06-0023 (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:
'0.6= 0.0-0-0-0-0 2 3
77415 CALLE ENSENADA
773-284-001-2 -000(
WALL/FENCE
COVE RESIDENTIAL .
6875
T4'!t °F 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or
$-lam
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of per)ur that I am licensed under provision of Chapter 9 (commencing with
Section 7000) of Division 3 of the B i ss and Professionals Code, a License is in full force and effect.
License Class: 13-C13 1,icense
34981
,,)>a Contrac[gr
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 _ 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.).
(_ 1 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 I am exempt under Sec. , B.&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 (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/04/06
Owner:
POWER FINANCE
P.O. BOX 134
LA QUINTA, CA 92253
Contractor:
CORONEL CONSTRUCTION
P.O. BOX 389
LA QUINTA, CA 92247
(760)564-4604
Lic. No.: 634981
------------------
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.
1 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 1744453-2006
_ 1 certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any ma r so as to become subject tot w kers' compensation laws of California,
and agree that,. if h uld bec a subje the. or17 'compensation provisions of Section
3700 of the Labor o , I sha forth h comply it hose provisions.
DI"".off Applican
WARNING: FAILURE 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.
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 1 have read this application and state that h above information i cor act. I gree to omply with all
city and county ordinances and state laws relating to b it g const ction, a hereby a horize presentatives
of this
county to enter upon the above-mentioned prop y or insp tion pur oses. .
Dacey `I Signature (Applicant or Agentl:
Application Number . . 06-00000023
Permit . .
. WALL/FENCE
PERMIT
Additional desc ...
Permit Fee
90.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
6875
Expiration Date
7/03/06
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
5.00 9.0000
THOU BLDG
2,001=25,000
45.00
-------------------------------'
Special Notes and
--------------------------------------------
Comments
200 L.F. 6' GARDEN
WALL, 75 L.F.
COMBO
WALL 2' RETAINING,
6! GARDEN, ALL ORCO
SYSTEM.
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
90.00
.00
.00
90.00
Plan Check Total
.00
.00
.00
.00
Grand Total
90.00
.00
.00
90.00
LQPERMIT