12-1326 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: C�i2700001326 >
Property Address: 77355 CALLE POTRERO
APN: 774-292-033-24 -000000-
Application description: WALL/FENCE
Property Zoning: COVE_ RESIDENTIAL
Application valuation: 4500
Tuyl 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
RYBAK
42760 MADIO STREET
INDIO, CA 92201
Contractor:
Applicant: Architect or Engineer: CORONEL ENTERPRISES
42760 MADIO STREET
INDIO, CA 92201
(760)775-1234
PIP
Lic. No.: 727199
VOICE (760e-753
FAX (760INSPECTIONS (760
Date: 11/07/12
--------------------------------------------------------------------------------------------------
LIC SED CONT ACTOR'S D LARATION
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of erj that I m licensed
nder provi ons f Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
' Section 7000) of Division 3 of th Bu ess an Professio
als Code, nd m License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
L' ense Class: B
License o.: 27199
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: \ • -�Z Contractor:
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 STATE FUND Policy Number BTAV - .R74598
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, i performance of the work for whit this p mit 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 an m ner so ecome su ct to t e work rs' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree tha if shouldme subje Yo thew rkers' ompensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the La or ode, h comply h t se provisions.
V�hal'lforthw
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).:
ate: k pplicant.
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure isnotintended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License 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 the work himself or herself through his or her own employees, provided that the
DOLLARS ($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 -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 1, 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.).
I—) I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
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:
LQPERMIT
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.
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 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 f 180 days will subject
permit to cancellation. '
I certify that 1 have read this application and state th t e abov informati i .correct. I agre to comply with all
city an county ordinances an state laws relating to u ding co struction and hereby utho ' e representatives
oft county to enter upon eabove-mentioned pro y for in action rposes.
ate: tk -�' - S' ature (Applicant or Agent):
Application Number . . . . 12-00001326
Permit . . . WALL/FENCE PERMIT INV FEE
Additional desc .
Permit Fee . . . . 144.00 Plan Check Fee
00
Issue Date . . . . Valuation . . .
. 4500
Expiration Date 5/06/13
Qty Unit Charge Per
Extension
BASE FEE
90.00
3.00 18.0000 THOU BLDG 2,001-25,000
54.00
----------------------------------------------------------------------------
Special Notes and Comments
80LF OF 6.' GARDEN W/2-3' RETAINING AT
WEST PROPERTY LINE, WITH 80LF OF 6'
GARDEN W/3-4' RETAINING WALL PLUS 20LF
OF 4' GARDEN W/2-4' RETAINING WALL AT
EAST PROPERTY LINE (CITY AND ORCO
SPECIFICATIONS] GARDEN WALL HEIGHT SHALL
NOT EXCEED FIVE FEET WHERE RETAINING
WALL EXCEEDS THREE FEET. PRECISION
CONCRETE BLOCK SHALL BE COVERED WITH
STUCCO, PAINT, OR TEXTURED COATING WHERE
VISIBLE FROM OUTSIDE THE PROPERTY. 2010
CALIFORNIA BUILDING CODES.
November 7, 2012 3:30:45 PM AORTEGA
- ----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN.(SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 144.00 00 .00
144.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 145.00 .00 .00
145.00
LQPERMIT
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c t--'APPROJED_ FOR CONSTF TI®APP- i
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NOV-05-2012 MON 1I:,Iri AM DESERT CONCEPTS' FAX No. 760 200 9007 P-001
.>...; ;:,:.. City.of -La Qu'
In lA
Building 61 Safety Division
P.O. Box 1504
'Pertrtit < 78-495 Calle Tampico
'=:>s La Quinta, CA 92253
1 <': 'Building Permit Application and Tracking Sheet
Project Address:�]'�-3 b• t o Dyer's Name: \ Q
A. P. N umber: Address: J �Z-V
City ST Zip -p•w o,
L egal Description: i �.� n
r /,
Telephone: r2: ?:t, =`°:
\\ =T
Con"cror: -\ ..�a.
c O c\ �tiy
Address:�a. -j �p project Description:
t�
Cit% -.ST. Zip:
it
TeJephone'
7Lf -1�3 c:)!:>:Ss:'a:a<ra <°A,:{;<t.a:>.: e,<
State Lic. r -7 a -I k ct City Lic, #:
Arch- Enfir.• Designer.
Od 1 3t �a '1 � � a,. . �•
w
Address:
61t
city. ST. Zip:
Telephone:
Construction Type; Occupancy.
'
State Lic. «.
t p%<; "° 3?£s �` g . Y
Projecttype (circle one): -New Add'n Alter Repair Demo
Natne of Contact Person:
Sq_ Ft.:
# Stories:
.# Units:
Telephone = of Contact Person: 6U ^S-7
Estimated Value of Project:
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