13-0029 (BLCK)r P,.O IBOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: Cr!:I`3�=r0:OO6 02.9
Property Address:
80350 VIA CAPRI
APN:
772-440-076- -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
6125
Tii�p VOICE (760) 777-7012
FAX (760) 777=7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Applicant: p Architect or Engineer:
V
--------------_------------------------------------
LICENSED CONC OR'S CLA ATION
I hereby affirm under penalty of y that I m licensedrcvi ons of hapter 9 (commencing with
Section 7000) of Division 3 of th Bu ' ess a d Professiode, d my cense is in full force and effect.
Li nse Class: B e N : 7 7199
Date: iMa�-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 ($500).:
(_) 1, 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, 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. 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 ISec. 3097, Civ. C.).
Lender's Name: A
Lender's Address: YI
LQPERMIT
Date: 1/07/13
Owner: D
I pa)A -350 VIA OAPP-1
94 3
LA QUINTA, CA 92253
FE
Contractor: �o�����
CORONEL ENTERPRISES
42760 MADIO STREET �Ip LA®UINTA
INDIO, CA 92201 FINANCE 901-
(760)775-1234
Lic. No.: 727199
-----------------------------------------------
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.
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 9033452-2012
_ I certify that, in the performance of the work fo hich t ' ermit is issued, I shall not employ any
person in any ma r so as t 4 become subj ct o th wor rs' compensation laws of California,
and agree that, ifI�IE
ectthew kers' ompensation provisions of Section
3700 of the Laborith mply th t se provisions.
ate: �� _t dpplilicariv
WARNING: FAI URt E TO SECURE WORKERS' 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.
APPUCANT 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 cessationft
80 days will subject
permit to cancellation.
I certify that 1 have read this application and state at he ab a informa ion i's ce to comply with all
city and county ordinances nd state laws relating t bu ding nstructio , and hze representatives
of th/is/Sounty to enterZ
the above-mentioned pro y for speaion urpos
Date: , ure (Applicant or Agent):
y.,
Application Number 13-00000029
Permit WALL/FENCE-PERMIT INV FEE
Additional desc .
Permit Fee . . . . 180.00. Plan Check
Fee
.00
Issue Date Valuation
. . .
. 6125
Expiration Date 7/06/13
Qty Unit Charge Per
Extension
BASE FEE
90.00
5.00 18.0000 THOU BLDG 2,001-25,000
90.00
---------------------------------=------------------------------------------
Special Notes.and Comments
218 L.F..6' GARDEN WALL, 25 L.F. 3'
GARDEN WALL, 25 L.F. 18" GARDEN WALL ALL
CITY STANDARD, & 8 16" X 16" COLUMNS
'(ORCO SYSTEM)INVESTIGATION FEE ASSESSED
PER 1997 UNIFORM ADMINISTRATIVE CODE
§304.5 FOR WORK BEGUN -WITHOUT BUILDING
PERMIT.
-------------------_------------------------------
Other Fees .". . . . . .BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged. Paid' Credited
Due
Permit -Fee Total 180.00 .00
.00
180.00 .
Plan Check Total .00 .00
.00
.00
Other Fee Total 1.00 .00
.00
1.00
Grand Total 18.1.00 -.00
.00
181.00.
LQPERMIT
DEC -205-2012 WED 0827 AM CORONEL ENTERPRISES FAX No. 11001755353 , P' 001
City of La Qu inta
Building 81 Safety Division
t., `'ii•f P.O. Box 1504
78-495 Calle Tampico
#?er3nit
oz�`> o 'La Quinti, CA 92233
Building Permit Application and Tracking Sheet ;
Project Address:, O i Owner's Name:
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Legal Description:
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