08-1325 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08-00001325
Property Address:
79600 CORTEZ IN
APN:
649'-052-008-32 -2667 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
375'
Tity/ 4 XP Q"
Applicant: Architect or Engineer:
-------------------
LICENSED,CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: LicenseNo::
Date: Contractor:.
OWNER -BUILDER DECLARATION
I hereby affirm underpenalty of perjury that I am.exempt from the .Confraetor's State License Law for the
following reason (Sec. 7031,6, Business and Professions Code: Any city or county that requires a.permitto
construct, after, improve,, demolish, or repair any structure, prior Wits issuance; also requires the applicant for the
permit to file a signed statement that he orshwis licensed pursuant.to;the provisions of the Contrector'srState
License Law (Chapter 9 (commencing with Section 7000) of Division 3.of the Busineas•and Professions Code) or
that he or is.exempt therefrom and the basis for the alleged exemption. Any violation of Section,7031.5 by
licant for a permit subjects the applicant to a civil penaltyof not more than five hundred dollars.0500).:
L(7T17, 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 _) 1, as owner of the property, am exclusively contracting with,lieensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Caw 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 Ucense.
( _-) I am exempt under Sec. , B.&P. rthl aro
Date: ' V Owner::
I, hereby affirm under penalty of perjury th
work for which this permit isjssued,(Sec.
Lender's Name:
Lender's Address:
DgyX1RUCTIOMICENDING AGENCY
I is a construction lending agency for the performance'of the
CIv.:C:).
Owner:
SMITH LAUILE
79600 CORTEZ LANE
LA QUINTA, CA 92253
(
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/05/08
Contractor:
Owner- it AUG 0 5 2000
LA
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.
_ 1 have and will maintain workers"compensation'insuranoe,,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 ----------------------- Policy Number
_ I certify that, in -the performanceofthe work for which this permit is issued, I. shall not employ any
person in anymanner sous -to - 'ect-to:the workers' compensation laws of California,
and: agree that, if I should o Labo 1 _ come eject the workers' compensation provisions of Section
3 00, of t h comply with those provisions.
l
Date: pplicant:
—kZWARNIN (LURE TO SECURE W KERS' 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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is, hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions sat 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 agree&to, and shall defend, indemnify,and hold harmless the City
of La Ouinta, 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 workds 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 certifythatl have read this application and state that^struction,
t. I agree to comply with all
,city and county ordinances and state laws -relating to authorize representatives
of thiscou y t -enter upon the above-mentioned-pro
Date: v Signaiure (Applicant, or Agen :
Application Number
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
. . . . 08-00001325
WALL/FENCE PERMIT
15.00 Plan. Check Fee .
Valuation . . . .
2/01/09
.00
375
Qty Unit Charge Per
Extension
BASE FEE
15.00
Special Notes_ and
- ------------------------------------------
Comments
-
15 IN .FEET X 6 FT
HT PER CITY STANDARDS
APPROVED T.H.
Fee summary
Charged Paid
-
Credited
Due
Permit Fee Total.
--- ----------
15.00 .00
---------- ----------
.00
15.00
Plan Check Total
.00 .00
.00
.00
Grand Total
15.00 .00
.00
15.00
LQrERMrr
TELEPHONE (760).777-7012 FAX (760) 777-7011
OWNER/BUH DER 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/Budder" 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 is being 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 by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following,information for your benefit and protection.
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 persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject.
to several obligations include State and Federal income 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 do 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, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division -of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors 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 labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
i
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 958.14.
Please complete and return the enclosed owner -builder verification form so that we can. confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF IA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760);2M-7
FAX:
--7g(,,,Z CO
PR�)EIj�ADDRESS
fvOJ% r
PERMIT NUMBER(S)
Bl" #
City of La Quints
Building ex Safety Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
1� J�
Project Address:
Owner's Name:
i iY% t I K
A. P. Number: (p I �� o a a _
Address: (20 Rkl- LA•#iE
Legal Description:
City; ST, Zip: L\t Dw w-{
Contractor: nmiac3z 6wLAey-Telephone:
Address:
Project Description:
City, ST, Zip:
I -S' x f
Telephone:
State Lit. # : City Lie. #:
Arch.; Engr., Designer:
Address:
City, ST, Zip
Telephone: Construction Type: Occupancy:
State Lic. #: Project type (circle one): New Add'n Alter MMqRepair Demo
Name of Contaet'Person:
Sq: Ft.:
# Stories: -T
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Ree'd
TRACKING _
PERMIT FEES
Plan Sets
Plan Check, submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Energy Cales.
Plans picked up
Construction
Flood plain' plan
Plans resubmitted
Mechanical
Grading plan
2'4 Review, ready for corrections/mut
Electrical
Subcontactor List
Called.Contact Person
Plumbing
Grant.Deed
Plans picked, up
S.M.I.
H.O.A..Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review, ready for correctionOssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees