BWFE2017-002578-495 CALLE TAMPICO
c&ttt 4 4v Qum&
LA QUINTA, CALIFORNIA 92253 DESIGN &•DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BWFE2017-0025
Property Address: 54545 AVENIDA MADERO
APN: 774261003
Application Description: STAKER RESIDENCE / BLOCK WALL
Property Zoning:
Application Valuation: $2,500.00
Applicant:
CORONEL ENTERPRISES INC
42760 MADIO STREET
INDIO, CA 92201
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 Professions Code, and
my License is in full force and effect.
License Class: B License No.: 727199.
Date: - ZZ ` 11 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 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).:
(_) 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.).
( ) 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
Lender's Address:
Owner:
MIM STAKER
42760 MADIO iT
INDIO, CA 92201
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
I
'� Date: 2/22/2017
W_
Z
LU
a
w
0
z �
� LL:
S a.
0 0
UJ
U C]
0
2
C3
ccn
LU
Q
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certifica-e of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
oliltherk 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: BENCHMARK INSURANCE COMPANY Policy Number: CST5009346
_ I certify that in the performance ofthe work for which this permit is issued, I
shall not employ any.person in any manner sc as to become subject to the workers'
compensation laws of California, and agree Wat, if I should become subject to the
workers' compensation provisions of S ion 3700 of the Labor Co e, shall forthwith
comply with those provisions.
Date: a " a -� 1 Applicant:
WARNING: FAILURE TO SECURE WORKERS' CC MPENSATION COVERAGEI NLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMIAAL 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 Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this appli,;ation 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 tie work being performedunder 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 wiihin 180 days from date of issuance of such permit, or cessation of work
for 180 days will subject permit to cancellatior:.
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 relating to building
construction, and hereby authorize representadives of thitp enter upon thne-
mentioned property for inspection purposes. ,C I r /
Date: -a - a'a -L-1 Signature (Applicant or Agen
C7 �
C= .
cV
Contractor:
a
CORONEL ENTERPRISES
IN M
LU
42760 MADIO STREET
li
INDIO, CA 92201
(760)775-1234
Q
Llc. No.: 727199
Z
LU
a
w
0
z �
� LL:
S a.
0 0
UJ
U C]
0
2
C3
ccn
LU
Q
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certifica-e of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
oliltherk 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: BENCHMARK INSURANCE COMPANY Policy Number: CST5009346
_ I certify that in the performance ofthe work for which this permit is issued, I
shall not employ any.person in any manner sc as to become subject to the workers'
compensation laws of California, and agree Wat, if I should become subject to the
workers' compensation provisions of S ion 3700 of the Labor Co e, shall forthwith
comply with those provisions.
Date: a " a -� 1 Applicant:
WARNING: FAILURE TO SECURE WORKERS' CC MPENSATION COVERAGEI NLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMIAAL 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 Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this appli,;ation 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 tie work being performedunder 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 wiihin 180 days from date of issuance of such permit, or cessation of work
for 180 days will subject permit to cancellatior:.
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 relating to building
construction, and hereby authorize representadives of thitp enter upon thne-
mentioned property for inspection purposes. ,C I r /
Date: -a - a'a -L-1 Signature (Applicant or Agen
Date: 2/22/2017
Application Number: . BWFE2017-0025 Owner:
Property Address: 54545 AVENIDA MADERO MIM STAKER
APN: 774261003 42760 MADIO ST
Application Description: STAKER RESIDENCE / BLOCK WALL INDIO, CA 92201
Property Zoning:
Application Valuation: $2,500.00
Applicant: Contractor:
CORONEL ENTERPRISES INC CORONEL ENTERPRISES INC .
42760 MADIO STREET 42760 MADIO STREET
INDI0, CA 92201 INDIO, CA 92201
(760)775-1234
Llc. No.: 727199
Detail: 110 LF OF COMBO WALLS, 2 FT RETAINING OF 5 FT HIGH GARDEN WALL AT PL
[SITE SPECIFIC SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM
OUTSIDE THE PROPERTY. 2013 CALIFORNIA BUILDING'CODES.
i
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
QTY
AMOUNT
FINANCIAL
DESCRIPTION
•• •
ACCOUNT
RETAINING/COMBINATION WALL EA SOLF
101-0000-42400
0
$45.60
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - EA ADDITIONAL 50 LF
101-0000-42404
0
$15.20
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$50.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$63.33
Total Paid for BLOCK WALL: $174.80
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00