08-0373 (BLCK)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
77
Application Number: 08=0000037'3 Owner:
Property Address: 51987 AVENIDA RAMIREZ ORALDO MOJARRO
APN: 773-165-024-12 -000000- 51987 AVENIDA
Application description: WALL/FENCE LA QUINTA, CA
Property Zoning: COVE RESIDENTIAL (760)203-0160
Application valuation: 600
Contractor:
Applicant: Architect or Engineer: Owner
RAMIRE',
92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/29/08
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------------------`�-------
- LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of perjury that I am licensed uhder.provisions of Chapter 9 (commencing with
1 hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: License No.:
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date:
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
- OWNER -BUILDER DECLARATION
insurance carrier and policy.number are: '
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier - - - - - - = - - - - - - - - - - - - - -Policy Number
following reason ISec. 7031 .5, Business and Professions Code: Any city:or county that requires'a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ'any'
construct,.alter, improve, demolish; or:repair any structure, prior to its issuance, also requires the applicant for the -'person
in.any manner'so as�to-become subject to the workers' compensation laws of California,.
permit to file,6 signed statement that he or she is licensed pursuant to -the provisions of the Coniractor's� State
,
- and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (C apter 9 (commencing with Section,7000)of Division 3 of the Business and Professions Code) or
L -
3700'of-the Labor Code, Ishall forthwith comply with those provisions.
that he. is exempt therefrom and the basis for the alleged exemption: Any violation: of Section 7031 .5 by
any a cant for apermit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: [
Date: ��ppl, icant:.
( 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, Businessand Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' 86te.0cense Law does not apply to an owner of property who builds or improves thereon,
-SUBJECT-AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
-and who does thework himself or herself through his or her own employees, provided'that the
DOLLARS 1$100;000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND -ATTORNEY'S FEES:
one year of, completion,.the owner -budder will have the burden of proving that he or she didnotbuild or
improve for the purpose of sale.).
I _ 1 I, as.owner. of the property, am exclusively contracting with licensed contractors to construct the project (Sec:
.7044,.B ' usiness and Professions Code: The Contractors' State License Law does not apply to an owner of
propertywho builds or. improves thereon,' and who contracts for the projects with a contractorls) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 I am exempt under Sec. B.&P.C. for this reason
Date: �� �� 4 Owwne :
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:
LQPERA11T
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building'and Safety for a permit subject to the
.conditions andrestrictions set forth on this application.
1 . Each person upowwhose behalf thisapplicationis 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 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:-� r nat` (Apppliicant. on Agent):
+4 a1
Application Number . . . . 08-00000373
•Permit . . . WALL/FENCE
PERMIT
Additional desc . .
Permit Fee . . . . 17.00
Plan Check
Fee..
.00
Issue Date . . . .
Valuation
... .
. 600
Expiration Date . . 8/27/08
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 2.0000 HND BLDG
501-2,000
2.00
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Special Notes and Comments
24 LN FT X 6 FT HT GARDEN BLOCK
WALL TO
CITY STANDARDS & APPROVED PLANS.
Fee summary Charged
-------------------------------------
Paid Credited
Due
Permit Fee Total 17.00
----------
.00
----------
.00
17.00
Plan Check Total .00
00
.00
00
Grand Total 17.00
.00
.00
17.00
LQPERMIT
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 "OwnerBuilder" .you. are the responsible party of record on such a
permit. Building permits are not required to;6e•signed byproperty 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 foe 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.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and proiection:
If you employ or otherwise engage fa
any persons other than your'immediate mily;arid.theawork.(including materials
and other costs) is $200.00 oramore. 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:Governmenras" an employer and you are subject
to several obligations include State 2Q_4ederal `income tax withholding, federal social security taxes, worker's
compensation insurance, disabiiiry insurance costs-'and_unemployinent compensation contributions. '
There may be financial risks for you if you do not carry 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 BusinessAdministration). 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 propertyowner is providing his or her own labor and 'material personally.
Buildi� permits are not required to be si ned,b property owners unless the are' ecformin their own work
gP q g YP P ty Y p g
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 958"14.
Please complete and return the;enclosed owner -builder verification: form, so that we can confirm that you are aware of
these matters. The building pernitwill-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
0,
OWNER'S SIGNATURE/DATE `
r
3 /'79 7 l 7Z
PROPERTY ADDRESS
PERMIT NUMBER(S)c4
Bin #
City Of La `Quanta
Building U Safety. Division
P.O. Box 1504, 78-495-Calle Tampico
La Quinta, CA 92253 - (760),777-7012
Building. Permit Application 'and• Tracking Sheet
Permit #
6S
Project Address:
"Owner's Name: ; ( e
A: P. Number:Address:
=- �q J
Legal Description:
Contractor:
Address:
City, -ST, Zip: Qt,�.-f 1 Z 'Z -S— 3
Telephone: 6 f
Project Description:
[LJ
City, ST, Zip:
GI: 71
Telephone:
/
State Lic. # :
City Lic..#:
Arch., Engr., Designer:
Address:
City, ST, Zip:
;t
Telephone:
State Lic. #: IM`,Project
Name of Contact Person:
;Construction Type: Occupancy:
type (circle orie): New Add'n Alter Repair Demo
Sq. Ft.: `
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS, LINE
#
Submittal
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans bicked up
Construction
Flood plain plan :
Plans resubmitted
Mechanical
Grading, plan
2nd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading.,
IN HOUSE:-
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
M