04-3542 (BLCK)BUILDING &.SAFETY DEPARTMENT
P.0: Box 1504 (760) 777-7012
.78-495 CAL1,E TA-MPICO FAX (760) 777-7011
LA .Q.UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760).777-7153
BUILDING PERMIT
Application Number 04-00003542 Date 4/16/04
Property Address 49440 ALI CT
APN: 649 -520 -014 -26 -290532 -
Application description.. WALL/FENCE
Property Zoning 'LOW'DENSITY RESIDENTIAL
Application valuation 1.000
Owner Contractor.
PM RENAISSANCE, LLC.' TRANS WEST HOUSING, INC.
9968 HIBERT STREET;. STE..102 9968 HIBERT STREET, STE #102
SAN DIEGO CA.92131 SAN DIEGO CA 92131
(858) 65373003
WCC: STATE FUND
WC: 164.8813. 10/0.1/04.
CSLB: 701039 0.1/31/05
CCC ::. B
------------------
:Permit WALL/FENCE. PERMIT
Additional desc .
-Permit Fee 25.00 Plan Check Fee .00
..Issue Date. Valuation '... 10.00
Qty Unit -Charge' Per Extension
BASE .FEE. 15.00
5.00 2.0000 HND, BLDG 501-2;000 10.00
Special_. Notes and. Comments.
. 40 L'. F : 6''' PROPERTY" LINE WALL.; ORCO.
SYSTEM
Fee summary Charged Paid, Credited. Due
`..Permit .Fee Total 25.00 .00 .00 25:00.
Plan Check Total .00 .00 .00 .00
Grand Total 25..00.. .00 .00 25.00
IIIIIII VIII I I VIII IIII 69 !� —
IE
P.O. BOX 1504 e �
VOICE (760) 777-7012
79-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: D'i�' 3S�a Date: �• all
Applicant: I Architect or Engineer.
Applicant's Mailing Address:
Architect or Engineer's Address:
Uc. No..
01A
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provistors of Chapter 9 (commencing with Section 7000) of Division 3 of the Business end. Professionals
Code. and my Licer full force and affect. 701sJ 3C)
License No.
r Data � ^2 0''" yContractor �2A7t/S 61/�S?' f -�oy JUNG
oWItkR-8U1tDER DECLARATION
1 hereby affam under penally of perjury tat I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5. Business and Professbra Code: Any
city or county that a perm b construct. alter. improve, demolish, or repair any structure, prior to its issuance. 81SO requires the apPOWA for the permit to fie a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' 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 Ume ehonm and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a perm subjects
the applicant to a civil penalty of not more than fire hundred dollars (M).):
U 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
W self or herself or though his or her own employees, provided that the improvements are not intended or offered for sate. If. however. the budding or improvement is
sold within one year of completion. the owner-biuider will have the burden of proving that he or she cid not build or
U L ss owner of the property. am exclusively contracting with licensed contractors to construct the � purpose of sale.).
State License Law does not appy to an owner of property who builds or' project (Sec. 7044. Business acct Professions Code: The Contractors
improves ihereor► and who contracts for the projects with a contractor(s) transect pursuant to
the Contractors' State License Law.).
U 1 am exempt under Sea . BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under 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 work for which this perm is issued.
_ 1 have and will maintain workers' compensation insurance, as required by Sermon 3700 of the Labor Code, for the performance of the work for which tiffs permit is
g.woAcecs'�rt sation ins carrier agdpof qy-rrpgr a
1-2 t'a/S"( �'- ('L�h Number
/ fo �` `' D"l'
_ 1 certify Yat, In the pedomance of the work for which this permit Is issued. I shah not employ any person in any manner so as to become subject lo the workers•
compensation laws of California, and agree Yat, it 1 should become subject Io the workers' compensation provisions of Section 3700 of the Labor Code.1 shah
ionto th.comply with those provisions.
- SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. .
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penally 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.).
Lenders Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT
Application Is hereby made to the Director of Building and Safety for a pemnit 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 perlomtmed under or pursuant to any pem*
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 Le Ouinta, its
officers. agents and employees for any ad or omission related to the work being performed under of 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 160 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 corned I agree to comply with all city and county ordinances and state laws relating to building
co strucbm and hereby authorize representatives of this county to enter upon the above-mentioned property for Inspection purposes.
Date --frignature (Applicant or Agent): ea4it `