11-0463 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA.QUINTA, CALIFORNIA 92253
Application Number:
11-00000463
,Property Address:
52060 AVENIDA JUAREZ
APN:
773 -211 -034 -
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1816
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CON CTOR'S D RATION
I hereby affirm under penalty of ery y that I am license under pro'
ons o Chapter 9 (commencing with
Section 7000) of Division 3 of th Bu Ines and Profes enols Code, nd m License is in full force and effect.
\License Class: 13 License o.: 27199
Date:_ Contractor:
OWNER -BUILDER DECLARATION
1 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 applicant 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).:
(_ 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, 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 _) 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 rnntracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_) 1 am exempt under Sec. , BAP.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 STR1
INDIO, CA 92201
Contractor:
CORONEL ENTERPR
42760 MADIO STR:
INDIO, CA 92201
(760)775-1234
Lic. No.: 727199
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/06/11
U L/
-----------------------------------------------
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
_ I certify that, m t erformance of the work for which this permit is issued, I shall not employ any
person in any a er so to become ject to th kers' compensation laws of California,
and agree that, 'f I houl ecome su ect to thew rker 'compensation provisions of Section
3700 of the La r ode, Jshall fort ith comply it hose provisions.
,,1ate.'�5,(,-1( Applican
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001.- IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDEu 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.
I certify that I have read this application and state t t the abLinftiC
ect. I gr a to comply with all
city and county ordinances and state laws relating t wildingn,by th rize representatives
of this corunty to enter upon the above-mentioned pro rty fp
Date:'5-t- (/ Signature (Applicant or Agent
Application Number
. . . . . 11-00000463
Permit . .
. WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . .
. 43.00
Plan Check
Fee
.00
Issue Date
Valuation
1816
Expiration Date
11/02/11
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
14.00 2.0000
HND BLDG
501-2,000
28.00
------------------------------------------------------------------------------
Special Notes and
'Comments
12 L.F. 4' SCREEN
WALL & 75 L.F.
5'
GARDEN WALL, BOTH
CITY STANDARD.
2010
CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . . . BLDG
STDS ADMIN '(SB1473)
1.00
Fee summary
-----------------
Charged
--------------------
Paid Credited
----------
----------
Due
Permit Fee Total
43.00
.00
.00
43.00
Plan Check Total
.00
.00
.00
.00
Other Fee Total
1.00
.00
.00
1.00
Grand Total
44.00
.00
.00
44.00
LQPERMIT
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MAY -05-2011 TNU 01:12 PM CORONEL ENTERPRISES FAX No. 760 775 5353 P,001
City of La Quinta
Building & Safecy Division
P.O. Box 1504
78-495 Calle Tampico
La Quinta, CA 92253
Building Permit Application and Tracking Sheet
Project Address: S-� �„� , v 0.rt Z Owner's Name.
A. P. •Number. Address:
Legal Description: City,ST, Zip: �\�
Telephone: 0 % 75 I� 3.s>.
LEM
Contractor:
G •rc� ��
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Address; 4 'X � ;
Project Description;
- a �� ,�
Ciry.ST. Zip�r� to l�-, �.
~ I S 4 r
Telephone:
S^ f•:tas
State Lic. _ % a-7 I 'q q
City Lic. M
Arch„ Engr- Designer:
Address_
City. ST. ,Zip:
.
Conwuction T c;
�
p ne;
Tele 1 v
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Project type (circle one): New Add'n Altcr Repair Demo
Lic.
Stare
Name of Contact Person:
Sq. Ft.:
1r stories:
# Units:
Telephone _ of Contact Person-
Estimated Value of Project:
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