06-2578 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
AP N:
Application description
Property Zoning:
Application valuation:
Applicant:
Z076-0 0 0 02.5,78t:�.
5110'0-CAbI;E OBISPO
770-142LO02-92 -000000-
WALL/FENCE
LOW DENSITY RESIDENTIAL
175
Architect or Engineer:
BUILDING &SAFETY -DEPARTMENT
BUILDING PERMIT
t
LICENSED CONTRACTOR'S DECLARATION
hereby affirm: under penalty -of perjurythat I arhlicensed•under provisions of Chapter:9 (commencing .with
Section 7000). of Division 3 of the Business and'Prdfes sionals Code`"and my License is inJull-force and effect:
License Class: - "' License No.:
.:te: ;ontractor• :v
`- 0WNER BUILDER,DECLARATIONy` -
hereby, affirm under".penalty of perjury that I am exempt from theIContractor's State License Law.Ifor.the
following'reason (Sec. 7031,.5, Business and. Professions Code:, Any city.'oi•.:county.that _requiies a�peimit to
construct, alter, improve, demolish, or repair any structure,.prior to.its issuance, also requires ihe,applicant,for the,
permit to file a' signedstatement that he or sheds licensed puisuant to the provisions bf the Coritractor's State
License Law
.(Chapter 9 icommencing with Section 7000) of Division 3 ofthe 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
ky applicant
-for a permit,subjects.the applicant to, a civil penalty of not more.tharefive hundred dollars;($500)-:
( 1 1, as ownei of the property,•or my employees with wages as their 'sole compensation will--do-the work, and. ••
thestructure is not intended or offered for sale (Sec. 2044; Business and Pr' C" '
Contractors' State License Law does not apply to an owner ofproperty who builds orimproves thereon;
and Who does the.work himself or herseli.tnrough'his'or her 6,w6-employees`pro'vided:that the
improvements are,not intended or offered.for sale., If, however, the building orimprovement is sold within '
one year,of completion, thdowner-builder wilbhave the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner -of the property, am exclusively contracting .with licensed contractors,to construct the project (Sec. - .
7044', Business and Professions Code: The Contractors' State License Law'does'not apply to an owner of
propertymho builds or improves thereon, and who contracts for the projects with a cohtractor(s) licensed
pursuant to the Contractors' State License Law.).
( 1 'I am exempt under Sec. ,,B.&P.C. for this reason
?J s
Date: _ `'I , y G wner: . (/
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:.
Lender's Address: I� 1. f/1
LQPERMIT
VOICE (760) 777-7012
.-FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/05/06
Owner:
MIHAJLO JOSIMOVIC
51100 CALLE OBISPO
LA QUINTA,-CA 92253
Contractor: JUL O 206
Owner
CIT`( OF LA
BIJINTA .
':FINANCE.QED
WORK ER'S'COMPENSATION ;DECLARATION
I hereby affirm under penalty;of perjury'one$ft' e44611owing declarations:
I, have and -will maintain a,certificate;of'consent•toself-insure for, workers' compensation; as provided
L.for by'Seciion 3900 of the Libor,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 .
Codezfor the performance,of the work for which this permit•is issued. My. workers' compensation
insurance carrier and policy number are:,'
Carrier Policy Number'
I certify that; m the performance of the work for: which his permit is issued, I�snall not employ -any
person in any manner. so as to become'subject to the.workers' compensation laws -of California;
and agree that if I:s_hould•-become subjecfto the workeis' compensation provisions of Section. -
3700'of the Lab ode,, shall forthv'/i h:'' mply, with those provisions.
