08-0260 (BLCK)P.O. BOX 1504,
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08-0000026.0
Property Address:
52205 AVENIDA .VALLEJO
APN:
773-222-021-10 -000000-
Application description:
WALL/FENCE
Property Zoning:'
COVE RESIDENTIAL
Application valuation:
758
Applicant: Architect or Engineer
C Y
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT'
LICENSED CONTRACTOR ECLARATION
I hereby affirm under penalty of perjury thaAPrsi
der prow ons of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business Code, y License is infullforce and effect.License Cllaass: B cense 617134.
`Date: G ` r� &ntractor:
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 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 ($5001.:
(_) 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.).
() 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 contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( ) I am exempt under Sec. . 8.&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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/05/08
Owner: U
BUSTAMONTE LIZA
52205 AVENIDA VALLEJ-r
LA QUINTA, CA 92253
(003) 702-7835
Contractor: -
GAM CONSTRUCTION
67250 PEINETA STREET
CATHEDRAL CITY, CA -92234
(760)883-0781
Lic. No.: 617134
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 insura e, as required by Section 3700 of the Labor
Code, for the performance of the work for which t s permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier EXEMPT Policy Number ' XE PT
_ I certify that, in the performance of the work fo whic this permits issued, I shall not employ any
person in any manner so as to become subj t to th w rkers' compensation laws of California,
and a ree that, if I should become ub ct he we er 'compensation provisions of Section
370 of the Labor C e I shall r ith o ply wit hose provisions. -
Date, plicant:
WARNI F URE TO SECURE WORKERS' COMPENSATION COVERAGE -IS UNLAWFUL, AND SHALL
SUBJEC AN MPLOYER 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 set forth on this application.
1 . Each person upon whose.behalf this application is made, each person at whose re est and for
whose benefit work is performed under or pursuant to any permit issued as a res of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hol armless the City
of. La Quinta, its officers, agents and employees for any act or omission related to a 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 t comm&ed-,�
within 180 days from date of issuance of such permit, or cessation of work for 0 days will subject -
permit to cancellation.
I certify that I have read this application and state that the abov inf
n is rrect. I a ee o comply with all
city and county ordi nces and state laws relating to buIdin stan reb au oriz representatives
of thiscoun er upon the above-mentioned prope f spr os
Datature (Applicant or Agent):
LQPERMIT
Application Number . . . 08-00000260
" Permit WALL/FENCE PERMIT
Additional desc
-
Permit -..Fee. 21.00 Plan Check
Fee
.00
Issue' Date,.-.' Valuation
758
Expiration Date 8/03/08
Qty Unit Charge Per:
Extension
BASE FEE
15.00
..3._00 2.0000 HND BLDG -501-2,,000
6,00
----------
Special Notes and Comments
35 LN FT X 5 FT HT BLOCK WALL WITH
WROUGHT IRON PER CITY STANDARDS AND
APPROVED PLANS / PER AJ
Fee summary Charged Paid_ Credited
Due
7.
Permit Fee Total 21.00 .00
.00
21...00•
Plan Check'Total 00 .00
.00.
.00
Grand Total 21.00 .00
.00
21.00
LQPERMIT
Bin #
City of La Quinta
Building a Safety. Division '
P.O. Box 1504; 78-495 Calle Tampico
La'Quinta, CA 92253 - (760) 777-7012
Building Permit Application and. Tracking Sheet
Permit #
Project Address:' z le,Owner's
Name: '
A. P. Number:
Address: s AV to.
Legal Description:
Contractor co�r��
City, ST, Zip: At
Telephone
Address:�i 44 .
7 ZM�k
Project Description:'
w
City, ST, Zip: 8 44
r
Telephon
State Lic. # :
City Lic. #:
o A/
Arch., Engr., Designer:
Address:
L
%-�
City, ST, Zip:
t
Telephone:
yy�
Construction Type: Occupancy:
Project type (circle ongew Add'n Alter Repair Demo
Sq. Ft.:.' # Stories: # Units:
State Lic. #:
Name of Contact Person:
34 tS
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount .
Structural Calcs.
Reviewed, ready for corrections _
Plan Check Deposit
Truss ,Calcs.
Called Contact Person
Plan Check Balance
,
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan.
2"d Review, ready for corrections/issue
Electrical '
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
i
Total Permit Fees
'�--- PROPERTY
LINES
WONTYARD:
AUfA TO BE
20 FEET LMMSCAkD .
NUNRAUM
12' To
CURBLINE
Within all districts, the maximum fence hei ht -shall
front setback area (measured from the street right -of wa. and six feet withhn any rear or side setback a in.the first ten feet of the required
ea'ad-
joining a public street. Y). _ ,
TELEPHONE (760) 777-7012 FAX (760) 777-7011
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/Builder" 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.
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 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 LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: 760) 777-7011
OWNER'S SIGNATURE/DATE
LJCI- o
S22OC2 61c
PROPERTY ADDRESS
.PERMIT NUMBER(S)