04-3852 (BLCK)000
BUILDING & SAFETY DEPARTMENT
P.O. Box 1.504' (7.60) •777=7012
78-495 CALLS TAMPrco , FAX (760) 777-70.11'
LA QUINTA', CAUFORNIX 92253 INSPECTION -REQUESTS (760) 777-7153
.BUILDING PERMIT
Application Number 04-00003852 Date 5/04/04
Property. Address :-.-.- --54765- AVENIDA RAMIREZ
APN: 774. -295 -013 -1 -0,00000 -
Application descr:pt ionWP;LL/FENCE
Property Zoning COVE RESIDENTIAL
Appl. cation 'valuation, 2467
Owner Contractor;
---------------
RAMOS EVERARDO M OWNER
.54765.AVENIDA
RAMIREZ
LA. QUINTA' :. :CA -92253
Permit WALL/.FENCE, PERMI-T
Additional 'dese
Permit`Fee 54:.00 Plan Check Fee 00
Issue Date- .. valuat`iori 2467
Qty Unit Cha=rge Per Extension
BASE ...;FEE - 45.00
1.00 9.0000 THOU BLDG 2,001725,;000 9.00
-------------------------
Special.Notes..and''Comments.
.90.LF 6' BLOCK WALL/10 LF 5' BLOCK WALL
PER CITY.STANDARD(
Fee summary.- ChArged Paid "'Credited Due
----------------- - --- - - - - ---
--- - - - - --------------- - - - --
r
Permit Fee Total 54.00 .00 ._ :00� 54.00
Plan . Check Total .00 ' . . 00 ' .: ,, 00. . 00
Grand Total .5-4 : 00-�; ;. ..00, 00- 54.00
lot
P.O. Box 1504
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Date:
Architect qrje. ineer:
Architec 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 1 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).):
(d 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,
N 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. , BA P.C. for this reason
Date Owner /
WORKERS' COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
1 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
XI 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 provisions.
Dated Applicant
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 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
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.
I. 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 cerfify 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 Signature (Applicant or Agent):
CITY OF LA QUINT"A
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRN
7.
DATE..�/� / �. BY
OWNERIBUILDER 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 shoul&be aware that as-."'Owner/:Builder" you are the responsible party of record on such a
permit. Building permits are not. require d -to be signed by,property owners unless they are personally performing their
own work. If your work ts'lietng performed by someone:other;tlian:yourself, you may protect yourself from possible
liability if that person -applies for,tle proper permit `in, .his or }ier.name:
Contractors are required-'by'law" to' - be" licenkci 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.
If you plan to do your own work, with the ezception',of various. trades that you plan to subcontract, you should be
aware of the following information for your benefitaand-protection:
If you employ or otherwise engage any,persons otherthan:your immediate family, ands the work (including materials
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
mployer:If you are an employer, you must register. with,the State and Federal Government as an employer and you are subject
to several obligations including -Slat —,and Federal income tax withholding, -federal social security taxes, worker's
compensation insurance, disability:insurance'co"sis and'unemployment compensation contributions.
There maybe financial risks'for. you'if you,do not`caiiy.out '"these obligations, and these risks are especially serious with
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 Adminstrauon) =