11-0101 (BLCK)W,:% _ -:
P.O.-BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T,it�v 4 4Q"
Application Number: V11.-00000101-\
Property Address: 52060-AVENIDA JUAREZ
APN: 773 -211 -034 -
Application description: WALL/FENCE
Property Zoning: COVE RESIDENTIAL
Application valuation: 3150
Applicant: Architect or !Engineer:
�D
LICENSED CONTRACTOR'S DECLAFOtTION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
hereby affirm under penalty of per'ury that I am licensed and r provisions C pter 9 (commencing with
Section 7000) of Division 3 of the Bu and P ofession de, and m Li nse is in full force and effect.
License Class: B icense No.: 7W199
rDate: .0 _-II Contractor: +
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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'applicam for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's 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).:
(_) 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 ISec. 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 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.).
(_ ) 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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_) 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
Owner:
HACIENDA GROUP
42760 MADIO
INDIO, CA 92201
VOICE (760) 777-7012
- FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/28/11
Contractor:
!F
r W
CORONEL ENTERPRISES
42760 MADIO STREET
iU
JAN 2�j NO
INDIO, CA 92201
{
(760) 775-1234
Lic. No.. 727199
11� (?rSA►laaa
,.raa, ;,:; :• ,2
— _ — — — — — — — — — — — — — — —
WORKER'S 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 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:
Carrier STATE FUND Policy Number 1948821-2011
_ 1 certify that, in the performance of the work for which th' rmit is issued, I shall not employ any
person in any m4aper so as to Vecome subje o the ork rs' compensation laws of California,
and agree that, iashIdbec a subject t thew kers' ompensation provisions of Section
3700 r the Lab e I forthwithtly th th se provisions.
` Date:'-�_ Applicants
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER)r.E IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRFn 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.
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 for 180 days will subject
permit to cancellation.
1 certify that 1 have read this application and state that above formatiCne. I ogre t comply with all
city and county ordinances and state laws relating to b ild g co truction, author' a epresentatives
of this county to enter upon the above-mentioned prope y or i ection p
Date: '2� Signature (Applicant or Agent):
LQPERMIT
Application Number . . . . . 11-00000101
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . 63.00 Plan Check Fee
..00
Issue Date . . . . Valuation . . .
. 3.150
Expiration Date 7/27/11
Qty Unit.Charge Per
Extension
BASE FEE
45.00
2.00 9.0000 THOU BLDG 2,001-25,000
18.00
----------------------------------------------------------------------------.
Special Notes and Comments
100 L.F. COMBO WALL 2- RETAINING, 6 -
GARDEN AT NORTH P/L & 23 L.F.- 6' GARDEN
WALL AT.REAR P/L. REMAINING WALLS BY
SEPARATE PERMIT. 2010 CODES.
------------7-------------------------------------------=-7-----------------
Other Fees . . . ... . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 63.00 .00 .00
63.00
Plan Check Total .00 .00 ..00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 64.00 .00 .00
64.00
JAN -21-2011 THU 10:47 AMORONr TERPRISSEVS FAX No. 7c0 77` :-5.3 P. 001
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City Of La Quai nta
Building & SafeEy Division
P.O. Boz 1504 '
y 78-495 Calle Tampico i
>%;;:::::::..:La Quanta, CA 92253
;►/\
Building Permit Application and Tracking Sheet
Pro jectAddress: �— ��,� ,lam Owner's Name: k��e e�Group '
A. P. Number• 13 -. t— O 344 Address: ,_ i
Legal Description: Ciry,ST, Zip`
Tel hone:
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Address: _� �Q Project Description:
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Arch., Ener.. Designer.
Address:
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