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04-5506 (BLCK)BUILDING & SAFETY DEPARTMENT 504 (760),777-7012 LE, TAMPICO FAX (760) 777-70,11 CALIFORNIA .92.253 INSPECTION REQUESTS (760) 777=7153 BUILDING PERMIT 0_4 =- _0_0 "EO -5-5-0�-&� 78595 SAGUARO DR APN: 646 -313 -0019 - Application description WALL/FENCEI.- Property Zoning . . . . . . . MEDIUM DENSITY RES Application valuation,. 12.50 ?,ate 7/15/04 Owner Cont,radtbr ------------------------ CORONEL ENTERPRISES INC ------------------------- CORONEL CONSTRUCTION P 0 BOX 389 P.O. BOX 389 LA QUINTA CA 92253.4 LA-QUINTA CA 92253 (760) 564-4604 WCC: STATE FUND �WC:l 1744453 01/01/05 "CSLB:,, 634981 01/31/06 CCC:' B -C13 ---------------------------- ----------- ------ ---------- Permit. . . . . . . WALL/FENCE PERMIT Additional desc,,. Permit Pee 31.00 Plan Check Fee .00 Issue Date Valuation 1250* Qty Unit Charge Per Extension BASE FEE 15.00 8.00 2.0000 HND 'BLD0,50172,000 .16.00 --------------------------------------------------------------------------------- Special Notes and:Comments 50-L.F. COMBO WALL, 21 RETAINING, .61 GARDEN, ORCO.SYSTEM Fee summary Charged ----------------- Paid Credited Due ------ Permit Fee Total 31.00 ------ ---- ---------- .00 .00 31.00 Plan Check Total .00 ".00 .00 .00 Grand Total 31.00 .00 .00 31.00 P.O. BOX 1504 78-495 CALLE TAMP►CO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: 041- 550 (o Applicant:. Applicant's Mailing Address: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7-/ Y- O Architect or Engineer: Architect or Engineer's Address: { AAl1 r Lic. No.. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I her y affirm under penalty of perjury that I am licensed and revisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals e, and my Lic a is in full force and effect. %� License Class n .��f 9c7 /Date % - (`l 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).): U 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 this reason Date Owner 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 -9of the work for which this permit is issued. I have and will maintain workers' compensatio insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is S iss ad. ork compensatio rance carrier and policy n� um r are: Cartier �� Policy Number \i �k .4 �4 m _ I certify that, in the performance of the work for -which this permit is i d, I shall not employ any person in any manner so as to become subject to the workers' compensationlaws of CalifK�ia, and agree that, if I should beco a bject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those\prdyisions.. 1� 0'�_ Date - t I - r_; 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, Ov. C.). Lenders Name 0. Lender's Address IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT CKNOWLEDGEMENT Safety a 1. Each person upon whose behalf this application is made, each person atwhos'e requ st and for whose benefit works rk to the conditions and restrictions under or pursuant to an issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La Quinta, its �rt 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 comme 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 ab v information is ccI agree to co cal with all city and county ordinances and state laws relating to building construction, and hereby authorize representative of this cc n to ent r upon bove mentioned operty for inspection purposes. Date -7 — I 1 -yYign�5 ature (Applicant or Agent):