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04-7997 (BLCK)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS.(760) 777-7153 Application Number . . . . Property Address . . . . . APN: Application description . Property Zoning . . . . . . Application valuation . . . BUILDING PERMIT 04 - 0 0 0.0'-99- 7--[----J 774:60 CALLE DURANGO 773-164=012-12 -00:0000- WALL/FENCE COVE RESIDENTIAL 3165 Owner Contractor HOLLENBECK BRIAN WAYNE Owner 774.60 CALLE DURANGO LA QUINTA, CA 92253 Date 12./27/04 P.O. Box 1504 • VOICE. (760,) 777-7012 '78-495 CALLE TAMPICO FAX (760) 777,4011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING 8i: SAFETY DEPARTMENT Application Number: Date: 2�Z4! Applicant: Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS 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'perjurythat I am exempt from the Contractors"State License Law for the following:reason (Sec. 7031.5, Business and Profeasions Code: Any city or county that requires a permit to construct, alter; improve; demolish, or repa'iranystructure, 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 Contractors' State License, Law (Chapter9 (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 therproperty, or my employees with wages as their sole compenssfion,.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,yearof completion, the owner -builder will have the burden of proving that he orshe 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 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.). U :Lem exempt under Sec. B.&,P.C. foythis reason WORKERS' COMPENSATION DECLARATION I hereby affirm,under penalty of perjuryone of the following declarations: I have and will maintain a oertificate.of, consent to self-insurefor workers' compensation, as provided for Section 3700 of the Labor Code, for the,performance of the work for which this permitis issued. _ I have and will maintainworkers' 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,ao I certify that, in the performance of the work for which this permit is issued, I shallnot 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 Sectlon:3700 of the Labor Code, l shall forthwith comply with those provisions. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANDSDOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,. DAMAGES AS PROVIDED FOR IN SECTION 3708 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.). Lender's Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the. Directorof,.Building and Safety for a permit subject -to the conditionsand',restrictions set forth on this application. 1. Each person upon whose'behalf this application is made, each person at,whose request and for whose benefitwork.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, indemnity and hold harmless the City of La Ouinta, its .officers, agents and employees forany act or omission related.to the work beingperformed under or following issuance of this, permit. 2. Any permit issued as a result of this application becomes null and votd'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 agree to comply with all city and county ordinances and state laws•relsfing to building construction; and herebyauthonze representatives of this county to enter yponthe aboye-mentioned property forinspection purposes.. (Applicant or Agent): Application Number . . . . . 04-00007997 Permit . . . . . . Additional d_esc . . Permit Fee . . . . Issue Date . . . . Expiration Date . . WALL/FENCE PERMIT 63.00 6/27/05 Plan Check Fee . . .00 Valuation . . . . 3165 Qty Unit Charge Per Extension BASE FEE 45.00 2.00 9.0000 THOU BLDG 2,001-25,000 18.00 Special Notes and Comments 100 LF 5' BLOCK WALL @ FRONT PROPERTY LINE. 40 LF 6' BLOCK WALL @ EXTERIOR SIDE YARD. ALL PER CITY STANDARD. Fee summary Charged Permit Fee Total 63.00 Plan Check Total .00 Grand Total 63.00 Paid Credited Due .00 .00 63.00 .00 .00 .00 ..00 .00 6.3.00 t s'► CITY OF LA QUINTX- BUILDING & SAFETY DEPT• APPROVED v FOR CONSTRUCTION 1 neT� t 2-� al 8 Dear Property Owner: 78-495 CALLE TAMPICO — LA.QUINTA, CALIFORNIA 92253 TELEPHONE (760) 777-7012 FAX (760) 777-7011 OWNERBUILDER INFORMATION 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: Ifyour 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 infonmatiowabout 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 IA QUINTA DEPT, OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA.92253 (760) 777-7012 FAX: 7 777-7011 OWNER'S SIGNATURE/DATE '77 PROPERTY ADDRESS PERMIT NUMBER(S)