T 'T h an
ate; c t:
i
WARNING ,.FAILURE'T05ECURE.WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECTt'AN EMPLOYER TO CRIMINAL PENALTIES, AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS':1810010001. IN ADDITION TO.THE COST OF COMPENSATION;DAMAGES AS PROVIDED. FOR IN
'SECTION 3706;iOF.THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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. °Eachperson 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, inCemnify 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 -7 my to enter upon the above-mentioned property for inspection purposes. '
te:— r� "$ignat Applicant or Agent):
Application Number . . . . . 06-00002578
Permit . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 15.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 175
Expiration Date 1/01/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
-7 ---------------------------------------------------------------------------
Special Note's and Comments
7 L.F. 6' GARDEN WALL, CITY STANDARD
Fee summary Charged Paid
--------------------
Credited
--------------------
Due
-----------------
Permit Fee Total 15.00
.00
.00
15.00
Plan Check Total CO
.00
.00
00
Grand Total 15.00
.00
.00
15.00
LQPERMIT
Bin #
City of La Quinta
Building &. Safety Division
P.O. Box 1504, 78=495 Calle Tampico
l a Quinta, CA 92253 - (760) 777-7012
Building .Permit Application;.and Tracking Sheet
Permit #
Project Address:
Owners Name: i
' %V A �J'L.o. J0JI 1i o 1/ C
A. P. Number:
Address: S�- /D o lLC / SP C7
Legal Description:
City, ST, Zip: 2,9 Q V /,/ i 9 , (.q .9 2, Z J-13
Contractor: =
Telephone: i'X-o - 09/S = 72SSg
Address:
Project Description:
City, ST, Zip:
Telephone:
City Lic: #: =�
State Lic. # :
L.p 11/
Arch., Eitgn, Designer:
Address:
City, ST, Zip:
Telephone:
-
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
77
Name of Contact Person:
Sq.- Et.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT'WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACMG .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed; ready for correctious
Plan Check Deposit
Truss Calcs.
Called Contaet Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction .
Flood plain plan.
Plans resubmitted
Mechanical
Grading.plan
2°" Review; readyfor correctionifissue
Electrical
Subcontactor. List
Called Contact Person .
Plumbing
Grant Deed
Plans picked up
S;M.L
H.O.A. Approval '
Plans•resubmitted .
Grading
IN HOUSE:-
'nd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval'
Called Contact Pelson:
A.I.P.P.
Pub. Wks. Appr
Date of permit is"sue
School Fees
Total Permit -Fees
0V
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.-"Owner/Bihlder" you,are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are .personally performing their
own work. If your work"' bemg'performed by someone other than`yourself, you may protect yourself from possible
liability if that person applies for 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 bylaw -to put their license number on all permits for which they
apply.
If you plan to do your own work; with, the exception of.variotis trades that you plan to subcontract, you should be
aware of the following information for your benefit; and;p'rotection:
If you employ or otherwise -engage any persons other. than your. immediate•family, ,and the work (including materials
and other costs) is $200.00`:or'�more� for the entire project, and such -of rsons -are not licensed as contractors or
subcontractors, -then you may be an employer:'
If you ar&an employer, you must register with the:Siate.and Federal Government as an employer and you are subject
to several obligations. include State' and Federal' n* come tax,:withholding; federal social -Security taxes, worker's
compensation insurance., disability _insurance_costs_ and_unemployment_compensation.contributions. _.__..
There may be"financial risks for you if you Ido 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,:contaci the Iriternai Revenue Service (and, if
you wish, the U.S. Small Business Administrat6ij? For more specific information. aboutyour obligations under State
Law, contact the Department of Benefit'Payments and the. ,Division of.Industial 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 property owner is -providing his `or'her.own_labov,and material personally.
Building permits -are not required" to- be. signed' by property` :owners unless they ?are performing their own work
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, 95814.
Please complete and return the'enclosedowner-builder verification,forn so that we -can confirm that you are aware of
these matters. The building permit will not be; issued until the verif cation. 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) 7774011
OWNER'S SIGNATURE/DATE..
tom/- /0,9 GAPS O
PROPERTY ADDRESS
as�8-
PERMIT NUMBER(S)