04-3545 (BLCK)BUILDING &.SAFETY DEPARTMENT
P.O. Box 1504 (760) 777-7012
78-495 CALLE'TAMPICO FAX (760) 777-7011
LA .Q.UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)777-7153
BUILDING PERMIT
Application Number4941:0-ALi
4-0000354`5'1 Date 4/16/04
Property Address CT
APN: '649.-520-014-27-290532-
Applicati.on description WALL/FENCE
Property Zoning LOW DENSITY RESIDENTIAL
Application valuation .1000
Owner Contractor'
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PM RENAISSANCE, LLC TRANS WEST'HOUS.ING, INC.
9968 HIBERT STREET,-STE. 102 9968 HIBERT STREET; STE #102
SAN DIEGO CA 921'31 SAN DIEGO CA 92131
(8 58) .653.-3003
WCC .` STATE FUND
WC.: 1648813. 10/'-01/04
CSLB :. 701039,.'. 0'1/31/05
B
Permit WALL/FENCE PERMIT
Additional desc
*Permit Fee . . . . 25..00 Plan Check.Fee .00
Issue Date valuation 1000
Qty Unit' Charge Per Extension
BASE -FEE 15.00
.5.00 2.0000'HND BLDG 501-2,000 10.00
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Special. Notes and Comments.
-40 L. F':.' 6'' PROPERTY', LINE WALL; ORCO
SYSTEM
Fee summary Charged. Paid Credited Due
77
Permit :Fee Total .' 25.00 00 00 25.00.'
Plan Check Total- .00 .00 .00 .00
Grand Total. 25.00. .00 .00 25.00
111111111111111111111111161 �
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+ 1E �. - .
P.O. BOX 1504 • s�G�
78-495 CALLE TAMPICO VOICE (760) 777-7012FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 FAX
(760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number. 3� 5 Date: o' 4
Applicant: I Architect or Engineer.
A
Applicanrs MailingAddress: .//
Architect or Engineer's Address:
Uc. No.
BUILDING PERMIT DECLARATIONS .
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commending with Section 7000) of Division 3 of the Business and'PnNessionals
Code, and my LmmtiVn WQ force and effect.
l�oe^se Clan v
�e•��-�` G''�./corrrracoor�/e/,�.✓S L✓b�.s?— f`�C%G.�/NG
1 hereby affirm under penalty of perjury that I am OWNER -BUILDER DECLARATION
city a confit. that requires t permit po A that
am � from the Contractors' State License Law for the tonsuring reason (Sec. 7031.6. Business and Professions Code: Any
irnpr?ve. denwfish, or repair any sbuctuM 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 (Chapter 9 (eonwrhencing with Section 7000) of Division 3 at the Business
and Professions Code) or that he or she is exempt theretrorn 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 Can five hundred dollars ($500).):
U 1. as owner. of the property, or my employees with wages as their sole compensation, win do the wok and the structure is not Intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractors' State License Law does rat apply to an owner of property who builds or improves thereon. and who does Che work
hunseU or herself or through his or her own employees, provided that the improvements are not Wended or offered for sale. If. however. the
sold within one. year of completion: the owner Mulder will have the burden of proving that he or she fid not build or improve for the purpose of went is
U 1. as owner of the roperty. am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not appy 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 1 am exempt under Sec. . B.3 P.C. for this reason
Date" Owrher
1 hiereb affirm under
WORKERS'COMPENSATION DECLARATION
y penalty of perjury one of the following declarations:
1 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 wok for Much 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 wok for which this permit is
s MY aorrpensatiorh rice carrier n p umbel
Carter 5K1?//v/i 1u nberI certify
that, In the performance of the work for which this pedT Sii issued. I stall not employ any person in any manner so as to become WNW to the workers'
compensation laws of Caitomia, and agree that. If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall
forthwith comply with Chose 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 THOUSAND DOLLARS ($100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST. AND ATTORNEYS 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 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 Oub-da, its
officers. agents and employees for any act or omission related to the work being performed under or following issuance of this perrniL
2 Any permit Issued as a result of this application becomes null and void if work is not commenced within 1s0 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
1 certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building
construction. and hereby authorize representatives of this cou* to enter upon the above-nhentioned property for Inspection purposes.
r I / tore (Applicant or Agent):