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04-4638 (BLCK) (2)�n Q. 2004 BUILDING•& SAFETY DEPARTMENT O.ox 1504 (760).777 7012 G - DIa°QI11P+T� Y 4tpf���,dCEDEPT78-495 C,ALLE TAMPICO FAX (760).7.77-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . 04700004638 Date 5/27/04. Property Address 53,890 AVENIDA VELASCO APN: 774-165=008-9 -000000- Application description . . .' WALL/FENCE Property Zoning .' COVE RESIDENTIAL Application valuation '. .' 541 Owner Contractor SABALA LUIS OWNER. ....53-890 AVENIDA . VELASCO LA QUINTA CA. 92253 Permit .' WALL/FENCE PERMIT Additional desc . Permit'Fee 17.00 Plan Check Fee IssueDate Valuation .00 541 .. Qty Unit -Charge Per' Extension. BASE FEE 15'.00 1.00 2..0000 HND BLDG 501-2,00v ` 2-.00 Special Notes and.Comments 5 LF 6.' BLOCK .WALL @ SOUTH -.SIDE .OF . HOUSE/26 LF 4' BLOCK WALL PROPANE TANK ENCLOSURE/ALL PER CITY.STANDARD. Fee summary Charged Paid Credited Due Permit Fee Total 17.00 .00 .00 17.00 Plan Check Total .00. ..00 .00 .00 Grand Total 17.00 ..00 .00 17.00 • P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 10 BUILDING & SAFETY DEPARTMENT Application Number: 1,1d_- 4 3 Date: Applicant: f—I— I Architect or Engineer-/�UNt%L Applicant's Mailing Address: Architect or ngi ddress: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 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 License No. Data Contractor. 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 tssuanoe, 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 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 (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 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code: The Contrectors'� State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with f colons o d licensed pursuant the Contractors' State License Law.). U 1 am exempt under Sec. B.& P.C. f this reason Date S/2 7 16 Owner WORKERS' COMPENSATION COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: —.1 have and will maintain a certificate of consent to selfinsure 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: Cartier / . Policy Number I certify that, in the performance of the work for which this permit is Issued, l shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that. if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. J Date Z 0 Applicant WARNING: FAILURE TO SECURE WORKS COMPENSATI N 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, Civ. C.j. Lenders Name Lenders Address IMPORTANT Application is hereby made to the Director of'Building CANT ACKNOWLEDGEMENT 1. Each g AP Safety Apermit subject to the conditions and restrictions set forth on this application. 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 Le Quinta, its 2 officers, agents and employees for any act or omission related to the work being performed under or following Issuance of this permit • I 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 Pew or cessation of work for 180 days will subject permit to cancellation. 1 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 county to enter u n the above-mentioned property for inspection purposes. Data r O Signature (Applicant or Agent): Ups td '