05-2616 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
C 5�- 0002616_.]
54665'AVENIDA VALLEJO
774-281-021-9 -000000-
WALL/FENCE
COVE RESIDENTIAL
1008
Architect
P
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
------------------
LICENSED CONTRACTOR'S DECLARATION
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: License No.:
Date: 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 r
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.). -
(_ I 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.).
(_ 1 11m�xempt�nder>c. , B.& .for this recon 41
Y9
/ate: -1"1 IV
wrier 11ULA tdL
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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
GONZALES CECILIA
54665 AVENIDA VALLEJO
LA QUINTA, CA 92253
---------------------------------
Contractor:
Owner
------------------
WORKER'S COMPENSATION DECLARATION
Date: 6/28/05
1 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 Policy Number '
1 certify that, in the performance of the work for which this permit is issued, I 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 shou d become subject to the workers' co nsation provisio of Section
/3700 of the abor CoU.f."tt"N comply with tho p visions.
ate: vS pplicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UN L, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE H NDRED 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.
I certify that I have read this application and state that the above information is correct. I gree to comply with all
city and county ordinances and state laws relating to building construction, and hereby a horize representa . s
ofthiscounty to enter upon the above-mentioned pr ope for in pe `purposes.
Date: gnature (Applicant or Agent):
LQPERMIT
Application Number . . . . . 05-00002616
Permit WALL/FENCE PERMIT
f
Additional desc .
Permit Fee . . . . 27.00
Plan Check
Fee
00
Issue Date . . . .
Valuation
1008
Expiration Date 12/25/05
Qty Unit Charge Per
Extension
BASE FEE
15.00
6.00 2.0000 HIND BLDG 501-2,000
12.00
- - - --- --------------------------------------------------------------
Special Notes and•Comments
63 L.F. 4' GARDEN WALL, CITY STANDARD
Fee summary Charged Paid
Credited
Due
Permit .Fee Total 27.00
.00
.00
27.00
Plan Check Total .00
.00
.00
.00
Grand Total 27.00
.00
.00
27.00
LQPERMIT
TELEPHONE (760) 777-7012' FAX (760) 777-7011
OVWNER/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.
J
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 contracts 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
F : (760) 777-7011 - -
SI NATURE ATE
PROPE DRESS i
05- a
PERMIT NUMBER(S)
Bin #
City of La Quints
on s tru '
Construction
ch 0 nTY pe..
Building 8t Safety Division
Permit A
..P -O- Box.1504, 78 -49S -Calle Tampico
La Quints, CA 92253 - (760) 777-7012
# Stories:
Building Permit APPlication and .Tracking Sheet
Project Address: _
Estimated Value of Project:
Owner's Name:
A. P. Number:
'Address:
Legal -Description:
'd
Rec'd
City, ST, Zip:
Contractor: '
Telephone --
Address:
Project Description:
City, ST; Zip:
Telephone:
State Lic. # :
Arch., Engr., Designer: .
Address:
City, ST, Zip:.
Telephone:
State Lic. #:
Name of Contact Person:
[Tlphon,# ofContact Person:
# Submittal
Plan Sets
Structural Calcs.
TrusswCalcs.
Title 24 61cs:
Flood plain plan
Grading plan
Subcontaetor List
Grant Deed
H.O.A. Approval
IN IIOUSE:-
Planning Approval
' Pub. Wks. Appr
School Fees
ri
a
City Lic. #:
on s tru '
Construction
ch 0 nTY pe..
.c
Occupancy:
P an c
Project type �c� rc Ic one New Add'n Alter Repair .Demo
Sq. Ft..
# Stories:
#Units:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS
LINE
'd
Rec'd
TRACKING'
PER\IIT FEES
Plan Check submitted
Item
Amount
Reviewed, read for corrections '
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
NLechanical
2" Review, ready for correctionsCssue
Electrical
Called Contact Person
Plumbing
Plans picked up
Plans resubmitted
Grading
Review, ready for. corrections/issue .
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees
I
R ESTABLISHED IN 1918 AS A PUBLIC AGENCY
G1
COACHELLA VALLEY WATER DISTRICT
POST OFFICE BOX 1058 • COACHELLA, CALIFORNIA 92236 • TELEPHONE (760) 398-2651 • FAX (760) 398-3711
DIRECTORS: OFFICERS:
JOHN W. McFADDEN, PRESIDENT STEVEN B. ROBBINS,
PETER NELSON, VICE PRESIDENT GENERAL MANAGER -CHIEF ENGINEER
TELLIS CODEKAS MARK BEUHLER,
RUSSELL KITAHARA ASST. GENERAL MANAGER
PATRICIA A. LARSON JULIA FERNANDEZ, SECRETARY
DAN PARKS, ASST. TO GENERAL MANAGER
February 25, 2004 REDWINE AND SHERRILL, ATTORNEYS
File: 1112.
Michelle Yurk
Dear Ms. Yurk:
Subject: Account No.
54-665 Avenida Vallejo, La Quinta, California
In response,to1your:inq4iry, this district does not have available information regarding the
completion=.of.actual-hook up to our sanitation collection system for the above -referenced
property.
In researching our records, we found that the subject property has met our sewer requirements.
It is the homeowner's responsibility to connect their pipeline to the sewer lateral.
If you have any questions please contact Rosie Anacleto, Customer Service Representative,
extension 2420.
`Yours very truly,
Richard Shonerd
Customer Service Supervisor
RIA:ra