitted in. your name listing yourself as the builder of the property improvements spedfied. For your protection you should be aware'fhat a9.,"0wner/Buil&r",you- are the responsible party of record on such a permit. -Building peimits are not required,'to be signed by pioperty.owners.uffless they are personally performing their own work: If your work is being.pejrforni'ed-byiomeon6 otherihan yourself; you may protect yourself from possible liability if that perso"Wapplies fomhe'proper permit -in his or her riaine' Contractors are required by law..to be licensiMandbonded by the State of -California and to have a. business license from the City or County. They are also required by 4o'. -put theii-licens6._.number on all permits for which they apply If you plan to do your own, woik with: the exception of various trades that you plan to subcontract, you should be or y.our`6eh6ht'.,and.protection:.'-" aware of the foliowihg' ido.imation f, If you employ or otherwise ap y persons other than your immediate and .the family, an.the work (including materials . * 6 and other costs) is , 8200.00`6rffil ,more for. the.'entiie'project,. and .1. such pe -r -sons are not licensed as contractors or subcontractors, then you may 66 'a'ri`em'jpfoyer. If you are an employer, you:must - register with the, State' and.Federal Government as an, employer and you are subject to several obligiii6hs'include '-St'�"'te-*aril -Veder'a"I-income -tax "withholding , federal s6cial' security razes, worker's compensation insurance., 'disabiliy insurance costs an unem qyment compensation contributions. tions. There maybe financial risks,for you- if y6iii do not carryout these obligations, and these risks are especially serious with respect to worker's compensation -insurance. For more specific information about y6urbbWaiionsunder Federal La contact the Internal Revenue. Service (and,if you wish, the U.S. S`m'aIflds_line'ss 'A-dem"in�is-tr"a-'t7io-n)-;*-*For'more specific information about your obligations under State Law, contact the Depqrtmebt cif'Ben-,dfit Payment , s and t"hebfyisfon of Industrial Accidents. If the structure is intended forsaie property owners who are' no I t. licensed contracts; are allowed to perform their work pers'onally or2thro*ug­eirow�'th n.emplbY.'ees*,"4,��ith6�utalic'ensed'c'o'n'I tract o*r 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 ')1ying;thA&-.the'ep4­ perty, owner is providi fig. his or her'o w n. labor and material personally Building permits are 'not �e�4ii ited permits imp., _I - Build 46 property owners unless they are perf6rmiAg: their own work persofWly. Information about licensed..c6htracior I s may be obtained by'contacting the Contractor ; s' State License Board in your community or at 100"N'. `95814. - Please complete and return the enclosed owner -builder verification form'sothat we can.confirm that you are aware of th6ematters. 'The liuildin& ermitwilt not issueduntil the verification is returned. U Very truly yours, CITY OF LA'QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Ta TP!co La9uinta, CA 92253. (760)`'77 " F VC.- 6 777-7011 OWWER'S SIG NAT4ff(E/VATE'- PROPERTY ADDRESS' 13 PERMIT NUMBER(S)